A Cascade of Interventions – THE DOULA DIARIES

Something I like to discuss early on with my birth doula clients is trying to get to about 5cm dilated before seeking out pain management. My hope is that women can go through labour unmedicated, but, as we know, this is not always the case. The longest part of labour is getting to about 5cm, the cervix needs to come down, thin out and dilate. Hopefully a woman’s body has been working on this three-step process during the pregnancy. Walking, practicing yoga positions and those Braxton-Hicks contractions can all help make cervical changes before labour begins. Going from 6-10cm is the intense part of labour, but is also the shortest, the cervix can literally melt away in no time.

I was called to a birth in the middle of the night, the dad-to-be letting me know the contractions were quite intense, and asking if I could meet them at the hospital. I walked into the triage room, the labouring woman was on all fours and her husband gently rubbing her back. Her breathing was short and rapid, the pain radiated to her lower back. I tried to bring focus to her breathing to help calm her down. Labour is intense, and can be scary, and the power of the breath is an amazing tool that can not only calm the mind, but also help the contractions feel milder. She was assessed by the resident and was about 1-2cm. She asked for the epidural.

Within the hour she was quite comfortable, and needing some rest. This leads into a discussion of “a cascade of interventions”. The idea being, one intervention, leads to another, and so on. With an early epidural women are on their back for the majority of labour not utilizing gravity. In the early stages of labour, women need to be changing body positions, swiveling their hips, and squatting down into those contractions (why a birth ball can be so helpful!)  All these movements help bring the baby down and the cervix dilate. An early epidural means no gravity. Without gravity, it’s hard for the baby’s head to sit nicely on that cervix, which helps bring on contractions. With weak or infrequent contractions, oxytocin is administered. Oxytocin is a natural hormone a labouring woman’s body makes, but it makes it differently than the medicated form. When your body naturally makes it, it waves in intensity and duration, all while ideally dilating the cervix. Medicated oxytocin is administered by a machine; it pumps it at a set interval which is increased every 30 minutes. It squeezes the baby intensely, and babies don’t always like it. Their heart rates dip, this signals beeping on monitors, and surgery can result.

Some women can have early interventions and have the vaginal delivery they hope for. For others the “progress” stalls and the baby is delivered via a C-section. The concept of holding off with interventions sounds good in theory, in the office when “pain” is not felt, but during the process things change and support is needed. Trying to stay calm, focusing on breath, using water, and having labour support are all things that can help. I’m not sure why it works for some, and not for others, but what I do know, is the result is the same, a perfect little being entering earth in the safety of their parents arms.


Rachel_Schwartzman_HSRACHEL SCHWARTZMAN is a naturopathic doctor in the St. Clair West neighbourhood. She is the co-owner of West End Naturopathic Doulas, a naturopathic collective that supports pregnant women and partners with the birth of their babies. WESTENDDOULAS.COM

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