Abstract

Caesarean section (CS) is a lifesaving operation that has significant effect on the outcomes of maternal and perinatal health. World Health Organisation considers a CS rate of 10 to 15% to be optimal; however, there is significant increase in its practice especially in low resourced setting despite the persistent inequalities in access to the procedure. To determine, track and audit caesarean section rates and groups, the Robson classification system that classifies 10 groups. Therefore, we assessed the determinants of caesarean section rate among women 15 to 49 years at Nakuru Level 5 Hospital. Obstetric records of women who had delivered via CS at the Nakuru Level 5 Hospital between June and December 2019 was used. Data on sociodemographic, obstetric characteristics, including indications for caesarean section were collected and analysed. The overall CS rate was at 27.9% with two-thirds of the cases attributed to groups 1 (n=40, 12.3%), 3 (n=37, 11.3%), 5 (n=78, 24.0%) and 7 (n=33, 10.2%) as per the Robson 10 classification system. The rate of caesarean section in the study setting is twice the WHO recommended rate with previous caesarean section, prolonged labour and malposition being the main determinants. There is need to support implementation of instrumental delivery and give women trial of labour after caesarean section (TLACS). Continuous on- job training of skilled birth attendants on prevention and early detection of abnormal labour and early intervention in-order to decrease the rate especially among low-risk groups (Robson groups 1-4).

Key words: Nakuru, caesarean section, Robson classification system, Kenya, determinants.