Older Mum - pressure to be induced

[HipHopopotomus]

I'm 43 years and 37 weeks PG. DD nearly 3.5 was VB not long after I turned 40. DD was one week over due and I went into labour 12 hours after 1st sweep at 41 weeks. Had her in birth centre - long labour but otherwise all good.

Saw doc yesterday - 1st time I've seen a doctor as all well otherwise with me.

They are offering me (and seriously recommending to me) that I be induced on my due date. Can't say how much this does not appeal to me. I'm all up for another birth at the birth centre if at all possible. However I've been told and I am aware that risk of still birth increases due to my age.

I suggested I have some sweeps prior to being induced and Doc agreed - so I've booked in for 3 sweeps in birth centre the 3 days running up to DD. However MW did say they usually don't do sweeps until 41 weeks - and she's unsure how effective it would be. She's recommended I get some acupuncture in advance of the sweeps to stimulate hormones.

Clearly I don't want to take any risks re SB, but neither do I want to rush down the inducement route (highly likely to have epidural/forceps & other interventions plus 25% increase in EMC chances too), especially as I have success with 'normal' VB previously. Although statistically risk of SB is higher in older Mum's that of course does not mean I personally would be at risk at all - I may or may not be - how do you know?

I also feel that inducing on the DD is a little OTT. I mean how many babies actually make a diary note which they then obey - oh must pop out NOW, as doctor says this is my DD?

I'm not to sure about other options. Any advice/experience of MN'ers I'd love to hear.

Tell them thanks, but no thanks.

You might find this interesting reading - its scary how often the "risks" can be mis-represented. If it were me then, before agreeing to induction, I would want to know more about the data behind the SB risk that the Dr seemed so concerned about. Was this purely taking into consideration maternal age? There are conditions that are more common with increasing maternal age that can be linked to SB - those need to be taken into consideration before the statistics are meaningful.

If they're that worried about you going beyond 40 weeks then they should be prepared to offer you expectant management in place of induction - that would mean you'd go into hospital every day or two for monitoring to try and ensure that the placenta is functioning well and there are no problems brewing. Its not normally offered until after about 41/42 weeks - but then neither is induction...

Don't accept. I was pressured into induction on due date for back problems. I will never agree to induction again unless major health issues. Are they expecting to be busy just after your due date

Thanks all - very reassuring to hear from you. I can't see myself accepting an induction - but I need to do some more research. I'll start with Tangles link - thanks.

One of the problem is that there will be 1000's of positive stories for older Mum's having normal births etc. But what about is the actual position re the risks? It's probably an unknown entity.

I was quite shocked at the doctors attitude though - acknowledging it was my choice but seriously pushing me towards it. Whereas the MW at the birth centre were much more relaxed.

As far as I know I have no other 'risk' factors. My step mum is a MW of 40 years and has seen/done it all. I'll talk to her at length over the weekend, however as much as an advocate for natural birth/BF etc she is, when I called her after 25 hours labour with DD she shouted EPIDURAL at me - I would have bitten her if she was in the room :) She later apologised and said she didn't know what had come over her - family I guess!

My DD is 28th April - day before the Royal Wedding

Oh and a friend of mine was induced at this same hospital recently - her baby was breech, they didn't spot it & they induced her (cause she was 40) !!!!!!!!!!

Where I live it is standard for the CMW to book you in for an induction 14 days after due date but they were quite relaxed and it was "just in case it's needed".

I went to the hospital for foetal monitoring at around 40 weeks and the consultant caught me on his rounds and said he didn't like to leave the induction date at 14 days and wanted it brought forward to 7-10 days after EDD. He did also say that I should arrange to have sweep a couple of days before induction. No-one thought to tell me what to do on the induction date ie; where to go, when to turn up, what would happen so I was going to use that as an excuse to not turn up!

So I arranged a sweep with the CMW and explained to her that I wasn't happy about the induction being brought forward. She said the docs tend to be nervous as they see all the worst case scenarios in hospital and she called and put the induction date back to 14 days.

Turned out I didn't need it as the sweep did the job and DD was born 8 days over my due date. I'd hang in there, ask the doc for his data and make a decision later to try and use the birth centre.

I was booked for induction on my DD due to diabetes. I hand expressed colostrum every other day (about 1ml each side) and (ahem) made sure I achieved the big O either with or without DH every day for 2 weeks.

Prostaglandin from DH, expression and orgasm all trigger the release of oxytocin which is the hormone that brings on labour. I delivered spontaneously at 39 weeks exactly. Note of caution, I wouldn't recommend trying all three before 37 weeks!

Good luck

no wonder you are such a happy camel!!!!!
top tips!

It's your body so your decision.

I was encouraged to be induced at 40 weeks for exactly the same reasons (I'm 42). But after a traumatic induction with DD1 I was desperate to have a home birth and wanted to wait. The hospital agreed as long as I attended for regular scans and monitoring. I had 2 sweeps which did nothing, but was my choice because I wanted to try anything to avoid another induction. Also I had a supportive community midwive which helped.

Fortunately my DD2 decided to make an appearance 2 days before my induction date. I was overdue by 10 days. And I got my longed-for home birth which was natural and lovely.

