rethinking modern birth part 4: the cascade of interventions
Be aware (beware!) of the “cascade of interventions”.
Why is it so necessary to be a thorn in your care provider’s side when it comes to refusing procedures or tests?
Why rock the boat? Why not just go along with the routine procedures?
How can an extra blood test, or refusing a vaginal exam now, make a difference in my birth experience later?
Enter the cascade of interventions:
Doctors are trained to deal in pathology, disease, and dysfunction.
They are constantly on the lookout for anything out of the ordinary that might signal a possible problem or complication down the road.
However, the fact that human-being bodies are designed to give birth without any assistance or intervention has been largely forgotten--while the medical professionals are hard at work looking for problems in the execution of nature’s plan.
When you’re expertly trained in the use of just one tool - a hammer - you’ll see every potential problem as a nail.
Each and every test or procedure that’s done to your body has the capacity to interfere with the natural progression of labor, whether physically or mentally/emotionally.
Even worse, it has the potential to provide information (that may or may not be accurate or useful) that might be used as justification for further intervention.
Here’s one example of the cascade of interventions and how it can f*ck with your birth experience:
A mother was having early labor signs for weeks, but when the midwife checked her cervix, she was found to be only 1 centimeter dilated.
The information really discouraged her, and made the continuing signs of early labor less tolerable to bear as time went on.
“If I’m feeling all these contractions, and my body’s not dilating yet, something must be wrong with me,” she thought.
Another cervical check a week later found her dilation to be the same, and her mental/emotional state declined further, as she worried why her body “wasn't doing anything”.
Eventually, frustrated, she gladly submitted to a hospital induction--but her belief that her body would not dilate on its own had started to cement itself weeks prior.
What if she’d never been put in a position to form that negative belief about her body?
What if she’d never had the cervical checks?
The fact that a woman’s cervix can change VERY rapidly under the right conditions--and not at all under the wrong ones--used to be common medical knowledge.
Cervical checks actually tell us virtually nothing about whether a woman is in active labor—and barring true emergencies, there isn't any reason to speed up a labor artificially.
Our bodies are not lemons. They work beautifully when all things are in alignment.
It’s worth noting here that the official diagnosis of “failure to progress”--which is the number one reason stated for Cesarean sections performed in the US--is officially defined as less than one centimeter of cervical change in two consecutive hours.
Who decided that this rate of progression was the minimum safety standard, anyway?
The answer is, this old, now-dead guy who was studying a tiny group of heavily sedated, young pregnant women, over 70 years ago.
Why do we still use this measurement, as if it’s scientific or remotely helpful?
It makes no sense.
Labor takes however long it takes.
Time alone does not indicate a problem…unless you’re an OB who wants to make sure he doesn’t miss his dinner reservation.
The bottom line? Be conscious of the cascade of interventions. Don’t just submit to procedures or checks without knowing and understanding what purpose they serve for you and your baby. It all matters.
Need support for avoiding the cascade of interventions?
Please get my Birth Plan Kit to help you make clear decisions, and learn how to assert yourself! It’s ideal for women who want to birth at home or unassisted, but lack access to that choice for whatever reason.
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RETHINKING MODERN BIRTH SERIES