The Cascade of Interventions: The domino effect in labor

Welcome to episode 235 of the Pulling Curls Podcast! Today, host Hilary Erickson, a seasoned nurse and mom of three, dives into the concept of the cascade of interventions in childbirth. Hilary untangles how one medical decision can lead to another, influencing the course of labor and delivery. She discusses various scenarios such as inductions and epidurals, and shares personal insights to demystify the process. Join us as we explore how to make informed choices during labor. Let’s get those tangles out!

Find it here on Apple or Spotify Podcasts

Big thanks to our sponsor The Online Prenatal Class for Couples — it is going to help you make your own choices and understand how they can affect future choices, don’t miss it!

Timestamps:

00:00 Epidural can lead to possible cascade of interventions.
04:45 Choices in childbirth impact future interventions.

Keypoints:

1. Definition of Cascade of Interventions: Hilary starts the episode by explaining the concept of the “cascade of interventions,” which refers to a sequence of medical decisions during labor and delivery that lead to additional interventions.
2. Induction as an Example: Hilary uses the example of induction to illustrate how one decision (inducing labor) can increase the likelihood of subsequent interventions like a cesarean section or the need for an epidural.
3. Natural Labor Comparison: The host contrasts staying at home during early labor versus going to the hospital for an induction, explaining that the former can potentially reduce the need for an epidural.
4. Epidural and its Effects: Hilary discusses the procedures followed after choosing an epidural, such as administering extra fluids and potential adjustments if the baby shows signs of distress.
5. Personal Experience: Hilary shares her personal experience with being induced and her hesitations about interventions, specifically about breaking her water, which she held off on out of fear of a rigid commitment to further interventions.
6. Outcome of Decisions: Ultimately, Hilary acknowledges that refusing certain interventions initially made her labor longer, suggesting that embracing some interventions earlier might have led to a quicker delivery.
7. IV Placement Misconceptions: The episode addresses common misconceptions about the placement of an IV, clarifying that it does not necessarily start a cascade of interventions.
8. Philosophy on Making Choices: Hilary emphasizes that making one choice in labor can open some doors while closing others, akin to a “choose your own adventure” scenario, stressing the importance of making informed decisions at each step.
9. Advice on Managing Fear: Hilary advises against letting fear guide labor decisions, recommending that listeners embrace the necessary interventions as they come rather than worrying excessively about future possibilities.
10. Conclusion and Season Wrap-Up: The episode concludes with Hilary wrapping up season 5 of the podcast, thanking listeners and inviting them back for the next season after a summer break.

Producer: Drew Erickson

Transcript

[00:00:00.870] – Hilary Erickson

Hey, guys. Welcome back to the Pulling Curls Podcast. Today on Episode 235, we are talking about the Cascade of Interventions, so let’s untangle it.

[00:00:11.330] – Hilary Erickson

Hi, I’m Hilary, a serial overcomplicator. I’m also a nurse, mom to three, and the curly head behind Pulling Curls and The Pregnancy Nurse. This podcast aims to help us stop overcomplicating things and remember how much easier it is to keep things simple. Let’s smooth out those snarls with Pregnancy and Parenting Untangled, The Pulling Curls Podcast.

[00:00:39.690] – Hilary Erickson

This episode is sponsored by the online prenatal class for couples. If you want to know more about how the Cascade of Intervention can work for you in your labor. Come join me. In just three hours. We can get you feeling prepared for your upcoming birth.

[00:00:52.960] – Hilary Erickson

Okay, so you might hear the words Cascade of Intervention mentioned. I feel like mostly by doulas. I don’t hear it It’s mentioned by a lot of people online, but it mostly means that when you make choice A, let’s say you’re doing the choose your own adventure that you loved in elementary school, right? When you make choice A, then you may have chances to do B or C, or you don’t have a chance to do X, Y, C, right? So let’s give an example.

[00:01:17.360] – Hilary Erickson

Let’s say you go in for an induction. You have immediately increased your chance of a C-section because inductions are higher risk. That doesn’t mean that you will have a C-section, but it does mean that you have an increased chance of an induction. It also means that you need an IV. It also means that you have a higher likelihood. Again, doesn’t mean you’re going to have to, but you have a higher likelihood of wanting an epidural.

[00:01:39.510] – Hilary Erickson

So as you can imagine, once you make the choice to have that induction, you then are more likely to have other choices come for you further down the line. Versus, let’s say you are in early labor and you decide to stay at home until you really can’t take it anymore, and then you go to the hospital. Well, your chances of needing an epidural are or less, because hopefully you’ve progressed a lot more and you maybe can just make it on your own until you can start to push, which, by the way, pushing feels so much better. So that’s a pro tip for you guys.

