Comfort Birth

Please Click The Link For The Subject You’re Interested In. (adapted from Lamaze International)

Ceserean

What is 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.

Many maternity interventions have unintended effects, especially during labor 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 called the “cascade of intervention.”

This chain of events can change the course of a woman’s labor in important ways, yet women and their partners often have little or no awareness that many interventions are used within a cascade of unwanted side effects.

The maternity interventions that can lead to a cascade of interventions include:

* using various medications to induce labor
* artificially breaking the membranes surrounding the baby and amniotic fluid before or during labor
* giving medications for pain relief
* using back-lying positions for labor or for birth.

In many instances, these interventions cause problems because they disrupt the normal physiology of pregnancy, labor and birth .. for example, by:

* interfering with hormones that move labor and birth along
* creating opportunities for infection, or
* interfering with a woman’s ability to push her baby out.

What is an example of the cascade of intervention?

Epidural analgesia can provide very effective relief during labor. It also increases the chance that a woman will experience a sudden drop in blood pressure, a longer birthing, difficulty moving about, difficulty urinating, difficulty pushing her baby out, fever, and other undesirable effects. 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 use of synthetic oxytocin to strengthen contractions, use of a urinary catheter to empty the bladder, and use of a vacuum extractor or forceps to help move the baby out. These in turn may have side effects and lead to 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, 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.

This chain of possible effects from epidural and other interventions shows the importance of making careful, informed maternity decisions.

How can women limit the problem of a cascade of intervention Isn’t it up to the Doctor?

Almost every intervention has some potential to cause harm. Decisions about whether to undergo an intervention should be made carefully by the informed mother. Interventions should only be used if they are more likely to offer benefit than harm. In weighing possible benefits and harms, it is important to rely on the best available evidence about effects, and also to consider how women feel about the possible outcomes. It is also important to learn about other options that may be available.

Unfortunately, it is impossible to fully and accurately know in advance the course of a decision, and the degree to which other interventions and their effects will come into play. The best way to limit the problem of a cascade of intervention is to avoid interventions with the potential for harm, whenever possible.

The following may help women avoid unnecessary interventions:

* choosing a maternity caregiver and a birth setting with low rates of using common interventions
* becoming familiar, if possible, with the best available research about a proposed intervention
* engaging in open and respectful dialogue with caregivers about the rationale for a proposed intervention
* exploring with caregivers the options of watchful waiting (doing nothing, for now at least) or using simpler, less invasive alternatives
* clearly communicating wishes to caregivers, and getting the support of a partner, doula, or other companions
* knowing that women have the right to accept or refuse procedures, drugs, tests and treatments, and to have their choices honored.

I credit Lamaze International for my information.