"a rather worrying trend of births to [older] women"

Interesting study, thank you. It’s still not something I would ever consider, but that’s me and we’re all different. And I’m also lucky to live near a hospital with a good maternity unit, which I appreciate isn’t the case for many.

@EarlGreywithLemon

I'm saying this based an a large meta-analysis published in the Lancet recently.

It included approximately half a million intended home births.
It's comparing low risk with low risk, the home birth cohort is not healthier, the numbers are not skewed.
If you transfer, it counts as a home birth.

Link below if you're interested.

www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext

@Nimnuan I see your point, but personally I wouldn’t go anywhere near a home birth no matter how healthy and uncomplicated the pregnancy. I understand that the chances of things going wrong are, in absolute terms, low. But the consequences can be disastrous if they do go wrong and there isn’t the proper medical assistance available. And when they go wrong, they can go very wrong, very fast. Deprivation of oxygen for the baby would be by far my biggest concern, followed by the risk of PPH. On the latter I speak as someone who lost 2.9 of blood very very fast. There’s no way you can get someone to hospital that quickly.

Re the safety of home births - the numbers are skewed from the start by the fact that it’s a healthier cohort with uncomplicated pregnancies vs the hospital cohort. Also, I’m not sure if the stats compare apples to apples. If someone started off as a home birth and was then transferred to the hospital, does that count as a home or hospital birth?

Just on another note, a year or so ago my friend was in hospital with midwives and felt that her baby was stuck and labour wasn't progressing. She asked repeatedly for an EMCS and they just ignored her and told her to keep trying. This is after they broke her waters without even telling her, let alone getting her consent.
It's goes both ways, intervening when they shouldn't and not intervening when they should. The important thing is to respect and listen to women, always.

What a lot of nonsense. My dm had babies at 38, 42 and 44 in 1959, 1963 and1965. I had ds when I was 45, in 2008. My BMI prior to pregnancy was 21.5.

I had no complications throughout my pregnancy, no nausea, and worked full time until 36 weeks. Blood pressure was normal throughout. My midwife told me I had gestational diabetes (wrong), that baby was breach (wrong), that I'd need a section (wrong). She tried to pressure me into a sweep at 9am on my due date, which I refused.

If inductions have increased that's down to the hcps bullying, not mums asking.

In my case the midwife was hopeless and my GP was calmly competent.

I went into labour naturally at 40+4 went to hosp at 40+5 pm and ds was delivered at 7.50am 40+6. I required help (ventouse) at the very end, which took about 10 minutes including stitching me up afterwards.

So my need for care was an amniocentesis at the start, a ventouse delivery and being stitched, plus 2 days in a bed after ds was born. Once we left hospital we didn't need any help.

All my dm's deliveries involved her staying in hospital for a week.

Good point.
Personally, I think that we are both too quick and too slow to intervene. For example we're too quick to go to hospital with perfect healthy pregnancies and slightly elevated risk factors when it's been shown that home birth is safer. Then too slow to intervene when women raise concerns, pushing women to keep trying when they say they want an EMCS or telling them they've weed themselves or they're having normal pregnancy pain when actually their waters are breaking and they're going into early labour.
Obviously labour sometimes goes wrong but the idea that the majority of women need medical intervention to get thorough it safely is just crazy. I'm incredibly grateful that we have modern medicine to save us when we need it but unnecessary medical intervention causes harm.

Makes sense.

That’s because of a study that showed a higher rate of stillbirths at 42 vs 41 weeks. The study was actually cut short because it was so clear, it would have been unethical to carry on with those who were in the 42 week group. I remember it well because my husband was reading about it when I was in labour with our daughter (pessary only induction, at 41 weeks, at my request).

Great detective work!

I also wonder the maternity scandals and the Ockenden report, followed by removing the C section target limit for the NHS had an impact on EMCS rates. If so, that’s also a good thing.