If you have had a straightforward pregnancy and feel well then there's no reason not to wait a bit longer. It's your choice.

Why don't you go for a private scan? They can check how the babies doing and also check the pacental blood flow - the ob/gyn i use is Dr Gibbs at the Birth centre on harley street. The Foetal medicine clinic is at the same location.
I've asked to be induced at 40+7 (which will be the 26th April) as i always go overdue and had a very easy indcution last time.

happycamel's idea didn't work with me, and I was induced at 40+14.

Excuse me copying and pasting: but below is my reply to a recent March thread on being an older mum and considering induction incl. sweeps.

"My own experience... Had DC1 aged 38, no problems and went into labour spontaneously at 39 weeks.

Had DC2 aged 41 last year. Different hospital and consultant. Scanned at 36 weeks because "older mum" and baby showed mild asymmetrical growth restriction (abdominal girth less than head or femur size etc) by comparison with previous 20 week scan i.e. baby not just small overall but probably not getting quite enough nutrition to put on abdominal weight. As OffToNarnia says this is likely due to poor placental function, which is more common as we age. I think there was a second scan at 38/39 weeks showing same but no worse.

So they said they'd sweep me from 40 weeks or so and then induce at 40+4. I had two sweeps: both uncomfortable and caused over 24 hours of irregular contractions and therefore no or poor sleep during the week before birth, aargh, but no active labour. Ended up going in for induction at 40+4 which was painful but very swift. I personally would definitely have another induction but not the sweeps.

The baby was beautiful but definitely slightly "post-mature" with wrinkled, dry, scaly skin and very little subcutaneous fat (can be indicators of "post-dates" or poorer placental function) so I'm glad we got her out when we did. If I ever have another I would do the same again at the same time or even a week or two earlier. The 36 week scan was a great warning, at least for me.

Hope this helps. Good luck with your birth: hope all goes smoothly!"

Have you had or will you have any late growth scans? Might inform and help your decision about induction or not?

Some hospitals do advocate induction at term, following on from studies such as this one but as Tangle says, you can narrow your risk down a bit by excluding some of the categories mentioned in that abstract.

It all comes down to how much personal risk you feel comfortable with and regular monitoring will help as what the doctor said may niggle away at you and increase anxiety.

If its any consolation, having a second baby following a successful first birth, even with an induction, still has you in a very low risk group for c/section or instrumental birth but obviously it will still be a far cry from the lovely relaxed birth centre birth that you want.

Good luck with whatever you decide:)

Also just out of interest - which hospital are you booked at?

I'm at Queen Charlottes in London.
Booking some accupuncture now!

That's interesting. My friend had a baby at Queen Charlotte's about 3 years ago and the policy then was to offer all women of 38 years or older an induction on their due date due to increased risk of SB due to maternal age.

It sounds like that's what they're doing. My friend was 38 at the time and declined induction on dd but was eventually induced at 40 +10 I think. There was generally a low uptake of induction on due date.

In answer to your question 'how do you know whether I personally would be at risk?' - the answer is you're probably not but no-one knows for sure. If the placenta is struggling you may notice reduced movements, a scan may pick up reduced fetal growth or amniotic fluid, a monitor may detect a concerning heart beat which is what monitoring is put in place for.

Definitely get going with the acupuncture. I'd also echo what mintpurple says about the general trends with induced subsequent births not needing multiple interventions/assistance but it sounds like your preference is to avoid induction.

Thanks rosebud - I was 40 when I had dd there 3.5 years ago. I never saw a doctor, inducement was never mentioned. I had a sweep at 41 weeks and dd was born 41 + 2!

UPDATE: just to thank you all for your advice and support. I declined induction, was given big lecture by doc who used the words " We don't allow women over 40 to go beyond due date" over and over. I asked him to please revise his wording - i wasn't asking for his permission, but advice as to options. They agreed I could be monitored etc and to come back in 5 days after bank holiday weekend for monitoring! Yes clearly he was very concerned about my baby!!!!!! I think I got extra pressure to be induced before the 4 day weekend.

Anyway DD2 arrived bank holiday Monday after quite swift labour - about 4 hours. She's amazing and gorgeous and has just had her first weigh in and has gained weight.

This old mum very happy & delighted no didn't let the fear get to me and I stuck to my guns. Very grateful for support of mn'ers and other older mums who shared their experiences and amazing fearless attitudes.

She was 4 days overdue

Oh that's great news HipHop! Glad you stood up for yourself and got the birth you wanted. As an older pregnant mother too I may be having this battle soon. Good luck to you and DD2.

Thank you both. I agree the language used was bad - "strongly recommend" I would expect, "not allow" I object to. What were they going to do to not allow me? Silly man!

So annoying and also revealing that monitoring was not offered/possible until 5 days later, unless I was concerned and took myself in due to lack of movements.

Best of luck handdived

Congrats on your new arrival :o

and also congrats on having the courage to stand up to the consultant :o. Lets hope he's learnt a lesson and moderates his language with other women under his care (yeah, I know - but I can dream!)

Cheers tangle.

It's so lovely having a baby in the house again. New babies were freaking me out before Dd2 came along - like aliens to me :) c but now she is here it's just the best thing ever.