Caesarean delivery rates have remained persistently high in many high-income countries (Gibbons, World Health Report (2010) Background Paper, No 30). The performance of a caesarean delivery impacts the management of subsequent pregnancies, increasing the likelihood of repeat caesarean delivery. This article reports intriguing results indicating that caesarean delivery in the first pregnancy is an independent risk factor for unexplained antepartum stillbirth in the second pregnancy. The few studies examining previous caesarean delivery as a risk factor for stillbirth have had conflicting results and have limited information available on the cause of the stillbirth. The authors found in a cohort of 128 585 singleton births, an overall 1.5-fold increased risk for unexplained stillbirth at 24 weeks of gestation and beyond in women with previous caesarean delivery and 1.9-fold increase for stillbirth at or after 34 weeks of gestation. A database of all births in Scotland with information on clinical, demographic characteristics and outcomes was linked to the Scottish Stillbirth and Infant Death Survey, a national registry that routinely classifies all perinatal deaths in Scotland based on clinical information obtained from local coordinators and pathologists. The association between previous caesarean delivery and unexplained stillbirth persisted when limited to women whose first birth was at term and regardless of labour duration. In addition to the use of databases containing high-quality data on important covariates, there are other strengths of this study. The cause of stillbirth was uniformly classified using a modification of the Wigglesworth classification. Deaths were classified by a single medically qualified individual, who had access to postnatal investigations and autopsy when performed. Furthermore, small-for-gestational-age birthweight was not regarded as a cause of stillbirth, which is important because in some classification systems it is considered a cause without regard to the true ‘cause’, i.e. the underlying condition that led to small for gestational age resulting in stillbirth. Confirmation through a meta-analysis of three other adequate quality studies bolsters the findings of this study of previous caesarean delivery as a risk factor for antepartum stillbirth. As the authors correctly point out, the absolute risk difference is only 0.1%; 1000 caesarean deliveries would need to be avoided to prevent one additional antepartum stillbirth. However, there are important avenues of future research with potential clinical impact resulting from this study. The potential biological plausibility of an underlying mechanism of abnormal placentation resulting in the increased risk of antepartum stillbirth is important. Caesarean delivery involves the creation of a uterine scar, which is associated with abnormalities of the placenta (e.g. abruption and morbidly adherent placenta), and may affect implantation. Therefore, it is possible that previous caesarean delivery could lead to abnormal placental function leading to stillbirth. The very few women in whom the scar induces impaired placentation could be investigated by ultrasound in their next pregnancy, which might serve to identify women at increased risk. Understanding the physiological changes in uterine blood flow in a subsequent pregnancy in women with a previous caesarean delivery may shed light on placentally based adverse pregnancy outcomes in general. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.