What is the cascade of interventions and why does it matter for my birth plan?

Our midwife friend Lauren of One Mama Midwife has broken down the basics for us on "What is the cascade of interventions when it comes to birth?" and even more importantly "What can I do to avoid the cascade of interventions during my birth?"

Understanding the cascade of interventions

The cascade of interventions refers to the use of one medical intervention leading to the use of multiple interventions during labour. A helpful way to imagine the cascade of interventions is as a snowball effect. Understanding the impacts of the cascade of interventions is essential in reducing unnecessary interventions, reducing the length of labour and reducing operative deliveries.

Woman wipes tears after birth with cascade of interventions in hospital

For example:

A woman may be induced by having her waters broken and a Syntocinon IV infusion (synthetic form of the body’s natural hormone, Oxytocin). She then is unable to spend early labour at home and is in the hospital for her whole labour. This along with the synthetic oxytocin reduces the amount of natural pain-relieving hormones the body releases (endorphins) means that she is more likely to have an epidural. Having an epidural means that the woman is unable to utilise gravity and is limited in her position changes, therefore she may have a longer first stage of labour. Women with epidurals may have decreased sensation to push, meaning a longer second stage of labour, higher incidence of fetal distress and an increased risk of an episiotomy, instrumental delivery or a caesarean section.

So, as you can see…

In a woman having her first baby, the use of an epidural has been shown to occur more often and earlier in the labour than that of a woman having her subsequent birth. Women who have an epidural, especially during early labour, are more likely to have longer labours sparking the need for the use of Syntocinon (aka – another intervention). Which can increases the risks of fetal distress, episiotomy, instrumental birth and caesarean section.

How can one intervention lead to more?

Interventions during labour and birth can inhibit the body’s natural ability to go into labour, inhibit the release of the necessary hormones for labour to progress normally and decrease the woman’s confidence in her body. Furthermore, interventions can increase the risk of infection and decrease a woman’s satisfaction with her birth experience. All of which can have devastating impacts on a mothers emotional and physical wellbeing postpartum as well as the ability to create positive mother-baby attachments. 

However, every woman and baby is different meaning that although interventions are more likely to cause more interventions, it does not mean that this is necessarily the case for you.

Preventing the cascade of interventions

In order to limit the cascade of interventions, it is important to have a trusted healthcare professional who you feel safe with but that also will only use interventions when they are medically necessary. Educate yourself on the normal processes of labour and birth, so that you are able to feel in control, have alternative ways to cope with your pain (such as hiring a TENS machine from Bliss Birth) and reduce your risk of further interventions. Make sure that you are fully informed in your decision making, yes that means questioning your healthcare provider on why they are recommending a certain intervention to you along with the risks or benefits. Finally, know that this is your labour and birth, and you are allowed to say no if something is being recommended to you that you do not want done and you are fully aware of the risks and benefits.

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