Cascade of interventions: the short and long-term impact on women and babies.
There is no doubt that many women’s and babies’ lives have been saved by the timely intervention of obstetricians and medical technology. Obstetricians are experts in abnormality but, unfortunately, over the last sixty years they have gradually taken over control of maternity care so that the vast majority of women are subjected to unnecessary and avoidable interventions. This is the first of a series of blog posts in which Beverley Beech discusses the modern problem of the ‘cascade of intervention’ that occurs for many birthing women and looks at the short and long term impact of this upon women and babies.
A happy, safe, and successful birth is much more likely when women are confident in their ability to birth; have peace and quiet and are attended by people they know. Midwives need to be confident in their ability to support a woman to birth normally and understand when to encourage her and when to intervene: sadly, these skills are being lost in the onslaught of medicalised deliveries, often in large, centralised, understaffed, dysfunctional, obstetric units.
The first intervention
The first intervention in childbirth is stepping outside the front door. For the majority of women throughout human history birth has taken place at home, but by 1962 63.3% of women in the UK gave birth in hospital. No evidence was ever produced to support the assertion that hospital was the safest place to birth, and Marjorie Tew’s analysis of birth outcomes refuting this was published in 1980 and largely ignored (Tew, 1980). Attitudes changed when The BirthPlace Study was published in 2011, comparing outcomes for 64, 538 low risk women and babies who planned to give birth at home, in a free-standing midwifery unit, an alongside midwifery Unit or a consultant unit in England between April 2008 and April 2010. http://www.bmj.com/content/343/bmj.d7400
The BirthPlace statistics show that the safest place for a fit and healthy woman to give birth is at home or in a free-standing midwifery unit, and their babies were just as safe.
So, what are the effects of these interventions?
As the table shows, those women who gave birth in the obstetric unit had more caesarean sections, more instrumental deliveries, more inductions (augmentation) and fewer normal births.
Following this study, the media focused on the very small number of adverse outcomes (250 out of 64,538 births), most of which caused no lasting damage to babies, rather than the very much worse outcomes for fit and healthy women who gave birth in an obstetric unit. That message has still not been conveyed to women.
Part two of this series will look at induction and augmentation of labour.
Tew M., Health and Social Service Journal [01 May 1980, 90(4695):702-705]