Cascade of Intervention

I reckon that I had the longest written birth plan in History.  It started (not the birth plan itself, but the ideas contained within) when I was expecting Sam, my firstborn.  After my long stay in hospital as a child, and the following years of blood tests, x-rays, scans and general check-ups, I had successfully avoided such places (if you don’t count my wisdom teeth) for some time, and now here I was, with doctors and midwives and consultants fussing fussily.

I, like many of my ilk, joined the National Childbirth Trust (NCT) first pregnancy round  partly because my friend Heather told me to) and it was there that I learned that, if I wasn’t careful, something called a ‘cascade of intervention’ could well happen to me.  Basically it means that once you intervene in the birth process, an epidural for instance, then it becomes more likely that something else will follow.  A simple example would be that if you can’t feel when/how hard to push you struggle to bring your baby to birth, so forceps or a ventouse are used, which then necessitates an episiotomy, which, in turn, needs stitches, these can get infected, can be stitched wrongly – you get the picture. The thought of this happening to me was very frightening, sending shivers not only down my spine but right out of the end of my toes.

It wasn’t just the NCT influence, though.  As a young undergraduate, I’d done a dissertation on women’s lives, loves and romance in the 16th and 17th centuries, and part of that was finding out about pregnancy and childbirth at that time.  I may have chortled at the idea of a wandering womb in a shocked-but-angry kind of way, but I could see a pattern emerging.  As midwifery left the realms of women and entered an age dominated by Men of Science, more and more mothers were messed with.  Forceps.  Positions that allowed easy access and observation, but did nothing to make the giving of life easier.  Lives lost where letting Nature take its course may well have saved them.  It may not quite have been mediaeval, but it coalesced into one desire.

What I wanted was to be left alone and do it as naturally as I could, and, being me, I wrote it all down, and added a paragraph (or two) to explain why (I left out the bit about the history of midwifery and classical allusions to Galen and the wandering womb theory, I thought that might be pretentious).  By the time I was in the delivery suite with Number Three my plan had grown to considerable proportions, including such gems as ‘please insist my husband eats something, he is diabetic and likely to keel over if this goes on too long, and he won’t say as he won’t want to be any trouble’ (this turned out to be quite a good part of the plan) and ‘if you insist on putting in a canula, please can you do it at the last possible moment and take it out as soon as you can because I really, really hate them’.  It took the midwives at least ten minutes to read, and, bless them all, they stuck as closely as possible to my wishes without me having to resort to too many tears and too much snot.

While I was busy worrying about the ‘kindest cut’ (there’s a misnomer if ever there was one), schools were buying into the concept  of intervention in an entirely different way.  Instead of it being whether a woman in labour was getting on as she ought, it became about a child.  If a child wasn’t performing, travelling along the Straight Line of Progress, then an Intervention was called for.  It took me a while, bearing in mind my aversion to messing, to get my head round the concept.  In schools, it has come to mean doing something different to the rest of the class, most likely with a Teaching Assistant, although not always, stuffed in at funny times of the day (assembly time is popular, or worse, the last ten minutes of lunch time play), or in funny places – out in the corridor, a table in the cloakroom, anywhere where you can get a bit of quiet, usually cold, and, if you have the misfortune to find yourself next to the toilets or the plimsolls, smelly.

Now that Intervention is my stock in trade, I find myself wondering about it.  I find myself wondering, knowing what I now know, just how much time my children, my Sam in particular, spent or spend in intervention groups.  OK, I know for sure some of what Sam experienced in primary school. I know that he spent his 8th birthday in the corridor – but that wasn’t so that he could be ‘intervened’, that was more a consequence of overexcitement and more fool him.  No, I find myself wondering about his  and their school experience in general.

During Sam’s primary years I often wondered just how much time he spent with his class teacher, how well they actually knew him, and I laid the deficiencies in this relationship at the feet of the TA.  It’s hard to get to know someone when there is always another person there, getting in the way.  It was one of the reasons we plumped for a special school for his secondary education  There would be no dedicated one-on-one support.  But, as I sit here contemplating The State of Education Today (or something like that), I can see that it’s a bit more complicated than that.

I can begin to see that this issue of intervention strikes at the very heart of an inclusive education.  Yes, of course if children aren’t ‘getting it’ then we need to do something about it, but at what cost?  Should they spend the majority of their days out in the corridor, or on the floor, or in cramped corners where the rest of the school passes by, being taught by a succession of people who aren’t as qualified as the teacher?   And when do these interventions take place?  Don’t these children deserve just as much Art or Music or Drama or Games or Athletics or play time as everyone else?  Don’t they deserve the chance to shine at every moment they possibly can?  Don’t they deserve the chance to be with the group, to share in the same educational experience, even if it means getting told off for doing each other’s hair during story time or staring out of the window and learning to deal with boredom?  Don’t they deserve to get to know their teacher properly, and their teacher them?

I make no apology for my support for ‘one teacher, one class’.  Yes, I could bang on about subject knowledge and all that jazz, but, and I see this every day when I go to work, I see it every day when I am at home; children do well when they know their teacher, they trust their teacher, and they are with their teacher enough for their teacher to make a difference.  Sometimes it’s the simple things that matter.



4 thoughts on “Cascade of Intervention

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