44 year old first time mum - which is lower risk, ECS or NVB?

[SpringMummy]

Hi all. I am new to Mumsnet, and will be having my first baby next spring. Me and Daddy to be feel very lucky to be expecting given my age. I have read the ECS v NVB debate thread with interest in response to the latest NICE guidelines. However I would like to hear from older mums re. their birthing experiences, and whether in hindsight they would have made different choices. I am currently on the fence on this issue. This will probably be our only child.

Congratulations SpringMummy - how wonderful.

After I had my DD at 41, a gynae/obstetrician my Mum knows was very surprised to hear that I did not have an ELCS authomatically given my age. As I understood it, the reason was that after 40 (or perhaps younger) your pelvis starts to seize or fuse or something and if you haven't already had children to stretch it (or something) a VB is going to be harder.

My consultant (who was fab in every other way) never suggested anything like that to me.

I ended up with an EMCS after induction/epidural/attempted forceps, so I suppose my view now is that it would have been a lot easier to have gone for an ELCS in the first place. However, had someone put that argument to me before the birth I might well have wanted to try a VB anyway to avoid the potentially lengthy recovery period (and I suppose to see if I could manage it).

I still have no idea whether my elderly pelvis contributed to my EMCS or if it was just bad luck.

What I would say is that comparing the experiences of people I have talked to since who had VBs, I am not sure I had the worse bargain, at least long term, in that my pelvic floor is in reasonably decent condition now. The problems I did have post-birth (sleepy and then dehydrated baby/me re-hospitalised with chest infection etc) probably had more to do with the emergency nature of the CS and the GA rather than the CS itself. So I suppose, if your consultant thinks that, being older, you have a high chance of needing a CS in the end anyway, it might be better to opt for an ELCS straight off.

I'm a wee bit younger (40 in 2 weeks) and baby due in a week - same situation first and probably only child. Sorry I don't come with experience but I did a heck lot of research and spoke with consultants about a number of risk factors when I first found I was pg.

My opinion based on these discussions is that it is very much down to you as an individual - your normal state of health and fitness. If you are in good health and relatively fit then the risks of birthing choices are similar to anyone else at other ages. Published age related risk studies tend to be focused on genetic or developmental risks, not physical birth.

It is very difficult to assess risks between ECS v NVB as you as an individual may have factors that tip the balance. For me I have physical reasons (higher bmi) that risks are higher for both choices so I have assessed my choices based on baby, me and relative risks. I hope for a complete NVB unless a medical reason arises.

Thanks both, so good to hear from you :-)

Hmmm, thinking about PamSco's post - I had a higher BMI too, so maybe the complications surrounding my birth could as easily be attributed to that as to age. My DD was overdue by a couple of weeks, hence the induction (though I went into labour naturally in hospital before they gave me anything). The intervention spiral I went into after that could have had as much to do with being in hospital and constantly monitored as it did with age or anything else. That being the case, as PamSco says, it is really down to individual factors as to what method of birth would be best for you and your baby.

Whatever route you decide to take, best wishes for the rest of your pregnancy and your birth.

If you have any spare pennies what about having an IM to help you think about information, options and, eventually, a decision. They would also accompany you to hospital for the birth and act as an advocate should you need it particuarly if you were unfortunate enough to start on the "cascade of interventions".

Hi, I had #1 at 39.5 and #2 a couple of months before my 41st birthday. Both were ELCS by choice (no medical reasons) . No complications and very quick recoveries both times but I was very fit and active (running) til a couple of weeks before birth both times.

Hi, I am 43 and have just had my third child. Because of my age, I was quite concerned about the risks of going over my due date and stillbirth/failing placentas. As the option of an ELCS was not available on the NHS, I was lucky enough to be able to opt to deliver privately as I felt I had more control over the type of delivery I would have. After discussions with the obstetrician about the risks and my previous history (2 straightforward VBs) I opted for an early induction with a low threshold for a CS if things weren't progressing (i.e. not waiting for an EMCS situation). The obstetrician did say though that if this had been my first delivery at the age of 43, an ELCS would be a no-brainer and that you wouldn't want to be 43 having to have an EMCS as that is when the risks are greater. That's obviously not to say an older mum can't have a completely straightforward VB and there are no doubt plenty of MNetters who can tell you their positive stories but for me, this was going to be my last chance to have another baby and I was feeling incredibly risk averse and just not willing to take any chances with the outcome.

Good luck in making your decision.

Hi. I was 41 when I gave birth (first and only baby) and no body even said anything about my age or gave me any option but giving birth naturally. Im a worrier so im glad i didn't know i might have a siezed or fused pelvis! My birth was straight forward, i guess you should see what your consultant recommends if id been a couple of years older and they had felt elcs was the best option then i would have gone with that. I like minstrel am risk adverse and it wouldn't have mattered to me how DS was born, just that he arrived safely.

Congratulations to you both.

Congratulations! I was 38 with DS1, and a few weeks off 40 with my twins. We had IVF for both and I also fought hard to stay pregnant - blood thinners, steroids, additional progesterone etc. I wasn't prepared to tolerate any avoidable risk to the baby so I had ELCS signed off relatively early in the pregnancy. As was explained to me, an uncomplicated VB has the best outcomes for all, but given my age, and additional risks in pregnancy, if there was any chance that my VB might be complicated then ELCS throws the burden of risk onto the mother and not the baby.

As it happened, it was all academic anyway and I had a low lying placenta which meant CS was even more likely, so my medical insurance covered me to have my CS privately, which meant my recovery was helped by fantastic post natal care.

I realise I was a tiny bit younger when I had my first but that was the way the risks were explained to me. My ELCS was a brilliant, lovely, deeply moving experience and was pain free. And I did it all again with twins!

Congratulations and very good luck x

Vaginal birth is safer. Emergency c/s is the most risky of all.

So - question is: have a vaginal birth with a risk of emergency c/s, or go straight for an elective?

Much of the risk depends on the type of care you get in labour and the emergency c/s rate at the hospital where they are giving birth.

Go to a hospital with poor staffing levels and a high emergency c/s rate then you're probably safer having an elective.

Have a homebirth and you may be about half as likely to end up with an emergency c/s, which really cuts your risk of a poor outcome for you and your baby.

My advice: reduce the likelihood of an emergency c/s as much as you can. If you opt for a hospital birth think about having a doula or a independent midwife to support you and your husband. Doula support is associate with better outcomes for birth. Something which is acknowledged in NICE guidelines!

And choose a hospital with a low emergency c/s rate and a good mother/midwife ratio.

i'll be interested to see if you're offered a choice. (on NHS) I had a difficult VB at 38 and have recently been told I can have a ELCS for my second, at 42, but it took some convincing the consultants and I have a couple of specific conditions that supported my case. Otherwise they were all set to put me up for VB again. I feel a lot safer this time knowing that the birth will be somewhat predictable and controlled (vs. lots of drama last time). I'm also glad not to run the risk of going over my due date and facing the increased risk of stillbirth, as minstrel said.
congratulations!