The comparisons in last year’s report were based on a low-risk population only. Because many childbirths were thereby excluded, those that remained may have been unrepresentative of the data that were to be studied. This year’s report switched to classification by Robson group, a system that Sweden and many other countries currently use in clinical practice. The first two of the ten Robson groups consist of primiparas with full-term pregnancies, single births and head presentation. Group 1 includes women with spontaneous labour, while Group 2 includes those with induced labour or with Caesareans before contractions begin. Thus, Group 1 provides a basis for determining the frequency of emergency Caesareans, whereas merging Groups 1 and 2 permits an assessment of how often any kind of Caesarean was performed among full-term primiparas with single births and head presentation. The shorter bar in Figure 48 shows the percentage of Caesareans among women in Robson Group 1, i.e., primiparas with full-term pregnancies (37 weeks or longer), single births, head presentation and spontaneous labour. For more details, see Appendix 1. This is the main category for which Caesareans should be kept to a minimum from a medical point of view. Caesareans were performed in 10.1 per cent of the births (15 274 deliveries) in 2006– 2010. The frequency for 2001–2005 was 9.8 per cent. The longer bar shows the percentage of Caesareans among the same group of primiparas (full-term pregnancies, single birth and head presentation) in a considerably larger population. The group also includes induced labour and elective Caesareans (Robson Group 2). The nationwide frequency of Caesareans for this group was 16.5 per cent in 2006–2010, as opposed to 15.4 per cent in 2001–2005 (not shown in the diagram).
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Cost per Care Event for Childbirth
A total of 28 hospitals in 13 counties reported childbirth costs to the Swedish Case Costing Database in 2011. The database contains the costs for each delivery and the interventions associated with it, but not check-ups, follow-up appointments or drug consumption in outpatient care – or outliers (in order to show a normal average cost per hospital and partially adjust for variations in case mix). Figure 49 shows cost per inpatient care event in DRG 370–373 for all deliveries, as well as for Caesarean sections alone. Costs for 80 357 deliveries were reported to the Case Costing Database in 2011. The number of deliveries varied substantially from hospital to hospital. The cost in the database averaged SEK 27 994 (excluded outliers) in 2011. Individual hospitals varied from SEK 21 000 to SEK 33 000. The differences were not wholly due to period of care, which was between two and just over three days for all hospitals. One variable that affected costs was the percentage of Caesareans, which are particularly resource-intensive because they are performed in operating theatres. Caesareans averaged a little over SEK 48 600, while vaginal deliveries averaged SEK 27 994. Caesareans accounted for 17–43 per
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