Contemporary caesarean section theory : risk, uncertainty and fear

In this chapter, we discuss several theoretical concepts relevant to an explanation of the contemporary use of caesarean section. We contend that, in order to provide safe and appropriate maternity care, midwives need to understand the multiple factors that influence the increasing use of caesarean birth by care givers and women. To begin, the prominent discourses of the competing ideologies of childbirth and the general changes to maternity care practices that have occurred over time are discussed. We then describe three 'zones of clinical practice' that help us understand traditional and contemporary reasons for caesarean section, as described in the scientific literature. From there, we critique three commonly reported approaches to decision-making in health care and suggest the limitations of these approaches in relation to decision-making for interventions, such as caesarean section. The theoretical framework developed, encompassing three zones of clinical practice and three decision-making styles draws on findings from an interview study of women's experiences of caesarean section from an interview study of women's experiences of caesarean section. With increasing use of technologies such as caesarean section, discourses of risk, fear, uncertainty, trust and confidence are shown to influence decision-making in childbirth.