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.