Has Labor Become a “Cascade of Intervention”? by DANIELLE TAUBMAN on APRIL 2, 2014
Although medical interventions during labor and childbirth are used with the intention of ensuring the safety of the mother and her baby, maternity care interventions may result in unintended effects. This is because these interventions disrupt the normal physiology of pregnancy, labor, and birth. These effects are often attended to with further intervention, which may lead to even more problems and side effects. This chain of events is frequently referred to as the “cascade of intervention”.
Without an unequivocal answer as to whether medical interventions should be used routinely during (low-risk) pregnancies, instead it may be more effective to ask whether medical interventions are being used properly and in a way that provides the greatest benefit to mother and baby.
A significant factor in the rising rate of C-sections is that obstetricians have become afraid of being sued if something happens to the baby after a vaginal labor and delivery. In an article in the journal of Obstetrics and Gynecology, the obstetricians’ college polled 5,644 of its members and found that 29% admitted to performing more Caesareans because they feared lawsuits.
How do women’s beliefs and attitudes about pregnancy relate to all of this?
Research demonstrates that women are not always happy with their birth experiences, and this may be influenced by fear and negative attitudes toward childbirth.
Researchers in one longitudinal cohort study with a sample of about 500 Swedish and Australian women aimed to develop profiles of women based on their attitudes towards birth and their levels of childbirth related fear.
They developed three clusters: the ‘Fearful’ cluster (high levels of fear and safety concerns), the ‘Self Determiners’ cluster (not afraid of childbirth and wanted control over experience), and the ‘Take it as it comes’ (not afraid of childbirth and no clear preferences for the birth) cluster. Belonging to the ‘Fearful’ cluster had a negative impact on women’s emotional health during pregnancy and increased the woman’s likelihood of an operative birth and a negative birth experience. Women in the ‘Take it as it comes’ cluster were more susceptible to having an operative birth. Finally, women in the ‘Self determiners’ cluster had the highest percentage of unassisted vaginal births.
It is possible then, that if doctors and midwives inform women and quell some of their fears about childbirth, they will be less likely to request, or end up requiring, certain kinds of medical interventions and also remember their labor and birth experience more positively.
Importantly, even if you plan to have a natural childbirth (intervention-free), the birthing process is as unpredictable as children (if you didn’t get the hint, this means they are highly unpredictable!). Oftentimes interventions are medically necessary, particularly in high-risk pregnancies. In these cases, they are very likely to be the “best” choice. It is, however, important to distinguish between medically necessary interventions and those that are used simply because the interventions are available.