cascade of interventions

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The Canadian Medial Journal recently published a study that looked at 2889 planned home births attended by registered midwives, 4752 planned hospital births attended by the same midwives, and 5331 hospital births attended by physicians in British Columbia between 2000 and 2004.  Not to my surprise, they found the risk of infant death following home births did not differ from that of hospital births.  Not to mention, they found that women who had planned home births had significantly lower risk of obstetric interventions including electronic fetal monitoring, pitocin, epidurals, episiotomies, forceps, and cesarean sections.  They also found these women had a significantly lower risk of adverse outcomes such as major perineal tearing, postpartum hemorrhage, and infections.  Newborns born at home were less likely to require resuscitation at birth or oxygen beyond 24 hours.  Homebirth may not be for everyone, but the belief that it is somehow less safe is innacurate, and fueled by hospital medical staff who are ignorant of homebirth.  Ask any doctor if they’ve ever seen a homebirth.. the answer is more than likely, no.

Wow. If I didn’t urge you to see “The Business of Being Born” when it was playing in very select theaters, I’m definitely urging you to see it now. For free. Online. It doesn’t get much easier than that. I just watched it for the 2nd time and it was as amazing, emotional and thought-provoking as the first time. Two of my favorite birth scholars, Robbie Davis-Floyd and Michel Odent are in the film.  Also, the documentary is set in NYC, so many of the names, faces and places are familiar to me. If Abby Epstein and Ricki Lake didn’t make this, I would have. Seriously.

Capsaicin, the compound found in chiles that makes them “hot,” as in picante, has been shown to have the ability to facilitate pain relief without affecting movement and touch as most anesthetics do. This could mean that mothers-to-be in labor could maintain the ability to move around during labor, know when to push and feel themselves giving birth, without the pain. Epidurals today do not allow this. The drugs used in epidurals today affect total nerve function, including those that send signals to the brain about the other non-painful sensations a person is feeling, as well as the nerves that send signals from the brain telling muscles how and when to move. Capsaicin has the ability to open channels selectively so that pain-killers given in conjunction will only enter the desired nerve cells.

The article from BBC NEWS explains how the Harvard research group used a compound which interferes with nerve signals just as conventional anesthetics do, but is actually too large to enter any nerve cell on its own. Capsaicin, however, has the unique capability of opening large enough channels in the cell wall for the large anesthetic compound to enter the cell. Channels are only selectively opened in the cell walls of pain receptor nerve cells, therefore no longer causing loss of sensation and paralysis in addition to killing pain.

Having the ability to walk, move and stand makes labor progress more quickly due to the helpful effects of gravity. But the implications of this go beyond speeding labor. Having an epidural as we know them today can often lead to what birth professionals call the “cascade of interventions,” where the administration of anesthesia (or some other medical labor or birth intervention) triggers a snowballing effect necessitating more and more interventions. Consider this scenario in which a laboring mother receives an epidural, is numb from the waist down so labor slows because she is not able to walk, move or change positions. Mom cannot feel when to push, so after trying pitocin to speed contractions unnaturally, the baby then has to be removed by forceps then requiring an episiotomy.

Here is a really nice diagram I found on the Birth International site. It nicely illustrates some of the trajectories that the cascade of interventions can follow. This one starts not with the epidural, but with induction which is often the case in these cascades. Induction is the act of artificially starting labor through the administration of pitocin (synthetic oxytocin) or other drugs. In terms of this diagram.. I think the use of capsaicin in conjunction with an anesthetic that cannot penetrate cell walls on its own, has the potential to route the cascade away from so many Caesareans and forceps/vacuum extraction methods, and the subsequent interventions.