Our goal with the study is to promote safe, patient-centred and evidence-based maternity care.
Caesarean sections are a life-saving procedure when there are medical reasons, such as with pelvic dispropotion or if the health of the mother or child is at risk. However, for women in the low-risk group – i.e. healthy pregnant women without complications – vaginal birth is usually safer and better for both mother and child. Despite this, the number of caesarean sections is increasing sharply throughout Europe.
"We analysed over 12 million births in 25 European countries between 2000 and 2025 by collecting data from previously published studies. To enable comparison, we used Robson's ten-group classification, an international tool for categorising women in labour based on five basic factors (see fact box)", says Sara Ebadi, a doctoral student at Lund University and junior doctor in surgery at Ystad Hospital.
Of the births included in the systematic review, 32 per cent took place in private hospitals. Southern Europe had the highest caesarean section rates at around 55 per cent. Of all births occuring at private hospitals, nearly three-quarters were by caesarean sections which is a very high number. The most striking difference between public and private hospitals was in the group of low-risk first-time mothers. They had the largest increase in the number of caesarean sections in privatised healthcare. The researchers believe that this indicates that non-medical factors – such as local routines, financial incentives or healthcare policy – can influence how often caesarean sections are performed. The women's own wishes may also be a factor.
"I think many women are afraid of the unknowns surrounding vaginal birth, and at the same time they are lack awareness of the serious consequences that a caesarean section can have. In privatised healthcare, they have greater opportunity to request and pay for a caesarean section. The healthcare facility, in turn, also earns more financially from a surgical procedure than from a vaginal birth", says Mehreen Zaigham, Associate Professor in Obstetrics and Gynaecology at Lund University and specialist doctor at Skåne University Hospital.
In Sweden, we have a research-based, structured healthcare system for women who want a caesarean section. They first undergo an assessment by a midwife and, if necessary, are referred to specialist care, where a multi-professional team conducts a medical and psychological evaluation. Based on the woman's perspective, risk factors and needs, an individual birth plan is then drawn up. Women at low risk are offered support and tools to manage their fear of childbirth and are encouraged to have a vaginal birth. This is one of the reasons for the lower caesarean section rate in Sweden – and also in the rest of the Nordic countries.
"Our goal with the study is to promote safe, patient-centred and evidence-based maternity care. The results can be used to develop guidelines and provide expectant parents with better information ahead of the birth, as well as to train healthcare staff to balance clinical indications with the patient's wishes. The next step is to continue research into the long-term outcomes for mother and child with different birth methods", concludes Mehreen Zaigham.