Table 2

Summary of three Zones of Clinical Practice

Zone

Explanation

Examples from women's accounts

Central zone

Caesarean section performed for unambiguous clinical reasons* (life-saving)

Footling breech, hand presentation, severe oligohydramnios at term, not in labour; severe pre-eclampsia; antepartum haemorrhage in labour, prior caesarean; severe unstable asthma.

Grey zone

Caesarean section performed for ambiguous clinical reasons*

Maternal 'exhaustion'; 'slow' progress in labour; mild gestational diabetes; suspicion of 'big' baby; mild hypertension.

Peripheral zone

Caesarean section performed in the absence of clinical reasons

Maternal request (past history of negative birth experience, fear for baby's safety, fear of vaginal birth).

*Adapted from: A guide to effective care in pregnancy and childbirth ed. Enkin M, Keirse M, et. al. (2000); Oxford University Press, Oxford [2].

Kealy et al. BMC Pregnancy and Childbirth 2010 10:47   doi:10.1186/1471-2393-10-47