Mode of birth among women with one previous caesarean section in the
Netherlands: a 20-year population-based study
Abstract
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.