The Cascade of Interventions

Let me first say, I would not be writing about the cascade of interventions if it wasn’t for my own experiences. I have had two hospital births, both of which my goal was a natural birth, but because of pressure from my doctor and hospital staff, turned out very differently.

It was because of these experiences that I chose to give birth to my third son at home, to avoid the battle against interventions that usually occurs in the hospital environment.

What is the Cascade of Interventions?

The term “cascade of interventions” refers to a sequence of medical interventions that work like a chain reaction. One small intervention has effects that potentially lead to yet another intervention, which leads to even more interventions.

For example, being hooked up to IV fluids inevitably limits mobility and movement during labor Movement during labor is a woman’s best natural defense against pain and malpresentation.

Limiting movement leads to an increased use of pain medication and epidurals, which leads to even less mobility.

I believe that the “cascade of interventions” should be titled something more like “the cascade of routine medical practices” because it’s not just the obvious interventions that get in the way of a physiological childbirth.

Just being in a certain environment, such as a hospital room, can impede the process.

As I wrote in ‘Privacy During Labor‘, environment can have a huge impact on the laboring woman. Not enough privacy can make labor more painful, less enjoyable, and less intimate, and can even stop or stall labor completely.

The list of interventions, their effects, and how they can lead to other interventions is seemingly endless. Every intervention come with risks, some of them very serious, and have the potential to impede the birth process.

The unwise use of needless interventions can complicate an otherwise normal, healthy labor and delivery.

Every pregnant mother and birth professional should study:

• The physiological birth process
• The effects of environment upon the birth process
• Every intervention, medical or otherwise, it’s potential risks, and it’s role in the cascade of interventions

Interventions have their place. They save many lives and help with complications that may arise. I am very grateful that we have the science, medicine, and technology that we have today, but it can be misused.

We must be extremely careful that we do not encroach upon a process that is best left to happen naturally.

Have you experienced the cascade of interventions?

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Vanessa Pruitt, MS, LIMHP, CPC

Vanessa Pruitt, MS, LIMHP, CPC, is a trauma therapist, writer, and educator specializing in complex PTSD, attachment, and play-based interventions. She is the founder of Seven Stones Mental Health and co-owner of Alfrey & Pruitt Counseling, where she supports children, teens, and adults through expressive, trauma-informed care.

Vanessa integrates EMDR, sandtray, and attachment-focused approaches in her work and is completing credentials toward Registered Play Therapist and EMDRIA certification. With a background as a certified birth doula and a passion for making healing accessible, she writes and teaches on the intersection of trauma, neurodevelopment, and story-based therapy.

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