The Slippery Slopes of Modern Birthing

updated: 25/11/2019

​​You have probably heard of 'The Cascade of Intervention'.  It is the idea that once an intervention occurs, the rest shall follow.  This is a 'Slippery Slope'.  It is however, a bit more nuanced than a cascade.  There is more than one slope.  And there are plateaus and forks. At the forks, we must make a choice.

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When faced with two options, a sliding doors moment if you like, we may wonder ‘what if’…

what if I had chosen the other path?
We’d have met different people. Had different experiences.  Found out different things. We would be a different person, potentially.

Considering birth this way, you can see the concept of the cascade of intervention as a series of decision-points.  The Sliding Scale of Birth Options (above) shows the main decision-points. 

Sometimes a decision is medically indicated, sometimes other external pressures put us at the decision-point, sometimes it is our internal dialogue that takes us there. With informed birth preparation, this can be an autonomous experience. It does not need to be traumatic, dramatic, stressful or crushing.  And it does not have to be a slippery slope.  Many women talk positively of their births, no matter where on the scale it is, because they were prepared, felt respected and included and understood what was happening.

The scale also shows that the move away from natural (normal physiological) birth starts with intervention. Induction interventions include the ‘stretch and sweep’, hormone gel inserts, artificial rupture of membranes and synthetic oxytocin. There are many more inductions than are necessary, and this often is enough to cause a cascade.  Knowing when to accept intervention is important.

Sometimes an induction ‘kick starts’ labour, and a women labours and births on her own. However, once a labour is induced, it will be managed. This may involve monitoring and observation, restrictions on the mother and interruptions that actually inhibit effective labour. The mother may now have a time frame and limit she ‘must’ labour to. If labour is not following this ‘schedule’, it may become augmented. This usually means synthetic oxytocin (which restricts movement and increases intensity). Often this is accompanied by an epidural.  This is why it is often referred to as a cascade.  It is very easy to find yourself 'going with the flow'.

Often an augmented labour leads to an augmented birth. This is also called 'assisted delivery'.  This might be directed pushing, vacuum assistance, or forceps. Often the mother will be in stirrups or have her legs held by people. This birth is usually set up for the benefit of attendants, not the mother.  This is also where the greatest risk of severe perineal tear occurs. (See Protecting your Perineum).

A managed third stage is often routine, and many women do not realise they have options or even what is meant by ‘third stage’. A spontaneous and unaugmented labour and birth can be interrupted by a managed third stage. This often leaves a mother feeling ‘dealt with’, rather than involved with the birth (increasing the risk of experiencing emotional trauma and/or postnatal depression). A separation from baby may occur at this time.

Many people refer to the broad spectrum of vaginal birth as 'normal' birth. This scale shows how important it is to not refer to all vaginal birth as 'normal'.  Normal is the natural, physiological process. When we accept this definition, the spectrum of vaginal birth, along the scale, become more nuanced.  Each point on the spectrum needs different considerations and carries different risks.  You may like to review the difference between danger, risk and opportunity.

Before birth, during early to mid pregnancy,  this scale of options needs to be understood.
Your obstetrician is unlikely to explain it to you.
Your midwife may mention it.
You will probably hear ‘horror’ stories which describe it (but do not explain it)…you will be told you have nothing to prove, that birth is not a competition, all that matters is a healthy baby, and various lines of bullshit that really mean: You Do Not Matter.

BUT.YOU.DO.
It is Your Body. Your Choice.

You are not a baby making factory, a vessel, devoid of emotion. How you feel about your birth, how you prepare for it, is essential. This is not about candles and incense, mood music for the sake of ‘experience’. This is about creating a birthing space where the mother feels informed, supported and confident. This is about HUMANISING birth.

For most women, this is a very daunting concept.

Where do you even start with understanding this, and personalising your birth, when your OB or midwife do not explain it..and certainly not with enough advanced notice to make an informed decision?

The answer is: Informed Birth Preparation!

You may even like to consider a doula.  The doula bridges the gap between personalised birth and routine birth. The doula helps you navigate the gauntlet, so to speak. Smoothing the way, so you can marvel in the wonder of your pregnancy, birth and baby. The doula gives you the space to BE, your pregnancy is not happening to you, but is of you.    


Find out more in The Birth Map: boldly going where no birth plan has gone before and join the Free Member Area to access a wealth of information and tap into a support network.

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