|
|
|
|
|
|
Cascade of Intervention in Childbirth
What is the "cascade of intervention?" What is an example of the cascade of intervention? How can I limit the problem of a cascade of intervention? What is the "cascade of intervention?"Many things in life have unintended effects: they may or may not have the effect that we want, and they may also have other unplanned and possibly unwanted effects.Many maternity care interventions have unintended effects during labor and birth. Often these effects are new problems that are "solved" with further intervention, which may in turn create even more problems. This chain of events has been called the "cascade of intervention." This chain of events can change the course of a woman's labor in important ways, yet women and their partners are often unaware that many routine interventions can lead to a cascade of unplanned experiences and unwanted side effects. The maternity practices that can lead to a cascade of intervention include:
In many instances, these practices cause problems because they disrupt the normal physiology of pregnancy, labor and birth — for example, by:
What is an example of the cascade of intervention?Epidural analgesia can provide very effective pain relief during labor. It also increases the risk of experiencing a sudden drop in blood pressure, a longer labor, difficulty moving about, difficulty urinating, difficulty pushing the baby out, fever, and other undesirable effects.A variety of interventions — such as continuous electronic fetal monitoring and intravenous fluids — are widely used with epidurals to monitor, prevent or treat these effects. And others become more likely, including use of synthetic oxytocin to strengthen contractions, use of a urinary catheter to empty the bladder, and use of a vacuum extractor or forceps to help move the baby out. These in turn may have side effects that lead to the use of other interventions. The impacts can also extend to babies. For example, epidurals increase a woman’s likelihood of developing a fever; if a mother has a fever, caregivers worry that her baby may have an infection. Though few babies whose mothers have an epidural associated fever do in fact have an infection, as a precaution these babies often have blood tests and are treated with antibiotics just after birth. They may also be observed in a special nursery, which can interfere with bonding and breastfeeding. This chain of possible effects from epidural and other interventions shows the importance of making careful, informed maternity decisions. How can I limit the problem of a cascade of intervention?Almost every intervention has some potential to cause harm. You should make decisions about whether to have an intervention carefully. We encourage you to accept only those interventions that are more likely to offer benefit than harm. In weighing possible benefits and harms, it is important to rely on the best available evidence about potential effects, and to consider how you feel about the possible outcomes. It is also important to learn about other options that may be available.Unfortunately, it is impossible to fully and accurately know in advance the course of a decision, and the degree to which other interventions and their effects will come into play. The best way to limit the problem of a cascade of intervention is to become informed, get all of your questions answered, set your goals and plans, and avoid interventions with the potential for harm, whenever possible. The following may help you avoid unnecessary interventions:
Most recent page update: 4/11/2011
© 2013 Childbirth Connection. All rights reserved.
Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality and value of maternity care through consumer engagement and health system transformation. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
News and Features
Listening to MothersSM III: New Mothers Speak Out (June 2013) reports on new national surveys about issues women face in the postpartum period and their views about maternity care.
Access the full report and supplementary materials  Listening to MothersSM III (May 2013) is the third national survey exploring women's experiences in pregnancy and childbirth. Commissioned by Childbirth Connection, conducted by Harris Interactive, and funded by the W.K. Kellogg Foundation, the survey polled 2,400 women who gave birth in U.S. hospitals from 2011 to 2012. Results show that medically intensive experiences are typical, and evidence-based practices are underutilized. Childbearing women need better support and knowledge to navigate their maternity care. Access the full report and supplementary materials New Report: Maternity Care and Liability Go to report and supporting materials New Report: The Cost of Having a Baby in the United States Go to report and supporting materials New Cesarean Resources: Go to Best Evidence Report Go to web pages and booklet for women 
For 95 years, Childbirth Connection has been dedicated to improving the
quality and value of maternity care for all women and their families. Learn
more about our rich history through our interactive
timeline and give
$95 for 95 in honor of
our 95th birthday. 
Childbirth Connection works to ensure that all women and babies get the best
possible maternity care. We have the collective vision and we know how to get
there, but we can't do it alone. Join the transformation
today.
The Transforming
Maternity Care website focuses on maternity care
system improvements designed to engage diverse stakeholders in quality
improvement efforts. The site offers full access to the landmark reports 2020 Vision and
Blueprint for
Action, features a Blog, and other
resources such as an Action Center, a
database of
quality improvement projects, an interactive data
center, and many more tools
for advocates and stakeholders.
Help Transform Maternity Care! |
