Key words: caesarean section, quality indicators, barrier analysis, Robson 10 Group Classification System, vaginal birth after previous caesarean section

"Towards optimal caesarean practice"

This dissertation focuses on improving caesarean section care. The goal was to identify groups of women for whom guidelines are not always followed and for whom improved care can be realised. This research shows improved care is possible in women with a previous caesarean section, women who are pregnant with a first child with signs of foetal distress, women who are pregnant with a first child when birth does not progress and in the continuous guidance of the birth. Strategies were developed to improve caesarean section care after identifying the factors which promote or impede optimal care, as well as those that influence the chance of an unplanned caesarean section. For example, continuous guidance results in fewer assisted births, fewer requests for pain relief and increased satisfaction of the woman postpartum.

Partially financed by zonMW (grant number 17100.3006)