title: Back to "once a caesarean: always a caesarean"? A trend analysis in Switzerland.
abstract: Caesarean sections (CS) have significantly increased worldwide and a previous CS is nowadays an important and increasingly reported indication to perform a repeat CS. There is a paucity of information in Switzerland on the incidence of repeat CS after previous CS and relationship between the rates of vaginal birth after CS (VBAC). The aim of this study was to analyse the actual trend in VBAC in Switzerland.
  
  
  
  We performed a retrospective cohort study to analyse the proportion of VBAC among all pregnant women with previous sections which give birth during two time periods (group 1:1998/1999 vs. group 2:2004/2005) in our tertiary care referral hospital and in the annual statistics of Swiss Women's Hospitals (ASF-Statistics). In addition, the proportion of induction of labour after a previous caesarean and its success was analysed.
  
  
  
  In both cohorts studied, we found a significant decrease of vaginal births (p < 0.05) and a significant increase of primary elective repeat caesarean section (p < 0.05) from the first to the second time period, while there was a decrease of secondary repeat caesarean sections. The prevalence of labour induction did not decrease.
  
  
  
  Our study shows that vaginal birth after a prior caesarean section has decreased over time in Switzerland. There was no significant change in labour induction during the study period. While this trend might reflect an increasing demand for safety in pregnancy and childbirth, it concomitantly increases maternal risks of further pregnancies, and women need to be appropriately informed about long-term risks.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Bern, Switzerland. cocoschmid@hotmail.com.
authors.forename: Corina
authors.initials: C
authors.lastname: Christmann-Schmid
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Bern, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Raio
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Bern, Switzerland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Scheibner
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Müller
authors.affiliation: Universitätsklinik für Frauenheilkunde, Effingerstrasse 102, 3010, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Surbek
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods / Q000639:trends*; D017604:Cesarean Section, Repeat / Q000379:methods / Q000639:trends*; D017558:Elective Surgical Procedures / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000639:trends; D011247:Pregnancy; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000379:methods / Q000639:trends*; D055815:Young Adult
keywords: Induction of labour; Maternal risk; Repeat caesarean section; Vaginal birth after caesarean section; Vaginal delivery