{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:19:45Z","timestamp":1785554385360,"version":"3.56.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T00:00:00Z","timestamp":1437523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81273091"],"award-info":[{"award-number":["81273091"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify factors that are associated with a relatively low caesarean section (<jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>) rate by examining the <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rate in various subgroups in the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 685\u00a0452 births in the Netherlands Perinatal Registry from 2007 to 2010.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A modified classification system for <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> was used to categorise all women into ten groups. Labour management, mode of delivery, maternal and neonatal morbidity and mortality were assessed according to these ten groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Caesarean section, labour induction, instrumental delivery, postpartum haemorrhage, perineal laceration, duration of second stage of labour, Apgar score, fetal and neonatal mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rate was 15.6%. Term, nulliparous and parous women with a singleton pregnancy of a fetus in cephalic position and spontaneous onset of labour had <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rates of 9.6 and 1.9% and instrumental birth rates of 19.4 and 2.4%, respectively; 17.3% of births were induced. Among women with a previous <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> and term, singleton pregnancies with a fetus in cephalic presentation, 71% had trial of labour, of which 75% had a successful vaginal birth. Of women with multiple gestation, 43% had <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>. Women with <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> due to \u2018failure to progress\u2019 in the second stage of labour had a median duration of second\u2010stage pushing of almost 2\u00a0hours in nulliparas and &gt;90\u00a0minutes in parous women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Several obstetric practice patterns may have contributed to the relatively low overall <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rate in the Netherlands: a relatively low <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rate in term, singleton pregnancies of a fetus in cephalic position and spontaneous onset of labour, relatively low rate of labour induction, a high rate of a trial of labour after a previous <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>, the use of vacuum and forceps, and a high proportion of women being taken care of by midwives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>The Netherlands has several practice patterns that may have contributed to its relatively low <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13520","type":"journal-article","created":{"date-parts":[[2015,7,27]],"date-time":"2015-07-27T02:58:10Z","timestamp":1437965890000},"page":"754-761","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Caesarean section rates in subgroups of women and perinatal outcomes"],"prefix":"10.1111","volume":"123","author":[{"given":"J","family":"Zhang","sequence":"first","affiliation":[{"name":"MOE\u2010Shanghai Key Laboratory of Children's Environmental Health Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Geerts","sequence":"additional","affiliation":[{"name":"Midwifery Science AVAG\/EMGO VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Hukkelhoven","sequence":"additional","affiliation":[{"name":"The Netherlands Perinatal Registry Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Offerhaus","sequence":"additional","affiliation":[{"name":"KNOV the Royal Dutch Midwifery Organisation Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Zwart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Deventer Ziekenhuis Deventer the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Midwifery Science AVAG\/EMGO VU University Medical Centre Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,7,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2007.00786.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12104"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-014-1498-8"},{"key":"e_1_2_6_5_1","unstructured":"GibbonsL Beliz\u00e1nJM LauerJA Betr\u00e1nAP MerialdiM AlthabeF.The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. 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