Informed Consent and the Cascade Effect

Hey M+W babes!

Today we’re talking about the true foundation of everything that I do as a Doula through fertility, pregnancy, and parenting! Informed consent is what will guide you to step into your power. Knowing all of the information about a specific topic or intervention like pros, cons, and alternatives will allow you to say yes or no in full confidence knowing you are doing what’s best for you and your baby.

You may be thinking “okay that’s fine and dandy but how do I know what questions to ask or my rights as a birther?” that’s where your B.R.A.I.N and your Doula come in.

B.R.A.I.N is an acronym that is great for mapping out your thoughts when you’re trying to make an informed decision about your birth. By using this acronym I can teach you what questions that you should be asking your health care provider whenever they are suggesting medical intervention. By being prepared in the event that your birth plan doesn’t pan out exactly the way you envisioned, it removes the fear of the unknown and puts you in the driver seat.

Learning How-to Use Your B.R.A.I.N

B = benefits

R = risks

A = alternatives

I = intuition

N = nothing

B) The first thing you want to ask yourself and your health care provider is what the benefits of said intervention are. Do you feel like the pro’s outweigh the con’s in this senerio?

R) When it comes to life in general there are always risks associated with anything that you do. In birth you have to analyze the risks of said intervention, to determine if it is the right thing to do for you and your baby.

A) When you don’t know your options, you don’t have any. Make sure you know what the alternatives are/if any and if what your health care provider is suggesting is medically necessary at this time.

I) Trusting your intuition is key. Asking yourself “does this feel right for me and my baby?” and if it doesn’t following that inner voice.

N) What happens if we do nothing? How long do I have to make this decision? Ultimately you have to make a choice that you feel comfortable with the possible outcomes of the decision.


The problem with the routine care that we see in hospitals today is what is called the cascade effect. In basic terms it means Doctors are so set in their routines that they don’t stop to think about the individual and their unique situation/needs. They follow hospital protocol, which although in my opinion is outdated ultimately can be a good thing. However what this means is that they rarely base their practices on the most current evidence and research. What is best for one person isn’t always what is best for everyone.

In the end we want a healthy baby and Mum/birther yet a lot of Doctors use a scare tactic and minimize the birthers feelings by engraining that “a healthy baby is all that matters”. When really, the birther’s experience is at least as equally important because it’s something they will never forget, and sets the stage for bonding with their baby.

We call this the cascade effect because interventions cause interventions. Here’s an example to help you understand:

A labouring person arrives at the hospital too early, having the intensity of their contractions minimised by the hospital staff (“oh you’re only 2cm dilated”), and either being sent home if not in active labour (which is actually a blessing in disguise!) or labouring in the waiting room or tiny triage room until a labour and delivery room is free.

Individuals are told to stay put as the monitors pick up the baby’s heart rate best that way, not knowing that their babies (and labours!) will be healthier and happier if a labouring person is free to do what they find comfortable and relaxing. If labour isn’t progressing as quickly as the staff would like, a their water is broken and Pitocin (synthetic labour hormone) is started.

These two interventions are often done as protocol, not offered as a choice, leading to a much more intense labour and are very commonly followed by an epidural. This epidural leads to more pitocin and many babies do not react well to pitocin. As the baby’s heart rate acts up, the staff get nervous and want to speed things up even more by an assisted pushing phase (vacuum or forceps) if the baby is low enough, or a cesarean section depending on how much the baby’s heart rate is lowering and where in their labour the birther is.


You can prevent negative feelings and the cascade of interventions by learning how to make informed decision using the B.R.A.I.N acronym! I can teach you how to ask the right questions and break down these interventions so you understand what you’re saying yes or no to. Knowledge is power.

I hope you were able to take something valuable away from this post!

I love hearing from you– so please don’t hesitate to reach out with any questions, feedback, or concerns you may be experiencing.

Stay well + stay smiling loves!

Published by Nicole

I’m Nicole & if you couldn’t tell by the name of this blog I love all thing that are cosy, warm, and bring you a sense of hygge.

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