Abstract
Introduction: Global cesarean section (CS) rates continue rising without corresponding maternal/neonatal mortality reductions. WHO recommends 10-15% ideal rates, yet Indonesia reports 17.6% (Riskesdas 2018) to 36% (BPJS 2019). Jombang District Hospital showed 38.9% CS rate in 2023, predominantly Robson Group 5 (16.9%). Objective: To compare CS rates and Robson Group 5 proportions before and after interventions at Jombang District Hospital in 2024, and evaluate management changes for women with prior CS history. Methods: Quasi-experimental study compared a pre-intervention period (January-June 2024: n=1,341) and a post-intervention period (July-December 2024: n=1,142) across a total of 2,483 deliveries. Hospital delivery records were analyzed utilizing the Robson classification. Chi-square tests assessed differences in CS proportions with a significance level of p<0.05. Results: The overall CS rate was 44.8% (1,113/2,483), increasing nonsignificantly from 43.3% to 46.6% (p=0.113). Robson Group 5 CS rates remained persistently high, shifting from 92.0% pre-intervention to 93.5% post-intervention (p=0.624). Vaginal birth after cesarean (VBAC) success was limited to 8-12%. Conclusion: Non-clinical focus group discussions among healthcare providers failed to reduce CS rates, highlighting the limitations of single-component interventions. Multifaceted strategies are essential, including mandatory second opinions for elective CS, standardized VBAC protocols, and intensive antenatal education.