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.