Cesarean section trends in the Nordic Countries - a comparative analysis with the Robson classification

Research output: Contribution to journalArticle


Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. Conclusions: The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.


  • Aura Pyykönen
  • Mika Gissler
  • Ellen Løkkegaard
  • Thomas Bergholt
  • Steen C. Rasmussen
  • Alexander Smárason
  • Ragnheiur I. Bjarnadóttir
  • Birna B. Másdóttir
  • Karin Källén
  • Kari Klungsoyr
  • Susanne Albrechtsen
  • Finn Egil Skjeldestad
  • Anna-Maija Tapper
External organisations
  • Karolinska Institutet
  • University of Copenhagen
  • Copenhagen University Hospital
  • National University Hospital of Iceland
  • Socialstyrelsen / Swedish National Board of Health and Welfare
  • University of Bergen
  • Haukeland University Hospital
  • UiT The Arctic University of Norway, Tromsø
  • University of Helsinki
  • University of Akureyri
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine


  • Cesarean section, Delivery, Induction of labor, Robson classification, Uterine scar
Original languageEnglish
Pages (from-to)607-616
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number5
Early online date2017 Mar 24
Publication statusPublished - 2017
Publication categoryResearch