Induction at 40+ for 40yo

[ScubaSarah]

I'm trying to get my head around advice I'm being given and find the right answer. Tempted to post in AIBU but got scared off.

I'll be 40 end April. Due end July and have been told I WILL be induced at 40+0 due to age and so risk of stillbirth. I feel if foetal heart rate is ok and movements are strong then I'd rather wait for the natural course of things. Risk at 35yo is 1:1000 and at 40 is 2:1000 so small small risks.
What should I plan for at 40+0 if DC hasn't made an appearance? Can I say no? Would it be reasonable to say no if all was well?

I know induction doesn't necessarily mean major intervention and CS but it won't be the zen natural / water birth I was hoping for...

I've had 2 friends in similar situations & am about to be myself (will be 41 when dd arrives).

Friend 1, age 41.5 wanted a natural labour & delivery, declined induction & went into labour at 42+3 - labour didn't progress & she ended up having emcs.

Friend 2, age 43.75 - had sweeps at 38/39 weeks & went into labour on term date, had natural delivery.

As for me, I'll definitely not see my term date, as my consultant put it. I'll end up having either elcs/emcs beforehand, as I had previous PE. I'm taking her advice.

I also work in an obstetric service & have seen many Intra-uterine deaths. It's just not worth the risk. Although the statistics are small, someone has to be "it" & I don't think I could live with myself or recover from something like that.

Good luck with whatever you decide xx

I would ask them how they justify this policy when it is not a national standard. Which research do their figures come from? Yes, placentas do degrade earlier with older women but lots of hospitals use 40+14 for all women, regardless of age.
I would discuss the use of ctg and scans, daily if advised, to monitor placental function, and accept induction at 40+14 if nothing happened by then. You have to do what you personally feel comfortable with though.
Also, and meant very kindly, maybe revise your hopes for birth. Prepare as much as you can, know our options, but aim for healthy mum and baby. IME women focussing on a zen experience often end up disappointed and aggrieved. It may be a lovely experience (mine was) and that has something to do with preparation, also needs a large dose of good luck.

its my understanding that the risk of still birth for women over 40 after 40 weeks without other risk factors increases from 1:1000 to 2:1000, ie doubles but from a very low base. I have been told that 550 women over 40 have to be induced to prevent one of them having an extra stillbirth compared to younger women.

The risk of scar rupture in a vbac is usually quoted as 3:1000, yet that risk is considered acceptable. Scar rupture can lead to the death of mother and baby.

The policy on over 40's going overdue seems to vary quite a lot between NHS trusts. I'm 41 and just overdue (40 +1). At my current hospital they're happy for me to go to 40 + 14 as I have no health issues and everything is fine with me and the baby. I moved house halfway through this pregnancy and at my previous hospital they wanted to induce at 39 weeks because of my age even though I've had a textbook pregnancy. Personally, as both me and the baby are fine and as my EDD was moved forward from the date by LMP by almost a week, I'm happy to go to at least 40 + 14 before considering induction, if no health problems arise in the meantime. I don't understand why there's such a variation between hospitals and I haven't managed to find any solid evidence of increased risk for the over 40's. Many of the studies on this are pretty old and don't take into account general improvements to women's health and increased longevity. However, this is just my view and you should research this thoroughly and decide what's best for you.

The NICE guidelines on overdue pregnancy state that anyone can refuse an induction and opt for foetal monitoring instead. Just because it's the policy of your hospital, you don't have to go along with it, if you don't want to, although I understand that consultants and midwives can put you under quite a lot of pressure to go ahead with an induction due to age. Again you need to decide what's right for you.

Thank you all and good luck swanlike
I will see how thing progress and concentrate on healthy and safe but hope for the best
At least I know I'm NBU to at least challenge it if all seems well...
Thanks again

I'm due mud April with dc3 wwill be 40 in may .

I'm still in the ELCS this time or third induction (40+15 and 40+12 last times) ELCS for medical condition. I asked could I be induced at 39/40 weeks Easter hols be easier lol but told very firmly NO! Either book ELCS or induction at 40+12 if I go overdue again. Must vary though of course I won't quite be 40 then

latest release from RCOG

www.rcog.org.uk/news/rcog-release-induction-labour-older-mothers-may-reduce-risk-stillbirth-say-experts

Thanks Stoatie, that's interesting.

I was induced at 40+6 for DD2. I am 41 and 1 month. Had a meeting with consultant on my due date and agreed it was a reasonable compromise between the risks and not really wanting an induction. Still feel ambivalent about the decision, as DD1 was a straightforward home birth, I'm healthy and had no problems in pregnancy. Tho I guess now I'm cuddling my 1 week old it doesn't seem so important either way!

You can ask for 'expectant management' which in most unit consists of daily monitoring after 40 or 42 weeks.

The main risk is the placenta degrading after the due date the risk of which increases with maternal age. Some units offer scan to assess placental function.

Is this your first DS? Is there a reason they'd go for induction before sweeps or is that also on offer.

