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Friday, 08 February 2013 18:00

The Cascade of Interventions

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.

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.



Published in Labour
Friday, 09 December 2011 08:01

An Introduction to Birth in the Hospital

There are many logistical reasons for choosing to deliver your baby in the hospital, all of which are valid.  Even if you would have preferred to deliver at home or in a birth center but are required (by insurance, care provider privileges, legal implications or distance challenges), you can still have a beautiful birth the way you would like.  The key is to educate yourself about your choices as a mother and a patient.  Regardless of where you birth, the experience is in your hands!  Planning and preparation is the key to a positive experience that ends in a healthy and happy mother and baby. 

The writings in this series will consist of information from my two hospital births, conversations with mothers who have had births in a variety of settings, as well as reading and research from a variety of sources.  I will include embedded links within articles to my sources, as well as list my sources at the end of each article.  If I am speaking from my own experience, or the experience of others I will indicate this as well.  I hope that through my experience and research that I may provide you with the tools you need to plan your birth the way you would like it to be.  There is no set way to birth that is foolproof or that works for everyone.  I had no idea how much I didn’t know until I stumbled upon various websites and Facebook pages that aimed to educate and inform women of their choices about birth.  It is my hope that through these writings, I may help you to better understand your options, especially those options you didn’t even know you had! 

Birthing in a hospital can provide a sense of security for both the mother and her partner by knowing that medical professionals are there to assist if complications arise.  However, it is important to remember that giving birth in a hospital comes with risks as well, including the risk that interventions may be encouraged by hospital staff.  Knowing the benefits, risks, and circumstances that would necessitate interventions beforehand will help you make informed choices if the time comes.  Knowledge is power, and a mother’s intuition is not to be discounted!

Birthing in a hospital provides the opportunity for elected pain management (epidurals, spinal block, IV medications,) fetal monitoring, newborn screenings and immunizations, and nurses to cater to your needs so your birth partner can focus on supporting you.  Also, in the event of maternal or fetal distress, birthing in a hospital allows medical professionals to quickly react accordingly such as performing a c-section or an instrumental delivery.  The availability of a hospital nursery may allow a new mom to rest and recover while her newborn is being cared for by the nurses.  Meals are delivered bedside and help is just a push of a button away.  Most hospitals also have a registered lactation consultant on staff that is available to aid in the initiation of breastfeeding.

Delivering in the hospital can also be a challenge.  Many mothers report pressure from the hospital staff to consent to fetal monitoring, IV’s, pain medication, and cervical checks against their wishes.  Mothers who intend to birth naturally and free of interventions often feel as though they are forced to allow monitoring, cervical checks, and feel pressured to consent to pain medications.  Mothers who delivered in a hospital also sometimes feel that the frequent vital signs checks are disruptive to post partum recovery. 

It is important for every pregnant mother considering a hospital birth to find out what the hospital’s general policies and procedures are, as well as make decisions about all aspects of her care prior to and during labor.  Developing a birth plan can aid in this process and further empower the mother and her partner to communicate their wishes to their care provider and the hospital staff.

Birthing in a hospital can be a beautiful and empowering experience with the right knowledge and support!  Information is power, and the key to having the birth experience you desire!

Go ahead to:

Step #1: Choosing a Care Provider Part 1: Obstetrician

Step #1: Choosing a Care Provider Part 2: Midwife

Go to: Birthing Methods Main Menu

Published in Birthing Places

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