The “Cascade of Interventions”

Labor usually happens best when it happens on its own.  Once someone intervenes in the natural process, risks to mother and baby begin to increase.  Of course, there is a time and a place for just about every obstetrical intervention.  In certain situations, interventions can be life-saving for mother and baby, and we are grateful for the skill that obstetricians have in using those techniques.  However, seemingly insignificant and routinely applied interventions can, indeed, have very significant effects.  It is this “cascade of interventions” or “snowball effect” that has greatly contributed to increasing the cesarean section rate in our country, and has pushed the USA to an appalling 50th place worldwide in maternal mortality.


Changing into the hospital gown
Something as seemingly harmless as wearing a hospital gown can have an effect on the laboring woman. Putting on the hospital gown shifts the balance of power from woman to hospital.  Her perception of herself shifts, and she sees herself as a patient, in the care of “experts,” rather than as a woman confident in her ability to birth on her own terms. This simple act may also make the woman feel less comfortable, feel cold or she may be concerned about modesty as well, which increases stress and makes relaxation harder.




Continuous Electronic Fetal Monitoring (EFM)
The major effect  of continuous EFM is that it keeps the mother immobile in bed. The use of EFM is not evidence-based, and even ACOG (American Congress of Obstetricians and Gynecologists) admits it has had no effect in improving outcomes for babies.  Evidence shows that Intermittent EFM with a handheld Doppler is just as effective as continuous EFM at identifying babies in distress.  The only effect continuous EFM has had is that it has increased the cesarean section rate.




Getting the IV
IV’s restrict a woman’s mobility and make it easier to administer fluids and medications that can interfere with natural birth.  Sometimes, IVs can be helpful, especially if a woman is unable to tolerate oral hydration, or in an emergency situation.  In normal labor, women need to be free to move their bodies throughout labor, and should be encouraged to change positions frequently.  Having an IV can hinder that. The IV is also simply uncomfortable, annoying and may interfere with her focus on relaxing with contractions as well and make holding hands with her support person more uncomfortable or impossible. Even a hep lock can be bothersome in the same ways. The perception that having an IV readily available is helpful in an emergency is not evidence based. Many times this IV port is not working well enough to handle an emergency and must be restarted.




Labor augmentation with Pitocin®
The use of synthetic oxytocin (Pitocin®) makes labor more painful for the mother, and more difficult for the baby to tolerate. There are studies that show Pitocin® may interfere with the body's natural ocytocin hormone production which may hinder the mother's natural efforts in the pushing stage, may contribute to postpartum hemorrhage and may interrupt her bonding with her baby, contributing to postpartum depression. http://www.birthresourcenetwork.org/resources/54-pitocin-the-whole-story-




Pain relief
Because the contractions are so intense with Pitocin®, the mother frequently will choose to receive an epidural for pain relief.



Restriction of movement
An epidural keeps a woman confined to bed for the duration of the labor and birth.  Being unable to move restricts the woman’s ability to help her baby get into a good position for birth. It may also hinder the baby's ability to move, too.



Contractions slow down
Epidurals can slow labor progress, which results in increasing dosages of Pitocin® to increase contraction intensity and frequency, which can lead to an even greater need for pain relief and greater risk of fetal distress.



Progress slows or stops
Assuming the woman reaches full dilation, the epidural can interfere with the woman’s ability to push effectively.



Fetal distress
Hard contractions, combined with reduced blood pressure and the lack of blood flow to the baby, can cause the baby to go into distress.



Cesarean section
After having exhausted all of the tools at the obstetrician’s disposal, this one option remains.

NOVA Natural Birth Center
4200A Technology Court ♦ Chantilly, VA 20151
Phone: 703-357-3808 ♦ Fax: 888-770-0243

Website Design, Engineering, and Hosting by
Computer Assist, Incorporated
Communities OnTheWeb