domino effect

The intervention cascade

You may have heard the phrase “cascade of intervention” being during your pregnancy. This section aims to uncover what that means for you and your baby.

When we look at intervention, it’s important to remember that for every action, there is usually an effect. While some of those effects are the ones we want, sometimes they have other effects that are not so desirable. In trying to counteract the undesirable ones, we cause another chain of events to unfold. This action often results in a domino effect that is almost unstoppable once the first domino topples. This phenomenon is an “Intervention Cascade”.

When does it happen?

While most of the time we hear this cascade in terms of birth, in reality, it can start at any time during pregnancy. Proper antenatal care and screening are vital to ensure the health of you and your baby throughout your pregnancy.

However, the event that starts the snowball may be something as simple as being diagnosed with gestational diabetes (GDM). If your blood sugars are well controlled, and your baby exhibits average growth, it will not affect your pregnancy.

Your doctor or midwife will weigh up the options, and discuss the risks versus benefits of the intervention, and hence the cascade begins. To manage the risks associated with gestational diabetes, your care providers may recommend serial ultrasounds.

These recommendations may lead to induction of labour, requiring constant monitoring, restricting your movement and increasing your need for pain management. An epidural will result in reduced effectiveness in pushing and an instrumental birth. In other words, a cascade of intervention.

What are the costs?

We can measure the costs of intervention in terms of dollars, as well as people. The economic consequences of induction and epidural in low-risk women birthing in the public health system have been evident in Australia since 2003 (61).

While the cost to the public health system is not a factor in most women’s decisions around their birth, care from a known midwife reduces the intervention rate, and hence the cost associated with birth (61). It also increases a woman’s satisfaction with care (62).

For more information please click here.

Nikki-Lee Rossiter (BMid), Registered Midwife
Photo by Kirill Kurashov used under license from