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The Cascade of Interventions

Friday, 08 February 2013 18:00
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The Cascade of Interventions aka the Snowball Effect

In a hospital setting where your care providers are actively managing your labour, once you have one intervention it makes more interventions more likely to be needed in order to remedy the effects of the previous ones.

In our Western society culture, there has been a tendency to turn pregnancy and childbirth into a medical experience. One intervention can lead to another in a cascading sequence of questionable procedures, many made necessary only because of a previous intervention.

We are lucky to live in the time of modern medicine, however medical interventions such as labour induction, pain relief, and cesareans—measures that have saved many lives—have been overused.

When you intervene uneccessarily with nature's role, generally there is a waterfall of effects that occur because one things leads to another.

Doctors need to inform their patients of all the risks instead of assuming we don't need to know. It is our bodies, after all...

Facts - did you know that:

  • The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent.
  • In the past twenty years, the cesarean section rates have nearly quintupled in the US to 23.8% in 1989 and nearly quadrupled in Canada to 18.3% in 1987-8.
  • Of 11,814 women admitted for labor and delivery and attended by midwives to 84 freestanding birth centers in the US, 15.8% were transferred to the hospital and 4.4% had a cesarean section. Although the women were lower than average risk of a poor pregnancy outcome, their cesarean rate is one-fifth of the national average.

This is a wonderful representation of how one intervention can snowball into the next from "Thinking Woman's Guide" by Henci Goer.

1. Changing into the hospital gown

Putting on the hospital gown shifts the balance of power from woman to hospital.  Her perception of herself shifts, and she sees herself as a patient, in the care of “experts,” rather than as a woman confident in her ability to birth on her own terms. This simple act may also make the woman feel less comfortable, feel cold or she may be concerned about modesty as well, which increases stress and makes relaxation harder.

2. Continuous Electronic Fetal Monitoring (EFM)

The major effect  of continuous EFM is that it keeps the mother immobile in bed. The use of EFM is not evidence-based, and even ACOG (American Congress of Obstetricians and Gynecologists) admits it has had no effect in improving outcomes for babies .  Evidence shows that Intermittent EFM with a handheld Doppler is just as effective as continuous EFM at identifying babies in distress.  The only effect continuous EFM has had is that it has increased the cesarean section rate.

3. Getting the IV

IV’s restrict a woman’s mobility and make it easier to administer fluids and medications that can interfere with natural birth.  Sometimes, IVs can be helpful, especially if a woman is unable to tolerate oral hydration, or in an emergency situation.  In normal labor, women need to be free to move their bodies throughout labor, and should be encouraged to change positions frequently.  Having an IV can hinder that. The IV is also simply uncomfortable, annoying and may interfere with her focus on relaxing with contractions as well and make holding hands with her support person more uncomfortable or impossible. Even a hep lock can be bothersome in the same ways. The perception that having an IV readily available is helpful in an emergency is not evidence based. Many times this IV port is not working well enough to handle an emergency and must be restarted.

4. Labour Augmentation with Pitocin

The use of synthetic oxytocin (Pitocin®) makes labor more painful for the mother, and more difficult for the baby to tolerate. There are studies that show Pitocin may interfere with the body's natural ocytocin hormone production which may hinder the mother's natural efforts in the pushing stage, may contribute to postpartum hemorrhage and may interrupt her bonding with her baby, contributing to postpartum depression. http://www.birthresourcenetwork.org/resources/54-pitocin-the-whole-story

5. Pain Relief

Because the contractions are so intense with Pitocin, the mother frequently will choose to receive an epidural for pain relief.

6. Restriction of Movement

An epidural keeps a woman confined to bed for the duration of the labor and birth.  Being unable to move restricts the woman’s ability to help her baby get into a good position for birth. It may also hinder the baby's ability to move, too.

7. Contractions Slow Down

Epidurals can slow labor progress, which results in increasing dosages of Pitocin® to increase contraction intensity and frequency, which can lead to an even greater need for pain relief and greater risk of fetal distress.

8. Progress Slows or Stops

Assuming the woman reaches full dilation, the epidural can interfere with the woman’s ability to push effectively.

9. Fetal Distress

Hard contractions, combined with reduced blood pressure and the lack of blood flow to the baby, can cause the baby to go into distress.

10. Cesarean Section

After having exhausted all of the tools at the obstetrician’s disposal, this one option remains.

 

 

Read 14438 times Last modified on Monday, 14 April 2014 07:13

I'm a Certified Lamaze Childbirth Educator (LCCE), Certified Prenatal Fitness Consultant (level 1), Certified Birth Doula, and most importantly a mother to 5 beautiful boys!

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