Studies on cascade of intervention?

[MellyH]

I have heard a lot about a 'cascade of intervention', where once you start with one intervention (like epidurual, induction, etc) it makes the likelihood of further intervention (c-section, e.g.) much higher.

Has anyone actually seen any studies about if this happens and at what rates? Like, if you get an epidural are you ten times more likely to end up with a c-section, etc? I know it will vary from hospital to hospital, but I was just curious to know how the numbers were coming out.

 

[Guppy051708]

I have seen studies (just browsing and reading over the last few years). It is true. but i dont know numbers.

i would implore you to watch the business of being born. It's very eye opening and touches on this subject well.

 

[MellyH]

Thank you! Please, if you come across any of them again, copy the links here.

Is the Business of being born a movie? Series? Where would I find it?

 

[Guppy051708]

Thank you! Please, if you come across any of them again, copy the links here.

Is the Business of being born a movie? Series? Where would I find it?

The Business of Being Born is a movie documentary. It is available on NetFlix and i think you can get it on youtube. There's also a DVD (video) out too.

Other good movie documentaries that address this topic are called "Born in America" (also on Netflix, and im sure you can find online like at youtube or something). and the sequeal to The Business of Being Born which is called "More Business of Being Born". You can get that on netflix too

 

[BunnyN]

The 'cascade of interventions' is pretty well known but it's hard to find good studies about it basically because there is no money to fund them. Most studdies center around things like which drug is better (because drug companies fund them), not the difference between drugs and no drugs etc.

 

[MindUtopia]

Yes, there definitely are plenty, but they're hard to weed out from the masses of research that's out there and frankly they aren't promoted as part of policy change in lots of countries because in for-profit health care systems, more intervention = more profit.

But here's a few:

This one is a study of how two different models of care in labour affect labour outcomes, but it also found that being induced/augmented and having an epidural both produced significantly higher rates of c-section.

https://www.ncbi.nlm.nih.gov/pubmed/23890679

This one talks about how epidurals are related to higher likelihood of an instrumental delivery (forceps or ventouse).

https://www.ncbi.nlm.nih.gov/pubmed/22965331

This one shows that rates of c-section and instrumental delivery (forceps or ventouse) were higher among women who were induced.

https://www.ncbi.nlm.nih.gov/pubmed/23864921

This one talks about how induction increases the risk of c-section and postpartum complications.

https://www.ncbi.nlm.nih.gov/pubmed/20085677

This one shows how induction is associated with higher rates of postpartum hemorrhage and pueperal sepsis (basically a massive body-wide infection that can kill you, actually used to be the main cause of death associated with birth back in the 1700s and 1800s!).

https://www.ncbi.nlm.nih.gov/pubmed/23702296

And there's another one I saw recently about how induction increases the risk of postpartum hemorrhage by 80%. I can't find it now, but even I was pretty shocked.

Unfortunately, most people don't have access to these sorts of studies (don't know where to look for them and can't actually read the article without paying for it). I'm a health researcher and actually do a lot of birth research, so I follow what gets published, but your average person just doesn't have access to this stuff and nor do a lot of medical providers (midwives, doctors, nurses). Most of them don't read scientific articles anyway as they don't have time unless they are conducting research themselves.

What I don't think there is though (or not that I could find with a quick keyword search of some databases) are studies tracing how the 'cascade of interventions' happens. I'm not sure we know how easily an induction leads to an epidural which leads to a forceps delivery which leads to postpartum hemorrhaging or postnatal depression or failure to initiate breastfeeding. There's a lot of research on how x is associated with y, but not tracing how a becomes b becomes c becomes d, if that's what you're asking. I just don't think the funding is there or many researchers are interested in trying to understand something that complicated (when they can get paid to do a simpler study).

All that being said though, have you ever read this blog on the concept of 'Pit to distress' (it's the practice of intentionally giving too much synthetic oxytocin during induction in order to put the baby into distress so a c-section can be performed - yes, really!). It's one of the most troubling things I've ever read about birth. Even though I have friends who claim it's happened to them (one of them had a bad PPH, nearly had to have a hysterectomy and almost died), it's still hard to fathom that medical providers actually do these sorts of things.

https://www.theunnecesarean.com/blo...ess-your-ticket-to-an-emergency-cesarean.html

 

[MellyH]

Thanks MU, I'm a researcher myself (physics, not health!) so those are the kinds of links I was hoping to find! Off to do some reading.