One important factor to be taken into consideration is how common an operative intervention is in a specific population. This is problematic as little or no common consensus exists, what labor dystocia really is and how to handle a dystocic delivery. Operative interventions in this study are more common in Switzerland; the predictive value of AFL might therefore be better in this subgroup than among the Tanzanian women, where fewer deliveries end in an operative intervention. On the other hand, more complications such as post-partum infections and post-partum hemorrhages are seen among Tanzanian women in the study. One maternal and three fetal deaths occurred in the Tanzanian group, all of them after extremely long deliveries with high AFL values. AFL is likely to be an even more useful measurement in these settings. The question becomes, whether we are using the correct operative delivery criteria when handling a dystocic delivery. Hopefully this study can help us to reach a new kind of consensus with a reduction in the number of unnecessary operative interventions.