The Cascade of Interventions
The Cascade of Interventions is a term used to describe the phenomenon where one medical intervention during labor can lead to a cascade of further interventions, often resulting in an increase in the likelihood of a cesarean section. For example, medication to induce or speed up labor may lead to an increased likelihood of fetal distress, which can then result in a recommendation for a cesarean section.
Why is it important to understand?
It is important to understand the Cascade of Interventions because it can have a significant impact on birth outcomes. Women who receive medical interventions during labor are more likely to have cesarean sections, which can lead to longer recovery times and increased risks of complications for both the mother and baby. Understanding the cascade of interventions can help you make informed decisions about your childbirth preferences and be an advocate for yourself during labor.
What are some common interventions that can lead to the cascade?
- Induction of labor without any medical indications.
- AROM or Artificial rupture of the membranes surrounding the baby before or during labor.
- Augmenting a naturally progressing labor with synthetic oxytocin (Syntocin or Pitocin) to make labor move faster.
- Giving medications for pain relief when not requested by you, with a full understanding of the risk/benefit ratio.
- Being confined to bed during labor versus being upright and moving about.
In many cases, these practices cause problems because they disrupt the normal physiology of pregnancy, labor and birth by:
- Interfering with hormones oxytocin and endorphins that move labor and birth along and help you to cope with the intensity of the sensations and physical challenge.
- Increasing the opportunities for infection (for you and your baby)
- Possible undesirable effects on your baby causing fetal distress.
- Making it harder for you to push your baby out.
- increasing pressure on you to “perform” according to hospital protocols and expected norms.
Therein lies the key to navigating interventions.
You always need to look at the big picture.
Here are some questions you might want to ask the staff and take into consideration.
- What is the situation we are dealing with?
- Was my labor progressing normally until now? What changed?
- What are we trying to achieve? What is the best case scenario? Could we achieve this with watchful waiting or is an intervention necessary?
- How far off the “expected norm” am I at the moment? Could this change?
Whenever a decision is required you want to make sure that you have all the relevant information and then engage in a conversation with the staff to make a decision that works for both of you.