A tertiary hospital in France has successfully reduced its caesarean section (CS) rate below 15% over seven years—without increasing maternal or neonatal complications—according to new data that support targeted efforts to limit unnecessary surgical births.
Researchers analysed 19,082 deliveries from 2017 to 2023 at a university hospital in Besançon, classifying each birth using the Robson Ten Group Classification System. The average CS rate across the study period was 14.4%, with a significant decline from 15.4% in 2020 to 13.0% by 2023. This reduction occurred alongside stable maternal and perinatal outcomes, including a notable 1.4% drop in neonatal transfers.
The decline in caesareans was largely driven by improved management of women in Robson Group 5 (those with a previous CS) and a downward trend in Group 6 (nulliparous breech deliveries). Group 1, comprising low-risk first-time mothers with spontaneous labour, maintained a low and stable CS rate of 8%.
Notably, the hospital also reported a rise in labour inductions during the same period, suggesting that careful induction strategies may have supported vaginal delivery rates without increasing adverse events.
The findings add to the growing body of evidence that CS rates can be safely reduced below the often-debated 15% threshold recommended by international health organisations. The authors suggest that key interventions—particularly focusing on prior CS and breech births—could help curb unnecessary caesareans while maintaining high standards of maternal and neonatal care.
Reference
Echalard J et al. Reaching caesarean section rates below 15%: experience of a French tertiary maternity using the Robson classification system. Reprod Health. 2025; DOI: 10.1186/s12978-025-02052-8