I went to 40+15 with DS1 and was induced, I was 37. Labour and delivery was fine, if highly medicalised.
I had emCS with DS2, then VBACs 2x with DS3 and DS4 - T+10 and at term exactely . I was 44 by then.

I think you are entirely right to ask for all the relevant information and to understand what is being proposed and why.

Very best of luck.

I was 39 when i got pregnant with DC4, but turned 40 3 months before she was born. I was 9 days overdue when she was born. I went in on the Monday and she was born on the Tuesday and was meant to be in hospitial on the Wednesday to be induced. So they didnt do it early for me, wouldnt give me a sweep until i have overdue.

I was 41 when DD was born. My consultant recommended induction at term but I was reluctant as I was induced last time and it meantt continuous monitoring, I was stuck on the bed, ended up with an epidural and a PPH. It was very important to me to have a better birth experience this time around. We discussed it several times (I am a midwife and saw her at work a lot) and in the end I decided to go with her recommendation as I have seen first hand the devastation a stillbirth can bring and I would never have been able to forgive myself if anything happened to her. The risks are very small but everybody is different when it comes to the level of risk that is acceptable to them and for me the decision to induce felt like the right one in the end.

After all the agonising over the decision she arrived the day before my booked induction!!

Just been through all the induction rigmarole at 40 yrs/40+ weeks and would have spotted this thread sooner if I didn't have a little baby attached to me all the time!

The induction dilemma was something that dominated the last few weeks of my pregnancy - I will try to summarise my experience later today when I can type properly...

Thanks all

Pacific it is first DC and I'm assuming they'll offer sweeps first. The daily monitoring sounds like a plan to keep risks down and hope DC makes his/her own way out first.

Eagleray hi! waves I was wondering how you got on, hope the snow didn't get in the way! Congrats

Hi Sarah - sorry forgot to say hello to you in my last post - yes we survived the snow but there were plenty of other spanners in the works regarding the birth!

From what I have seen, the induction recommendations vary between doctor, hospital and health authority, ie there are no set policies and it really depends on where you live. I had regular sweeps from 38+5 with a view to being induced at 40+3. The sweeps were disheartening as they didn't work, and I declined induction on the planned date as there were no health issues/risks identified. I felt under immense pressure to be induced once I had passed my due date, but they were also telling me it was unlikely to work as my body wasn't ready!

I had a lot of monitoring, went into labour naturally (after a vigorous sweep no. 6 at 40+8) but then had to be induced due to PROM and ended up with a very medicalised birth.

Everyone's experience is different but here are a few observations from my own experiences:

• you cannot have induction forced upon you - your body and your choice
• you will only just be 40 at due date. How would you feel about everything if you were, say, 40 in August instead? Would you feel differently about it all? And do you think the hospital would be treating you differently?
• I had early sweeps authorised by the obstetrician. Seemed like a good idea at the time, but they will only work if your body is ready! I found them fairly soul-destroying and the 'readiness' of my cervix etc seemed to depend on who was assessing me at the time.
• I had some expectant management but the opinion of the docs was that it is of limited use as only tells you what is going on at that point in time, not what will happen an hour later.
• it is best to try and get your head around all scenarios - it is not difficult to prepare for a lovely waterbirth with hypnobirthing etc, but there are 1001 reasons it seems which will put the kaibosh on your best-laid plans so it is a good idea to prepare yourself for the other birth 'options' as well.
• from what I can recall on the January birth thread, there were a fair few others facing induction and having medicalised births and almost every single one was under 40, so think to some extent you are in the lap of the gods whatever your age.

Sorry for long rambly post - I hope there is some useful information in there somewhere. My head is still a bit jumbled after the birth and I don't have time to think before I type!

Thanks Eagleray that's really useful. Hope you and DC are doing well after it all!
I'm becoming very aware I need to ensure I have a plan for all eventualities - I want to ensure a happy ending more than anything but would love the whole thing to be natural / zen like, of course.
I am annoyed but the fact that if I were just 3 months younger this issue would never have come up. I need to get DH onto the right page - he is the biggest challenge right now. Having said he'd advocate natural for me he is so on the side of medical intervention I'm wondering if I should invest in a doula as well?
I'll go with the sweeps, long walks, hot curries, raspberry leaf tea etc etc and hope hope hope it's a non issue in the end...

Thanks again for everyones input on this - it's really helped me get perspective and different view points!!

Scuba - I'm 40 weeks plus 3 days over.

I am 41 years old and 3/4.

I went to post dates clinic had check up for me and baby have been advised to mobilise. All looks good from hospital perspective - they've spoken about induction and offered a sweep. Asked me to come in Weds I said could I leave it a few more days and they were completely fine.

My age was not mentioned once - was even asked by one Doc if I'd consider another one after this my second. They were fine I declined sweep.

Said I should move around more (I'm not yet just been resting in bed) but they also said I seem in really good health at last (had a tough time of it) I am also very big but I felt really assured and my age has not been mentioned once yet.

Good luck!

Thanks sleep. I've NCed since OP...
Good luck and hope your DC makes an (easy) appearance soon