Previously, emergency c sections were denied in risky situations in which they really should have gone ahead in the name of a fixation with “natural birth” at all costs. We all know about some of the most horrific cases, in which mothers or babies died, or babies were disabled as a result. But on a lower level, I wonder how many traumatic births or birth injuries were caused by these unfortunate targets.

As an example, a friend who had had a very prolonged labour was first granted and then denied her repeated requests for a C section. She then had a 3b tear, with lasting effects, and her daughter was born not breathing and needed medical assistance. This was at a hospital that prides itself on its low rate of C sections. Our NCT teacher went on endlessly about that and about their amazing birth centre during our course. Meanwhile I had already chosen a different hospital because it had a high rate of sections. It may sound perverse, but it has an excellent maternity unit and I wanted to know that if I needed intervention I was going to get it, and quickly, irrespective of some pointless target.

Your comment above said it was a small contributor, which means like me you thought it had made some difference. I agree that the change is mostly due to greater EMCS rates, but that aspect of it is not what I was commenting on there.

As I've commented above, the ELCS rate doesn't seem to have changed much, if at all. The difference is mostly because of EMCS rates.
Agreed that if the change was due to women's choices that would be unequivocally positive.

The induction policy has changed since Ockenden, which will result in more c-sections as well. Although you can refuse, you are strongly pushed to have an induction from 41 weeks, and if the induction doesn’t work then you’ll end up with an emergency c-section. While there were good reasons for changing the induction policy, it’s had consequences.

Yes, that's bound to have made a difference and is an unequivocal positive. The previous CS percentage excluded a cohort who would've wanted an ELCS, but for whatever reason couldn't successfully navigate the system well enough to get one.

Probably a small contributor and obviously that would be a good thing. I honestly doubt it's contributing very much though as the rate has gone from 25% of births by CS in 2015 (including emergency and planned) to 29% emergency and 13% planned in 2023.

According to this report I found the emergency/planned split for 2015 was 13% Vs 14% (27% total as opposed to 25% in the article because the report is for England only whereas the article includes Scotland and Wales). Therefore the increase is pretty much entirely due to emergency CS.

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2015-16#:~:text=The%20number%20of%20deliveries%20for,pdf%2C%20size:%20143.0%20kB%5D

Could this also be because NHS policy has changed and they can no longer refuse maternal request C sections? Which is surely a good thing.

I never thought of that. Interesting point.

This article made me so angry. A small increase due to mum's being a bit older/heavier? Maybe. 50% increase in C-section rates over less than a decade? No eff-ing way.

Not necessarily. Age only put me at medium risk (I was over 40 for 2 or my 3 pregnancies), and that wasn’t consultant led. I saw a consultant as part of a joint cardiology/ obstetrics clinic because I have a congenital heart condition, but otherwise I usually saw a hospital midwife.

But mothers over a certain age will automatically be under an obstetrician rather than a midwife won't they?

My consultant said it’s not having a baby over 40 that’s the issue (if it’s your second or third or fourth) it’s having your first baby over 40 that’s riskier because it’s the first time your body goes through pregnancy, childbirth and labour. Apparently all of which are statistically easier for subsequent births on the whole

I agree.
Also a lot of women are traumatised by birth and being pushed to do absolutely everything else before c section.

I agree it’s a lot of first babies and first
babies are generally more difficult,
so a first labour in your 40s is a very different to the women who have had many easy labours since their 20s and continued in their 40s. There would have been a number of women who had terrible births in their 20s and either died/had complications which meant they never had children in their 40s. Those same women today would start in their 40s and struggle even more.
And a lot of women struggle to conceive naturally in their 40s so you have to take into account all those having babies when naturally their bodies wouldnt.

You don’t need to be offended by science op. Best of luck with your pregnancy and birth.

Same. And surely we all know that being older and overweight causes more
problems?

You are obese and older. Both of those are statistically risk factors for greater intervention at birth. It may not turn out to be true for you as an individual, but that’s the way stats work.