loading page

Mode of birth among women with one previous caesarean section in the Netherlands: a 20-year population-based study
  • +2
  • Ian Koorn,
  • Linda Vis,
  • Kim Verschueren,
  • Ageeth Rosman,
  • Thomas van den Akker
Ian Koorn
Amsterdam UMC Locatie AMC

Corresponding Author:[email protected]

Author Profile
Linda Vis
Author Profile
Kim Verschueren
UMC Utrecht
Author Profile
Ageeth Rosman
Author Profile
Thomas van den Akker
Leiden University Medical Center
Author Profile


Objective Describe changes over time regarding mode of birth and perinatal outcomes in women with one previous caesarean section in the Netherlands over the past 20 years. Design Population-based study. Setting Nationwide. Population All women with one previous caesarean section and no previous vaginal birth, who gave birth to a term singleton in cephalic presentation between 2000 and 2019 (n=143,308). Methods Analysis of Dutch perinatal registry data. Main outcome measures Primary: mode of birth per year, intended vaginal birth versus planned caesarean section. Secondary: failed versus successful vaginal birth in case of intended vaginal birth after caesarean (VBAC), and adverse perinatal outcome (perinatal mortality up to 28 days, low Apgar score at 5 minutes, asphyxia, and NICU admission >24 hours). Results A decrease of 21.5% was seen in women with one previous caesarean section intending VBAC in a subsequent pregnancy, from 77.2% in 2000 to 55.7% in 2019, with a marked acceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%. Overall caesarean section rate (planned and unplanned) increased from 45.1% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared to planned caesarean section. However, after an initial decrease, perinatal mortality remained stable from 2009 onwards with only a minimal difference between both modes of birth. Conclusions In the Netherlands, the proportion of women intending VBAC after a previous caesarean section has decreased markedly, particularly from 2009 onwards. This decrease was not accompanied by a synchronous decrease in perinatal mortality after that year.
17 Mar 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Mar 2022Assigned to Editor
20 Mar 2022Submission Checks Completed
21 Mar 2022Reviewer(s) Assigned
22 Apr 2022Review(s) Completed, Editorial Evaluation Pending