Cascade of Intervention…

There is an important phenomenon all women should be aware of – the Cascade of Intervention.

This phenomenon is well recognised in the medical community and in relation to maternity services describes the idea that there can be unintended consequences to medical interventions.

Example 1:

Induction (chemical and mechanical) and the use of fetal heart monitors typically go hand in hand. Someone women do go beyond their due date and induction does become a necessary conversation. However, the use of continuous fetal heart monitoring, often paired with induction, reduces a woman’s mobility significantly, increasing dramatically the amount of time a she will spend lying on her back. This can have a notable knock on effect on her ability to labour effectively, setting off a chain of events that may result in failure to progress, ultimately increasing the likelihood of further interventions being needed.

Knowing the potential of this effect means women can investigate alternatives:

  • Continuing to do nothing (for a safe period of time), labour may still commence naturally
  • Request mobile monitoring, this is offered as a matter of course in some places, but certainly not everywhere. Being mobile reduces the impact of immobility, which in turn has the potential to interrupt a cascade of intervention

Example 2:

Some women want to use patient-controlled epidural as their form of pain management. This can work really well for some but some hospitals combine its use with the use of fetal monitoring. The potential for a cascade of intervention is therefore also present in this instance too as once again the woman can spend long periods of time immobile as the fetal monitor is used (albeit intermittently), setting off a chain of events that may result in failure to progress, ultimately increasing the likelihood of further interventions being needed.

Knowing that a diagnosis of failure to progress can, if unchallenged result in a caesarean means it is very important women understand:

  • What really constitutes a failure to progress and when intervention is truly necessary
  • The Cascade of Intervention phenomenon and which interventions can exacerbate the situation

A great source of information is the Childbirth Connection website.

“The best way to limit a cascade of intervention is to become informed, get all of your questions answered, and put plans in place in advance that will help avoid potentially harmful interventions.”

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