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.

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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.

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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?

Vanessa Pruitt, PLMHP, MS

3 thoughts on “The Cascade of Interventions

  1. Hi vanessa,

    I was super lucky with my hospital birth. I had a doula who helped me create a birth plan that didn’t insult the nurses and I was lucky in having a really great doctor. She was from Argentina and had five daughters all naturally so she was more then happy to help us deliver in a way that we wanted.

    Seven years later and I am pregnant with our second child. I really really wanted to have a home birth, but we have military insurance and it won’t cover the cost. And since they offer us free coverage in the base hospital my husband just can’t see spending the money to have a home birth.

    I am worried about about the eye goop, vitamin k shot and hep b shot. Being Forcably administered to the new baby. I am pretty sure with our first son these things were done and we just weren’t aware of any risks or the fact that they are unnecessary or we would have tried to decline them.

    Can you tell me if in a hospital setting are we allowed to turn down these three things for our newborn? Also how do you politely ask that you be left alone as much as possible in your room, with out offending the staff? I really just feel like having an unassisted birth but my husband wants nothing to do with that.

    Thanks for any tips!!!


    1. Hi Michelle, I would definitely make sure they know ahead of time that you do not consent to these things and have it in writing. You are definitely allowed to turn down these things. Preferably don’t let them take the baby out of your room and if they do, have dad follow and keep a close watch. It’s becoming more common for people to refuse, but it will really depend on the hospital whether they put up a fuss about it or not. You could even find a pediatrician or family doctor to sign off on it beforehand, then they would be going against doctor’s orders if they did it.

      Good luck on your birth. You can have a great birth in the hospital, but you’ll have to be very prepared to advocate for yourself.

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