If you are somewhat immersed in the birth world like I am, then you’ve probably come across the term, “The Cascade of Interventions”. Sadly, for many of us in the birthing biz, this is an all-too-familiar term; describing the snowball effect of modern hospital maternity care, where women are often unknowingly subjected to the conveyer belt of medicalised birth, starting with induction and ending in Caesarean surgery.
The relationship between the Cascade of Interventions and Caesarean section is a well-researched one. The large scale Australian study by Tracy et al. in 2007 of over 750,000 low-risk women concluded that there was a fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby.
While on the one hand it’s reassuring to see what those of us who work as birth professionals know all too well anecdotally, confirmed by reliable evidence-based research, it is also incredibly frustrating.
If I hear one more time that the reason for all these inductions, interventions and Caesareans is because birthing women today are older, fatter, more risk-averse, too posh to push or have more complex health issues than in the past, I think I will scream! Let me just repeat the last sentence regarding that massive Australian study;
“…particularly amongst women with no identified risk markers and having their first baby.”
No identified risk markers.
This is known as iatrogenesis, which describes the unwanted effects of health care that can stem from medicalisation.
To be brutally honest, I think that the term, “Cascade of Interventions” is way too gentle. Cascade makes me think of waterfalls, and soothing running water. I think we need a new term to reflect the frightening upscale of birth intervention that we are seeing today in most first-world nations.
My preferred terminology would be a Tsunami of Intervention. Tsunamis are brutal, they often come with little to no warning and people find themselves in a state of panic where they are hit by one.
How many women do you know (perhaps you are one of them) who went into hospital as a healthy, low-risk woman, having had a healthy low-risk pregnancy, only to end up with an unplanned, emergency Caesarean – or at the very least, experienced a long, exhausting, painful, intervention-heavy labour that left you feeling like a battle-scarred soldier?
The analogy of the soldier is not so far-fetched by the way. Studies have also looked at women who have experienced traumatic births and have gone on to suffer PTSD.
Between 25 and 34 per cent of women report that their births were traumatic. A birth is said to be traumatic when the individual (mother, father, or other witness) believes the mother’s or her baby’s life was in danger, or that a serious threat to the mother’s or her baby’s physical or emotional integrity existed.
Is anyone else as blown away by that statistic as I am? Between a quarter and third of all births are considered to be traumatic! What is going on? How did we get to this point, and perhaps more importantly, how do we get out of this horrendous situation? What can we do to ensure that women feel safe, secure and supported throughout pregnancy and childbirth?
How can we get the message out to women that birth is a normal and natural life event? How do we educate women to trust birth and trust their bodies? To believe that they are perfectly designed to birth their babies? I am not suggesting that everyone will have a textbook perfect labour, free of complications – of course not. There will always be a small percentage of women (and babies) who need the additional medical support which, for those of us fortunate to live in the affluent West, are incredibly lucky to have available to us. But these women and babies are in the minority.
Unfortunately, the statistics tell another story.
Australia has one of the highest Caesarean section rates in the world – currently 33% (although this figure is significantly higher in private hospitals). We are more or less neck and neck with the United States, although this one race we should not be aspiring to win.
As a Lamaze Certified Childbirth Educator, I passionately believe in education. Knowledge is power. But we can all be birth advocates. Advocating for safe and healthy birth is not just the realm of professional educators, doulas and midwives. A mother who has experienced a positive, joyful, empowering and transformative birth has a duty to share her story with other women. Shout it loud, and shout it proud! Too many women are bombarded by horror stories – stories that imprint them with fear and dread. We need to share the positive, affirming birth stories and let women know that birth can be beautiful – and normal.
It is time, as midwife Lonnie Morris says in Debra Pascali-Bonaro’s wonderful film, Orgasmic Birth, for “women of earth to take back your birth!”
Tanya Strusberg is a Lamaze Certified Childbirth Educator (LCCE) and founder of birthwell birthright, an independent childbirth education practice based in Melbourne. In 2015, Tanya was inducted as an FACCE (Fellow of the Academy of Certified Childbirth Educators) in recognition of her significant contribution to childbirth education. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators.
Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.