The Cascade of Interventions

The Cascade of Interventions is a term used to describe the domino effect of using medical interventions during labor. One intervention may lead to the need for another intervention which in turn could lead to the use of more interventions. These interventions can result in an unplanned c-section. Hospital labor interventions include, the artificial rupture of membranes (breaking your water for you), induction of labor, giving Pitocin to help labor progress, pain management through an IV or epidural, and continuous electric fetal monitoring. Anything that disrupts the natural process can potentially have an adverse effect on you or your baby. The issue with many hospitals is that more times than not, women are having these interventions performed on them without informed consent. Saying yes to a procedure does NOT equate informed consent. Informed consent means you have all of the information presented to you before you make a decision.

Here is a breakdown of each intervention:

Artificially rupturing membranes is a way to speed up or start labor which increases your baby’s risk of infection, not because they are no longer surrounded by the amniotic fluid that acts as protection, but because the attending nurse continually checks your cervix to see how far dilated you are. When the nurse does this they are potentially exposing your baby to bacteria. This is unnecessary and serves no benefit to you. If labor does not start shortly after your water breaks, they will try to convince you that labor should be helped along, with the use of Pitocin, since the baby is no longer protected by the fluid. The truth is, your body replenishes the amniotic fluid, so there is no need to rush. It is safe to wait for at least 48 hours for labor to start on its own. Waiting 48 hours does not align with hospital protocol and, more times than not, hospital protocol is hardly favorable to laboring women nor is it supported by research. Hospitals need to stop rushing a natural process. Unless you request it, they do not need to continually check your cervix. I don’t know how you may feel, but I personally don’t want someone’s hand periodically up my vag on a good day let alone while in labor. I recall it being very uncomfortable amid my contractions. No thanks! You may keep your hands to yourself.

Checking to see how dilated you are is important when you first arrive at your birthplace to see where you are in labor. It is also important in determining if you are eligible for an epidural should you ask for it. Outside of those two scenarios it only informs your birth attendant how progressed you are so that they can determine if it’s time to intervene in the event that you aren’t progressing “fast enough” according to their policy and procedures. You can choose to decline cervical checks. Remember, hospitals are businesses who are more likely to follow a business model over the evidence-based birth model.

Inducing labor by giving Pitocin (synthetic oxytocin) should only be done if there is an issue that requires your baby to be born sooner or if your baby has passed their due date by two weeks. The reason being that after 42 weeks the placenta stops performing at optimal level or the level needed to nourish your baby properly. It’s also safe to go two weeks past your due date because after all, a due date is only an estimate and if you induce labor too soon you could be robbing your baby of the additional important and needed development that would have taken place. That one or two weeks really matters! Also, inducing labor is rough on mom and baby. Instead of getting breaks between contractions like you normally would if labor came on naturally, you and your baby will be working overtime. Constant contractions rob your baby of oxygen (fetal distress) which is usually why a lot of women end up having an unplanned c-section.  

There are two popular options for pain management. Receiving it intravenously (IV) and through an epidural. Some hospitals provide nitrous oxide (laughing gas) as well, but this option is not as popular. Pain meds through an IV can make your unborn baby sleepy and can impede the breastfeeding experience after your baby is born, making it difficult for them to latch and suckle. An epidural limits your range of motion and will require catheter insertion because you will no longer be able to walk. While it’s a great pain medication it has the potential to slow labor. I was in the delivery room with my cousin and my sister during their labor and delivery. While the epidural did not seem to drastically impact the labor progression for my cousin it slowed my sister’s labor tremendously. Because the epidural can slow labor, hospitals will often suggest beginning Pitocin to restart or speed it up. Once started Pitocin dosage is gradually increased. This can be a miserable time for women due to the continual contractions. I did not use Pitocin during my labor and let me tell you, I appreciated those breaks between contractions. If it wasn’t for those breaks I would have asked the Lord to take me from this place. As aforementioned, the absence of those breaks means an absence of a break for your unborn baby as well. Fetal distress is often a consequence of Pitocin.

Continuous electric fetal monitoring monitors your baby’s heart rate. In this process women are confined to a bed with a monitor wrapped around their belly. This is the essence of “team doing too much” if you ask me. You do not need to be strapped to a bed with a monitor wrapped around your belly to observe your baby’s heart rate. In addition, research has shown that it lacks accuracy. You can opt for use of a handheld baby monitor instead, which is used to periodically check baby’s heart rate while also giving you freedom to move about and labor in whatever position you choose. This is the ideal way to go for low-risk healthy pregnancies. Many, if not most, women do not want to be confined to a bed. Handheld baby monitors can also be used under water, which was how it was used for me during my labor and water birth.

Now that you are informed please know that I am not the intervention Nazi. While I strongly believe natural is better I cannot tell you how to give birth. I just want you informed and empowered. With information you can make all of your decisions with a level of understanding and confidence and you will be even more empowered to ask additional questions when in doubt. YOU HAVE OPTIONS and you do NOT need to say “yes” to everything the hospital suggests. Note that not all hospitals are the same and many medical staff are just doing what they were trained to do. Even they are not always aware that there’s a better way of doing things.

Not everyone in hospital settings is malicious, so don’t approach the situation with claws out, rather approach it using knowledge and wisdom. You will get better results that way anyway. Listen to, and trust your body, and make sure you have a trusted support person who knows what you want for your birth experience and therefore can help advocate for you during one of the most important and special moments of your life. I am rooting for you as you take control of your birth experience!