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).