Traditionally, at facility level, monitoring of CS rates is done by using the overall percentage of deliveries by CS. Variations in this “overall CS rate” between different settings or over time are difficult to interpret and compare because of intrinsic differences in hospital factors and infrastructure (e.g. primary versus tertiary level), differences in the characteristics of the obstetric population (“case-mix”) served (e.g. percent of women with previous CS) and differences in clinical management protocols (e.g. conditions for induction or pre-labour CS). Ideally, there should be a classification
system to monitor and compare CS rates at facility level in a standardized, reliable, consistent and action-oriented manner (12, 13, 14)
Before going to the classification system in depth, it is important to have a clear agreement on the internationally recognized CS indications