Birth Education

Understanding the Cascade of Intervention

Many things in life have unintended consequences; they may or may not have the effect that we want, and they may also have other unplanned and possibly unwanted effects.

Maternity interventions can have unintended effects, especially during labour and birth.

Often these effects are new problems that are ‘solved’ with further intervention, which may in turn create yet more problems. This chain of events has been labelled the “cascade of intervention”.

The Cascade of Intervention can change the course of labour in important ways, yet we often have little or no awareness that many interventions are used within a cascade of unwanted side-effects.

Maternity interventions that can lead to a cascade of intervention include:

  • Using various medications to induce labour
  • Artificially breaking the membranes surrounding the baby before or during labour;
  • Giving medications for pain relief
  • Using back-lying positions for labour or for birth.

In many instances, these interventions cause problems because they disrupt the normal physiology of pregnancy, labour and birth – for example, by interfering with hormones that move labour and birth along creating opportunities for infection, or interfering with a woman’s ability to push her baby out.

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An example of the cascade of intervention

  • Firstly, you might choose to have an IV pain medication to help with the pain of contractions.
  • Due to the side effects of that medication, you are now considered by your health care providers a fall risk, so you are limited to labouring in bed.
  • Because you are less mobile, and can’t make use of gravity as you would if you were able to move about, your labour slows. You are offered syntocinon.
  • Due to the intensity of the contractions that you are now experiencing, you opt for epidural pain relief.
  • The epidural is effective, but now you cannot feel the urge to push when it comes time.  Pushing without the urge can prolong the pushing phase, exhausting you.
  • After a while, you’ll either have an episiotomy, to make an instrument-assisted birth possible or, if baby isn’t handling the induced contractions, you will have a c-section.

What started out at a low-risk, uncomplicated birth became a heavily  medicated and assisted birth.

A variety of interventions are used with epidurals, both to anticipate these effects and to deal with them when they arise. Due to these effects, some interventions, such as electronic fetal monitoring and intravenous fluids are widely used with epidurals.

And others are more likely, including the use of syntocinon to strengthen contractions, use of a urinary catheter to empty the bladder, and use of a vacuum extractor or forceps to help move baby out. These in turn may have side effects and lead to the use of other interventions.

The impacts can extend to babies. For example, epidurals increase the likelihood of fevers in mothers, and if a mother has a fever, the caregivers worry that her baby may have an infection. Though few babies whose mothers have a fever associated with epidural do in fact have an infection, these babies often have blood tests and are treated with antibiotics as a precaution just after birth.

Why does it ‘cascade’?

Because birth is a normal physiological process – not a illness to be treated or cured.  Birth involves the release of different hormones, and interfering with the natural process adds risks.

Like anything, occasional deviations from normal are to be expected where intervention becomes necessary. However, in the birth process, this is more often the exception than the rule.

Most births, when properly facilitated in a safe environment, will unfold without complication or need for intervention.  When we keep interfering with the natural process, additional risks and side-effects are added to the mix, which then require another intervention to handle the results of the last.

None of this information is not to discourage you from making decisions around how you wish to birth your baby; in fact, it shows the importance of making careful, informed decisions.

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