The Cascade of Intervention & what it means for you and your baby.

Updated: Apr 9, 2019

There are a multitude of reasons I’ve heard for women choosing to have an unmedicated, intervention free or ‘natural’ birth. From horrific experiences with previous pregnancies, to feeling ‘the urge’ to birth under a tree on the family farm. One of the most common reasons though is one which the wonderful Rhea Dempsey describes perfectly in her book, Birth with Confidence, as the ‘Cascade of Intervention’.

It is exactly how it sounds. The snow ball, the slippery slope, the domino effect. Medical intervention that starts with a stretch and sweep and ends in emergency c section.

It’s why lots of women are now looking to educated doulas and midwives, who advocate for an unmedicated birth (where appropriate and safe), for support and guidance.

Once we start the intervention process, the risk of us requiring or electing for the next, more serious intervention is much more significant.

So just how significant are we talking?

Research currently shows that in Australia, the more interventions you have, the higher the risk of you having another. Ie. Once you start with a membrane sweep or some Pitocin, you are much more likely to then have an epidural and then again more likely to have a vacuum extraction, forceps, episiotomy or C-section. We also know that at private hospitals the rate of intervention is more than double that at a public hospital.

It’s a scary concept and one that has many women anxious to go down the pathway of even the most modest of intervention pathways.

What’s interesting as someone working alongside pregnant women and children are the reasons WHY we go down these pathways, especially as research from New South Wales hospitals (both public and private) actually show no more risk of mortality (death) to mother or child when these interventions are not used.

It’s also worth noting that studies now show risks of developmental delay for children born with intervention.

So if there are no medical benefits for going down this pathway (where not deemed medically necessary) what can we do to avoid this slippery slope? There are several things we can do to minimise this risk…

1. Choose your health provider carefully.

All hospitals are different and have different policies, as do birth centres and private midwives. It is therefore pivotal that you ask plenty of questions, from what you’re allowed to eat during labour to their rules around skin to skin time post birth, to ensure there is no confusion or disappointment on the day.

2. Talk to your birth team.

Make sure you are comfortable with your birth team. There are now so many options around where we birth and how we do it, so get to know your team and ensure that you are comfortable with them – this is one time in your life where you really want to be able to trust that those people have the same goals you do.

3. Make a birth plan.

It is essential that you and your partner have discussed in detail and agreed on a birth plan. Explore all possible outcomes and options and what you would like to do in each scenario. You can check out a template of a birth plan here.

4. Have a support person.

And make sure it’s not your partner. Well not that it can’t be, but what we know is that giving your partner that role is challenging for them when they see you uncomfortable because they love you and don’t want to see you in any pain. If you have a great relationship with a holistic midwife or are prepared to hire an experienced doula, these can be great options instead.

5. Read ‘Birth with confidence’.

Rhea Dempsey so beautifully details the cascade of intervention and how as savvy women birthing, we have to be determined to have the outcome we want rather than handing over the reins.

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- Dahlen HG, Tracy S, Tracy M, et al. Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open 2012;\

- Lothian, J. 2014. Healthy Birth Practice #4. Avoid Interventions Unless They Are Medically Necessary.Fall 2014, Volume 23, Number 4. Pages 198 -206.

- Jansen, L et al. 2013 First Do No Harm. The Journal of Perinatal Education, 22(2), 83–92,

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