"Was That Really Necessary?" (The Slippery Slope of Labor Interventions)

Everyone has heard the old adage, "One thing leads to another." This is absolutely true, and applicable in the birth world. One intervention often leads to another, and then another, and another, resulting in the "cascade of interventions," that results in a domino-like effect. It really is a slippery slope, and it's very hard to keep your footing once things get into motion.

What are these interventions I'm talking about? How do they lead into one another, and why it is a bad thing? What are these "slippery slope" scenarios I've become so familiar with? Well, let's go with my usual route and start with some examples:

1. A mom is induced by cervidil or a foley catheter overnight. She's hooked up to an iv for fluids, just in case, and has on a blood pressure cuff. In the morning, they start pitocin, which leads to continuous monitoring, which makes moving around for pain management purposes very difficult. The contractions are far more intense than normal labor contractions, and the pain becomes unmanageable quickly, so mom requests an epidural. Now she is really stuck in bed, a catheter is put in place because she can't get up to empty her bladder, and her labor stalls because she's lost the advantage of gravity and the baby is no longer putting pressure on her cervix. She's only 3-4cm dilated, so her doctor breaks her water "to get things going." Now she's at risk for infection, and she's put under a 12-hour time limit for labor progression due to this "risk." Things move slowly, she gets a fever, baby's heart rate starts dropping, and dilation stalls again. A c-section becomes necessary due to the baby's distress.
2. A mom comes to the hospital in active labor, 5cm dilated, and is hooked up to an iv and given pitocin (without her knowledge or consent), because it's "routine." Her contractions get crazy difficult, and she requests iv pain meds such as Stadol. These cause loopiness, nausea, and shaking, and her baby is born lethargic (though healthy). She's so out of it that she hardly remembers the birth, and baby is too sleepy to latch and it hinders her desire to breastfeed.
3. Any or all of the above, add "directed pushing" (mom's pushing is coached, instead of allowing her to follow her instincts), an episiotomy, and a vacuum extraction or forceps delivery.
4. Again, any or all of the above, but with the doctor breaking the water while baby is still high and not engaged, causing cord prolapse and the need for an emergency c-section.

These are honestly just a few examples of scenarios playing out every single day. Here's a good compilation of common labor and birth interventions and their risks/benefits, and how they lead to the cascade of interventions:  http://www.caroldenny.com/index.php?option=com_content&view=article&id=175:common-interventions&catid=42:birth-plan&Itemid=78

How many of these everyday situations really would have become an emergency if all those interventions weren't done in the first place? If moms knew the risks of all the procedures being practiced on them, would they really consent?

• Did you know that Pitocin is not FDA approved for elective (non-medically necessary) inductions?

• Did you know that that AROM (artificial rupture of membranes) can lead to compressed or prolapsed cord, infection, and raises your chance of having a c-section?

• Did you know that epidurals can slow labor, make your skin itch uncontrollably, cause nausea and vomiting, residual headaches, spinal issues, lower your blood pressure, cause you to run a fever, and increase your likelihood of needing forceps, vacuum, or cesarean delivery?

Those are just the three most common labor interventions today. And with a 32.8% cesarean section rate and a 1 in 3 induction rate, those interventions obviously aren't doing us any good. So before you consent to anything in your pregnancy and birth, ask what the risks are. If they are outweighed by the benefits in your case, then go for it. But you should know how each intervention leads to another, and why, before you agree to anything.