DISCLAIMER: This post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding you or your baby’s health. Please read my Medical Disclaimer for more info
For the mothers who hope for a low-intervention birth experience, the cascade of interventions is something to be aware of. In the United States, cesarean rates are 33%, however, the World Health Organization recommends a rate of 10-15%.
In addition to cesareans, there are many medically induced labors that are occurring. These induced labors are too often suggested by providers without a comprehensive conversation about the benefits and risks of this with low-risk mothers.
When the benefits and risks are thoroughly discussed with your provider, based on you and your baby’s health status, this is called informed consent.
You may not be aware of the cascading risks that can come with medical interventions; however, your midwife or OB is, and you deserve to know what they are before following through.
What are Interventions?
The cascade of interventions is when an intervention (even small ones), directly results in another intervention becoming necessary.
Medical interventions during labor and birth include:
- Routine use of IV fluids
- Eating and drinking restrictions
- Continuous fetal monitoring
- Epidurals
- Augmentation of labor (including Pitocin, Cervidil, and Cytotec)
- Leaving home
Yes, leaving your home is an intervention to the birth process that often distrubs your natural labor hormones. Check out 5 Things You Need to Create a Calm Birth Space for more about what can hurt or help your labor hormones!
These interventions are used in the majority of U.S. births. However, they disturb labor’s natural process. Therefore, causing more and more interventions to be required for labor and childbirth.
As mentioned above, most women in the hospital are administered Pitocin, and 70% of women are administered an epidural.
An epidural can lead to not pushing effectively due to the lack of feeling, likely making the pushing process longer and harder on the mother. With this, the mother may need further medical interventions to birth her baby faster such as a cesarean, forceps, or a vacuum-assisted birth.
This was one example of how the cascade of medical interventions can turn out for a woman giving birth. This is fine for those who don’t mind a high-intervention birth, as long as they feel empowered with their experience. However, for those who desire un-medicated or simply low intervention births, these interventions may make things problematic.
Normal Physiology of Labor
During normal labor, oxytocin increases the strength and efficiency of contractions. These contractions become increasingly painful. As the woman copes with the pain, even more oxytocin is released.
But if the pain is taken away, the oxytocin levels drop and the woman’s contractions lessen and become less effective. Next, Pitocin may be needed to keep the labor moving. Then, the contractions will become more frequent and more effective again.
However, in physiological birth, when oxytocin levels get very high, endorphins are released. Endorphins produce a dreamlike state and pain perception will decrease making coping with the contractions easier.
Endorphins in labor are sometimes called “nature’s narcotic.” However, if a woman has an epidural (or another medical pain-reliever) and Pitocin augmentation, she doesn’t experience this endorphin release because Pitocin doesn’t cross the blood-brain barrier, therefore not creating the high levels of oxytocin which results in endorphins released.
When it’s not medically necessary, the result of medical disturbance is a cascade of interventions. These interventions increase the chances of cesarean birth, induction/augmentation of labor, assisted deliveries, and more.
Another hormone in labor is called catecholamine, the stress hormone, which is released if the mother is fearful, anxious, or if she doesn’t feel safe and protected.
In early labor, high levels of catecholamines can slow or even stop labor.
However, after labor, there’s a natural surge of catecholamines that facilitate a baby’s quick birth, even in a tired mother.
When the physiologic process of labor and birth are not disrupted, both mother and baby have large amounts of oxytocin and catecholamines circulating at birth. Additionally, the mother will have high levels of prolactin and beta-endorphins following birth. The effect of these hormones is an alert, eager mama and baby ready to meet each other calmly and begin breastfeeding!
How Can You Avoid The Cascade of Interventions?
There are two choices that will affect your birth experience the most: your provider and where you give birth.
Furthermore, I’d say the next most important thing is your birth space. Your birth space can have a powerful influence on your hormones and experience during labor and childbirth. It’s crucial to think about where you will feel the most comfortable and relaxed for labor. Check out these 5 Things You Need to Create a Calm Birth Space for more information!
Conclusion:
To avoid the cascade of interventions and lower your risk of cesarean birth, induction/augmentation of labor, assisted birth with forceps or a vacuum, and episiotomy:
- Choose a low-risk maternity care provider, such as a midwife, with lots of expereince in unmedicated or low-intervention births. Unmedicated and low-intervention births are technically more work for healthcare professionals in U.S. hospitals. Therefore, choosing someone who truly enjoys these kinds of labors is key. Check out my post on, How to Choose Between a Midwife or an OB-GYN?
- Look into your hospitals cesarean rates using leapfroggroup.com. Furthermore, look into the Research on Birth Centers and Homebirth if these options interest you and you are low risk. (Blog post coming soon)
- Avoid elective inductions or augmentation of labor (‘elective’ means there’s no medical need to start or speed up your labor)
- Utilize ongoing labor support from a birth doula
- Talk with your provider about ways to reduce the risk of interventions, and the options you have if it becomes necessary or desired. Such as desiring an epidural but having the option of a ‘walking epidural’ (low dose epidural) or turning down the epidural during the second stage of childbirth, so you can feel the urge to push.
Childbirth is going to be one of the most significant and most memorable moments in your entire life. You got this, mama! Comment below any of your thoughts to share on this topic. I’d love to hear from you!♡
DISCLAIMER: This post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding you or your baby’s health. Please read my Medical Disclaimer for more info
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