Domino Effect in Labor
The domino effect is how one intervention in labor often leads to another. This effect is most dramatic in first pregnancies. Of course, interventions are blessings when used appropriately. Unfortunately, today the use of many interventions has become routine. Here is a typical scenario.
A healthy woman carrying her first child decides on a labor induction because her obstetrician will only be available on Wednesday. She wants to naturally and wants him at her birth. No one explains that coercing her body to enter labor before it is ready can become an ordeal. This woman's cervix is firm, like an unripe pear, and will not open easily. Her doctor schedules an overnight ripening procedure in the hospital for Tuesday evening.
A medication is inserted deep into her vagina. At nine o'clock, she takes a sleeping pill but finds she cannot rest because of the cramping caused by the ripening agent. The beeping IV pump, the fetal monitor that alarms if she moves too much, and the staff coming in and out also interrupt her rest. In the morning, she is tired. After breakfast, a nurse adds synthetic oxytocin hormone (Pitocin) to her IV. Pitocin will cause regular contractions. The monitor must be constantly attached because induced contractions can become dangerous. At noon the woman asks for lunch but is told only to drink juice. By 4 pm, the contractions are every 5-6 minutes, and they hurt. Her cervix isn't dilated enough for an epidural, so the nurse gives a narcotic through the IV narcotic. The pain eases quickly, but the narcotic slows the contractions down. The nurse increases the Pitocin. A few hours later, the laboring woman asks again for the epidural. This procedure will numb the contractions, her legs, and her bladder. She won't be able to walk or pee. So, the nurse inserts a urinary catheter to remain until after the delivery. The woman also has an automatic blood pressure cuff attached.
The anesthesiologist injects numbing medications into a space near her spine. The woman closes her eyes as the pain subsides and her body relaxes. The pale woman mutters weakly, "I don't feel well." The blood pressure machine alarms. Her pressure has plummeted. The nurse glances over and sees the unborn's heart drop. The nurse hits the call bell, and more nurses rush to the rescue. "Turn off the Pitocin, get her on her left side, open the IV line, put oxygen on her, and give her ephedrine to get her b/p back up!"
Fear grips the room. Adrenaline is coursing through the family and staff. It will take hours for all to calm down, restart the Pitocin and get those contractions into a regular pattern again. The family is grateful for the competent staff for saving their loved ones. Thank God they are in a hospital, they think. Will anyone tell them the epidural caused this critical situation?
The night wears on, and the woman is hungrier, which releases more adrenaline. She can't move well, causing less blood flow, including to her uterus and baby. At 11 pm, a nurse checks her cervix and tells her to start pushing. She tries pushing while semi-seated in the bed. Bearing down is generally strenuous with a first baby but more challenging when nature's intense urge to bear down that would direct her efforts has been obliterated. "Push harder, push longer, hold your breath longer," the nurse yells. The exhausted woman struggles. She doesn't understand why the baby down isn't moving down. "I want to squat." "Your legs are too numb and weak," the nurse replies. The laboring woman and her baby are more stressed. The pushing attempts continue. An hour later, the baby's heart rate drops. The doctor checks but can't use the vacuum to pull the baby out because the head is too high in the pelvis. The nurse injects medication to slow the contractions allowing the baby's heart rate to recover. The doctor says a cesarean is needed, and the woman agrees.
Common interventions often result in the domino effect leading to more and more interventions and increasing the odds of winding up in the operating room. These domino-effect cesareans are often preventable surgeries if we avoid inductions and interventions that are not medically necessary. Remember that if all is going well, research shows it is best to go into labor naturally when your and your baby's bodies are ready.