Setting
Between 2000 and 2019, 3,436,258 women in the Netherlands gave birth after 24 weeks’ gestation, with an average of 171,812 births per year (in 2000 n=184,246, in 2019 n=160,898). In 2000, 64.5% of births took place in obstetrician-led care in the hospital, 9.5% in primary midwifery-led care at a low-risk birth unit in the hospital and 25.2% were homebirths attended by primary care midwives. In 2019, these percentages were 72.7%, 14.5% and 12.7% respectively(24).
During the time period 2000-2019, the caesarean section rate after 24 weeks’ gestation was 15.4% (n=528,096), with a change from 13.2% in 2000 to 16.8% in 2015 (maximum) and then to 15.8% in 2019. The caesarean section rate increased especially among women with a previous caesarean section, who can be classified as Robson group 5(25, 26). The proportion of caesarean section in Robson group 5 among all women who gave birth by caesarean section increased from 16.1% in 2000 to 25.7% in 2019 (see Appendix S2). In the same period, births of women in Robson group 5 represented 6.2% of all births(24).
Women with a previous caesarean section – without other risk factors – generally receive antenatal care by a midwife in primary care, until 34-36 weeks’ gestation, when mode of birth is decided in an individual counselling process with the obstetrician. Women opting for VBAC are advised to give birth in obstetrician-led care in a hospital with intravenous access and continuous CTG monitoring.