Have you ever thought about how every time you make one decision, you are causing another decision to come about. In labor and birth we often refer to this as the cascade of interventions. Think of a bunch of dominoes, lined up all in a row; now watch as they all tumble once you push the first one. This is what happens in when you make decisions in birth. One intervention is offered up and then all of the sudden, you have a domino like effect of interventions that you never signed up for.
What is an intervention? Any intervention is anything that deviates from the norm of labor and birth. So, if you were laboring in the forest with no help at all, that would be an intervention free birth. An intervention can be anything from breaking your water, to offering a medication. Inherently there is nothing wrong with interventions; it’s more about what they cause when it comes to labor and birth.
For example. A woman is in labor, she is 7 cm dilated and labor has totally stalled; uh oh, now what? She has been laboring beautifully in a hospital room surrounded by support and encouragement and her contractions just stopped. The doctor offers to break her water to speed up labor, she relinquishes as the idea of labor lasting any longer is not sounding fun. The doctor breaks her water, and all the sudden the cord drops under the baby’s head (a cord prolapse) and now they are heading into an emergency cesarean birth. Did the mom say yes to an emergency cesarean birth? No. She said yes to breaking her water. Did someone intentionally cause this to happen. Of course not. The parents made an educated decision and felt that there were no other options and trusted the judgement of the doctor. This is the cascade of interventions.
What would have happened if the mom would have used the “BRAIN” acronym?
Well let’s see.
– Moving labor along hopefully, meeting her baby
– Risk of infection from an open bag, and risk of cord prolapse
– Nipple Stimulation with a breast pump, sex, clearing the room and allowing her to feel safe again, position changes, acupuncture, chiropractic
– What does your mommy or daddy gut say about this?
– What will happen if we do nothing
Now by going through the BRAIN acronym, every parent can make an informed decision. If the questions, “Is baby safe? Is Mom safe” can be answered with a yes, then the couple can have five minutes to go through this acronym to make a decision. Will this acronym ensure that the cascade of interventions will not be applied to these couple? No. But the couple will be aware of all the risks associated with whatever intervention is needed, and then be able to own that they were in control of the situation, no matter what direction the birth went.
The cascade can be evidenced by how many more Cesareans births occur with the use of epidurals. When a mom signs up for an epidural, she is not saying yes to a Cesarean Birth; but does she know that there is an increased risk of this happening? To be in control of your birth, you must be educated. You must know the risks, and the benefits.
That’s how you make informed decisions and do your best to stay away from the Cascade of Interventions.