Strengths and limitations
The main strength of our study is the nationwide population-based design
and robust data extraction of almost all births in the Netherlands of
the past twenty years.
Limitations are indwelled in the retrospective nature of a registry-set
and some under- and misreporting might have occurred. The registry did
not include the option to analyse women with one previous caesarean
section who also had a previous vaginal birth. Our study design does not
allow for conclusions of causality particularly since indications for
caesarean sections are not reported.