Avoiding the Cascade of Interventions

Is the Cascade of Interventions Real?

Yes, it is a real thing. Is it something you should be scared about? No. Is it something you should be educated about? YES! Should you need to fight tooth and nail with your care provider to prevent it? No, and if you are I would like to suggest looking into changing providers. The cascade of  interventions is something you need to be able to talk openly about with your care provider.

The Cascade of Interventions is simply this: one intervention has the potential to lead to another. It isn’t an evil plot to take away your birth. Neither is it something that is guaranteed to happen if you consent to a single intervention. With every intervention, there are potential benefits and potential risks. When you are needing to make a decision, it is important to explore both. Interventions, in some cases, are used to counteract the side effects of a previous intervention. Sometimes this is necessary, and other times there are things you can do to avoid the cascade of interventions simply by using your BRAIN.

Using your BRAIN

Before we really dive into the interventions, let’s talk about BRAIN.  It is a helpful acronym for helping you to make a decision. It goes like this:

  • B – Benefits: What are the benefits of this procedure on me, my baby, and my labor?
  • R – Risks: What are the risks?
  • A – Alternatives: Is there something else I can do before consenting to this procedure?
  • I – Intuition: What is my gut telling me?
  • N – Nothing: What would happen if I did nothing right now?

Before making a decision, think about these questions and ask them to your provider. Then you will be ready to make the decision that is best for you. Try not to make a decision out of fear of an intervention. Each intervention during labor was originally created to fill a need, it might not be right for you but it might also help you achieve your ideal birth. Having open and honest discussions with your care provider about this is very important. As is learning everything you can about birth. To do this, we recommend attending childbirth education classes.

The Infamous Epidural

The epidural has gotten a bad reputation as part of the cascade of interventions. The truth is, with the epidural in place you will be bed bound. Movement is decreased and in many ways so is control. This loss of control can potentially stall labor and make it harder to push effectively. These things can lead to administering Pitocin and delivery assistance devices, like forceps.

There are a couple things you can talk to your provider about doing to help, though.

  • Ask for a peanut ball and use it to switch positions every 30 minutes or so.
  • Ask for what some call the ‘walking epidural.’ This is a low dose epidural that may give you pain relief without losing full control of your legs.
  • When it is time to push, ask to have the epidural turned off. Some suggest that turning the epidural off, or down, when it is time to push will allow you to push more effectively reducing the need for other interventions like forceps or an episiotomy. However, turning it off does mean that your body will need to ‘catch up’ producing hormones that assist in pain relief. This means, turning it off may feel more painful than if you hadn’t had the epidural at all until your body adjusts.

On a positive note, the benefit of an epidural besides the obvious pain relief is the ability to take advantage of that pain relief and get a little rest before it is time to push. In some cases, long labors where the mother becomes incredibly exhausted can even lead to stalled labor. A well-timed epidural can provide the body enough relief to get things back on track. A conversation with your care provider before labor about epidural timing can help you get on the same page about what you want for your labor.

Pitocin, Oxytocin’s Complicated Twin

Pitocin is complicated. It was created as the synthetic version of Oxytocin to facilitate labor. Oxytocin is the hormone women produce that stimulates contractions. Pitocin is most often used to induce labor, but can also be used in a stalled labor and after the baby is born to assist in placenta delivery. During labor, once Pitocin is started you will also start continuous fetal monitoring (if you hadn’t already been doing so). This often means you will be confined to the bed, or close to it.

So what can you do?

  • Some hospitals have wireless monitors. If this is an option at your hospital, ask for them. Once they are hooked up, then there is a good chance you will still be able to stand and move around with the Pitocin wheeling close behind.
  • If you cannot get very far from the bed because of wires, ask for a birthing ball and rock or bounce on it through contractions. Stand up and lean on your partner or the bed. Any movement will help you better cope with contractions.
  • Finally, much like the epidural, if you are stuck in bed ask for the peanut ball and put it to use.

There are other risks to administering Pitocin, but these need to be discussed with your care provider. In some cases, the Pitocin can be turned down or turned off after active labor starts to avoid the need for other interventions. Use the BRAIN method to talk this through with your provider.

Options Before You’re in Labor to Avoid the Cascade

  • I’ve talked about this already, but it is important enough to mention again. Choose a care provider you connect with, who is willing to have these conversations with, listen to your concerns and provide feedback. You should be able to trust them and believe that when they recommend an intervention it is because they believe it is the best option.
  • Talk to your care provider about ‘watching and waiting’. This falls into the ‘N’ portion of BRAIN. Are they open to waiting 30 minutes or an hour to see if the situation changes? Labor comes in hills and plateaus. Sometimes time can move you along from a plateau.
  • Look into who else you want to have on your birth team. Continuous labor support has been shown to reduce the need for interventions and in cases where interventions were needed, keep them from progressing along the cascade of interventions. Having labor support, especially in the form of a partner and doula, can help you find your voice.
  • Create a birth plan and discuss it ahead of time with your care provider. Go through plan B and C with them too.
  • Educate yourself, attend a class, and feel confident that you know and understand what may happen with your body. Understanding interventions and procedures that may or may not be needed empowers you to make the right choices for your family.

One Final Thing

A cascade is not a failure. Your body did not fail. Let me say it one more time. YOUR BODY DID NOT FAIL. Just because you have had a labor that included a cascade of interventions, does not mean that you failed. It is impossible to predict what is going to happen when an intervention is introduced 100% of the time. Every woman and every labor are different. What is right for you isn’t right for someone else. A change in hospital, care provider or your knowledge about the process may or may not have changed the outcome. It is impossible to know. If you find yourself blaming your body or the cascade of interventions for your birth trauma, please seek help to work through those feelings.


Did you experience a cascade of interventions?