Interpretation of results
The decline in intended VBAC indicates that it is less often the chosen mode of birth. While previous studies have demonstrated an area under the curve of 68-71% for various VBAC success predictions models(23), the described changes over time will have certainly undermined the validity of these models. It is possible that currently used tools aimed to aid the decision-making process may deter women and clinicians from intending VBAC. We therefore question whether these prediction models should be applied in mode of birth counselling in case of a previous caesarean section.
Supporting VBAC has been suggested as a strategy to curb increasing caesarean section rates and their negative health consequences(3). A recent study in Sweden demonstrated it is possible to turn the tide of decreasing VBAC in a similar obstetric culture and environment as compared to the Netherlands(34): reporting a rise in intended and successful VBAC without an increase in adverse maternal and neonatal outcomes(35). The authors mention an maternity care team with experience in managing labour in women with a previous caesarean section as the greatest contributor to the rising successful VBAC rate by increasing the number of women intending VBAC (35).
We aim to raise awareness for the decrease in VBAC attempts in the Netherlands that appears not to be associated with improved clinical outcome. We recommend clinicians and policy makers to contemplate on the driving determinants behind the unjustified increase in caesarean section rates and look for means to counter this trend. As, in addition to all previously mentioned points, women indicate a higher quality of life after a VBAC compared to an elective caesarean section, VBAC is more cost-effective, and leads to considerably lower CO2-emissions than elective caesarean section (36, 37).