[00:02:10.410] – Hilary Erickson

The Cascade of Interventions is something that a lot of people mention because There are things that start to add on. And it is something that your provider should bring up, maybe not using those words, but when you schedule an induction, you are increasing your likelihood of a C-section. You’re more likely to want an epidural, mostly because an induction is super boring. It lasts a little bit longer, and you’re just going to want some rest, usually, I find. Although most people, studies don’t show this, but a lot of people feel like an induction is more painful than natural labor, and everybody varies on that.

[00:02:47.470] – Hilary Erickson

Let’s give another example. If you choose to get an epidural, there are some cascades of interventions that often start. Initially, we give you extra fluid so that your blood pressure doesn’t drop after you have the epidural placed. And then, sometimes the baby doesn’t love it because your blood pressure still drops a little bit. We might come in, we might stop your induction for a little bit. If that’s what’s going on, we might turn you side to side. Once you’ve made the choice to have the epidural, there are some other interventions meaning stuff we do at the hospital that may need to be done to help you compensate.

[00:03:19.290] – Hilary Erickson

And there is always the chance that your blood pressure falls, baby doesn’t look so good, and then we have to have a C-section. It’s super rare, but it is a possible cascade of interventions that started by making the choice to have an epidural.

[00:03:32.920] – Hilary Erickson

Now, I have to tell you guys that I was so worried about the cascade of interventions when I went in to have my last induction that I would not let them bring my water because I knew that once I broke my water, there was no going back.

[00:03:46.900] – Hilary Erickson

I couldn’t go home. My only option was a C-section if I didn’t progress. And I had been 5 centimeters for a really long time. But I was just sitting there saying, No, no, no, because I was afraid of this cascade of interventions. And that didn’t do me any favors. Me living in fear of the cascade of interventions mostly just made labor longer. Honestly, I think I probably could have done it without an epidural because I just sat there being like, No, I’m not going to let them break my water. And then I started to get tired and I wanted to nap. It was just hurting longer and longer. Whereas once they broke my water within an hour or two, she was bored, boom. I think it would have happened if I just let them break my water a little bit earlier.

[00:04:27.450] – Hilary Erickson

Now, something I see online that people are like, Oh, that’s going to start the cascade of interventions is getting an IV. Just because we place an IV doesn’t mean that we’re for sure going to use Pitocin on it, or you’re for sure going to want IV pain meds, or what got an epidural.

[00:04:43.370] – Hilary Erickson

Placing an IV is a safety measure. I would not call it the beginning of the cascade of interventions. Now, if you want an epidural, you need an IV, so it is part of that cascade of interventions, I guess you could say. But I see so often people saying, Oh, everyone refuses the IV because they don’t providers to induce them with Pitocin. Then you refuse the Pitocin. It’s not part of a cascade of interventions.

[00:05:07.610] – Hilary Erickson

I just think that most of this is really important that you understand that once you make one choice, just like in the Choose Your Own Eventure book in fourth grade, you are limiting or enhancing your future choices. But everything in life is like that. You made the choice to get pregnant, and so now you have the choice on how you’re going to give birth and all those different kinds of things. Life is a Cascade of Interventions. We all understand that when you make one choice, you’re closing some doors and you’re opening others. And this is just how it works in labor and delivery. So don’t be scared of it. Don’t be like Hilary saying, No, no, no. Sometimes you can just embrace the Cascade of Interventions.

[00:05:45.950] – Hilary Erickson

Do what works for you at that point in time. Don’t be scared about what’s going to come down the line and make the best choices for you right then.

[00:05:53.560] – Hilary Erickson

Now, this is the final episode of Season 5. We will see you guys in the fall in Season 6, and I hope you guys have a wonderful summer. We’ll see you then.

[00:06:03.060] – Hilary Erickson

Thanks for joining us on the Pulling Curls Podcast today. If you liked today’s episode, please consider reviewing, sharing, subscribing. It really helps our podcast grow. Thank you.

Keywords:

cascade of interventions, labor and delivery, epidural, c-section, induction, prenatal class, doula, pregnancy, childbirth, interventions in labor, IV fluids, Pitocin, blood pressure, delivery options, hospital birth, natural labor, labor choices, pain management in labor, maternal health, childbirth education, birthing process, labor induction risks, medical interventions during labor, pushing during labor, birthing experience, delivery complications, anesthesia in labor, pregnancy and parenting, choose your own adventure, labor progression.