External version

The KNOV aims to ensure that each pregnant woman with a breech presentation is offered the external version procedure. Assuming a successful version policy, expectations are that the number of breech births will reduce. The external version can be carried out in both first and second line care.

This policy is formulated in the KNOV viewpoint on the External Version. The viewpoint further includes guidelines for practical implementation and recommendations.

On 22 December 2006, the KNOV, NVOG and ZN issued a joint statement in which they toned down media reports, indicating to be in agreement about the fact that external version is a safe and effective method for reducing the number of breech births. The NVOG, KNOV and ZN have agreed to investigate the possibility of a multi-disciplinary guideline. The CBO knowledge institute has been asked to support the development of the guideline, with the involvement of the Dutch College of General Practitioners.

The agreement between the KNOV and ZN about the obstetricians' quality policy
On 31 March 2006, ZN awarded the financing of the obstetricians' quality policy and has set the condition that the KNOV realises savings through efforts at macro level. This can be done through e.g. reducing the number of referrals and caesarean sections by applying external version at the end of the pregnancy.

The financial agreements in the agreement do not relate to individual obstetricians. Therefore, obstetricians are not awarded bonuses for applying the external version procedure. The obligation of means ZN has requested from the KNOV is in line with current activities that form part of the total quality programme.