Caesarean section (CS) is a lifesaving operation that has significant effect on the outcomes of maternal and perinatal health. While the World Health Organisation considers a CS rate of 10–15% to be optimal, 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 CS into 10 groups based on parity, the onset of labour, foetal presentation, gestational age, and number of foetuses was introduced. Therefore, we assessed the determinants of caesarean section rate among women 15–49 years at Nakuru Level 5 Hospital. We reviewed systematically sampled medical records of women who had delivered via CS at the Nakuru Level 5 Hospital between 1 June and 31 December 2019. Data on sociodemographic, socioeconomic, and obstetric characteristics, previous caesarean section and indication for caesarean section were collected using data extraction tool and analysed using frequencies and percentages. 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 a 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). Focused antenatal care should also be promoted to identify pre-existing health conditions and detect early complications arising during pregnancy by adopting the WHO eight visits of the Focused antenatal Care for prevention and early detection of abnormal pregnancy which could lead to unnecessary caesarean section.
Keywords: Nakuru, caesarean section, Robson classification system, Kenya, determinants