Main findings
The proportion of women intending VBAC in the Netherlands was stable between 2000 and 2008, but from 2009 onwards there was a steady and considerable decrease in VBAC attempts. This decrease is likely related to the publication of the EURO-PERISTAT report, which showed relatively high numbers of perinatal mortality in the Netherlands as compared to other European countries (33). Publication of the report was followed by the designation of a steering committee on perinatal care in 2009, which developed and implemented a perinatal mortality reduction strategy over the years. The emphasis on reducing perinatal mortality is likely to have caused more defensive obstetric practice, with clinicians attempting to minimize adverse perinatal outcomes in the short term rather than considering women’s outcomes or perinatal outcomes in subsequent pregnancies. Interestingly, this change in practice, with fewer women undergoing VBAC and more women giving birth by planned caesarean section after 2009 was not accompanied by a marked decrease in perinatal mortality in the second decade of the study period.