The cascade of intervention is a term thrown around in lots of pregnancy classes by lots of natural birth advocates, it means…
Having an intervention (an intervention being an induction, an epidural, cesarean etc.) in pregnancy or childbirth will increase your chances of having more interventions as birth progresses.
I myself am a mahoussive natural birth advocate. However, I’m more of a woman’s choice and safe birth advocate. The cascade of intervention is a phrase that I’ve recently begun to question. Let me tell you why…
Firstly, let’s ask ourselves does the phrase in itself do more harm than good? Let’s take induction as a starter. So many pregnant women fear the process of induction because of this cascade concept. If you’re scared of an induction then science tells us that fear makes things more painful anyway. Your body becomes tense so contractions feel worse. Often because of this fear mindset women are more likely to choose an epidural with an induction- this cascade of intervention is one that is supported by research. Let’s flip it on the other side though, if pregnant women weren’t aware of this phrase or the negative stories that surrounded induction and were prepped more on what to expect from an induction then would that cascade be less or non existent from a reduction in fear? I have seen so many women have amazing induction experiences, they’ve hypnobirthed there way through, had waterbirths, stayed active and mobile with the hormone drip. It’s these stories that pregnant women need to be hearing to reduce the fear of being induced. It’s a self-fulfilling prophecy.. if you tell a pregnant woman that they’re more likely to choose an epidural after induction then they are more likely to make that choice.
Sticking with the theme of induction, a new piece of research this year found that cesareans were less in the group of women who had uncomplicated pregnancies and chose to have an induction at 39 weeks compared to women who waited for labour to start naturally or had an induction using current guidelines (such as at 42weeks for being overdue). This bit of research suppports another theory of why the cascade of intervention isn’t necessarily true. For example, let’s look at pregnancy conditions like pre-eclampsia. If you’re offered an induction due to having this, then during labour have an emergency cesarean, it’s more likely that the cesarean was due to the pre- eclampsia than the induction itself. Similarly, if you’re offered an induction due to being overdue and a similar situation occurs then that’s not necessarily the induction that’s made that happen but placentas work less efficiently past 42weeks which may be the reason. So the cause of further intervention is not the first intervention, but the reason why the intervention was chosen in the first place.
I feel like we need to change the press of interventions. When women choose not to have an induction because of the worry of the cascade of intervention then their choice they’ve made has been swayed by a concept that’s not entirely true.
My tips for all pregnant mothers when offered an intervention would be…
- Always know your options and ask why you’re being offered an intervention. Birth interventions get a lot of unnecessary bad press when actually they are a much needed part of the birth world.
- Keep your mindset strong. Choosing one intervention doesn’t mean you’re automatically going to cascade yourself to a negative birth experience. Keep reminding yourself that you’re making positive choices for you and your baby.
- You can use this acronym to help you make a choice when given an option of intervention.
E- Is this an Emergency?
B- What are the Benefits?
R- What are the Risks?
A- Are there Alternative options?
N- What happens if I do Nothing?
What are your thoughts on the cascade of intervention?
Photo credits- Instagram @benzalphotography
For more tips and info on anything covered in this blog come to antenatal classes or hypnobirthing!!