childbirth at 42 years old

[nics17]

I just had my 12 wk scan and spoke to a consultant.
He told me I can't deliver in the birthing unit as it's midwife led, as I'm 42 years old.
I'm so upset as this was my plan to be in the water again.
My son was born in water when I was 37
Has anyone else had problems / or had it easy?
I know there are more risks after 40
Can I get a second opinion?
Is it up to the hospital or consultant?
Thanks in advance for any advice

@Laurel543 I am greatly relieved to see your second post where you say you are leaning towards hospital for your delivery. As a 44 year old, first time mother, you really are high risk. I would be interested to know what the midwife who was very supportive of you for a home birth said to you about risk. Did she tell you that first time mother is in itself a big risk factor for home birth, with double the risk of bad outcomes for otherwise-low risk first timers? How did she deal with your age? You say you are led by evidence, which is a very sensible approach, but how does that reconcile with what your midwife should have told you? Or did your midwife do what so many reported on here do, and just gloss over the risks without properly explaining them and cheerlead you towards taking risks with your baby?

You say you are led by evidence, which is a very sensible approach

I couldn't agree more. Can you cite the evidence you have for your own comments? I'm sure many would be interested in your own evidence for your rather extreme views.

The desperation of some women to gamble with their baby's life because of a desire to have a better birth "experience" never fails to shock me

'Desperate to gamble with their baby's lives'? What a horrible thing to say to someone 12 weeks pregnant and trying to make an informed decision about birth.

Or did your midwife do what so many reported on here do, and just gloss over the risks without properly explaining them and cheerlead you towards taking risks with your baby?

Yes. Midwives do that all the time. Ffs.

Did she tell you that first time mother is in itself a big risk factor for home birth, with double the risk of bad outcomes for otherwise-low risk first timers?

Double the risk of bad outcomes? Can you define 'bad outcomes?' and citing this source would be useful as well.

Many of us are very familiar with the research around first time birth/homebirth, but I haven't seen the evidence you've cited.

Incidentally, you know the OP isn't a first time mother, right?

I used the MLU at 41, i was consultant led due to age, but neither he nor my midwife ever questioned my preference to use the birthing centre.... in-fact they encouraged it!
They did however say that if baby was overdue they would want to induce instead. she conveniently arrived two weeks early and we had a quick, problem free birth in the MLU.
It may have made a difference that our MLU is in the hospital just down the corridor from the main maternity suite so if any problems occur they can whip you down there within seconds!

shegot 'Desperate to gamble with their baby's lives'? What a horrible thing to say to someone 12 weeks pregnant and trying to make an informed decision about birth.

Why is is a horrible thing to say? It's simple common sense! If the professionals around you are telling you that you need to give birth in a hospital and you are fighting that because you have a vision of a certain kind of birth then you ARE gambling with your child's life in favour of your experience. To me, the birth matters not one jot. A safely delivered baby is all that matters. I say this as an older mum (I was 39) who had a cord prolapse with dd2 who would have died had I been anywhere except where I was. As it is, she is a wonderfully healthy 3 year old thanks to the operating theatre staff who delivered her in a crash C section within 5 minutes of the problem.

You can still have a water birth when you are consultant led! I think all hospitals have at least one pool on the maternity wards.

You dont have to choose the hospital nearest to you. Research the hospitals within a reasonable distance from you and look at their facilities. Some may have more pools than others which would give you a higher chance of getting to use one. You can transfer your care to any hospital you want.

Recent research supports not letting older mothers go over 40 weeks and that this should reduce stillbirth levels quite significant. Good layman’s summary here: www.newscientist.com/article/long-let-pregnancy-run-induced/

Original work here: Plos Medicine, DOI: 10.1371/journal.pmed.1002425

There is a balance to be struck here op - you’re well within your rights to ask why any recommendation is made, and to ask if there are alternatives. At the same time it’s worth acknowledging that the consultant is going on the best evidence base they have and evidence based good practice guidelines.
I personally would want to be no more than set of double doors away from all the bells and whistles and technology.

It's simple common sense! If the professionals around you are telling you that you need to give birth in a hospital and you are fighting that because you have a vision of a certain kind of birth then you ARE gambling with your child's life in favour of your experience

Read the OP's OP again.

She is not doing this. She is seeking advice to weigh things up like any sensible, enlightened person.

Some of the comments on this thread are deliberately scaremongering and reek of prejudice and ignorance rather than any desire to help this OP.

Having said that, I suspect the OP is capable of sorting the reasoned, well meant ones from the others.

you’re well within your rights to ask why any recommendation is made, and to ask if there are alternatives. At the same time it’s worth acknowledging that the consultant is going on the best evidence base they have and evidence based good practice guidelines.

Good advice.

She is not doing this. She is seeking advice to weigh things up like any sensible, enlightened person

She's seeking advice from people on the internet despite having been given advice from the professionals around her.

She's seeking advice from people on the internet despite having been given advice from the professionals around her.

Yep. That's about the size of it. You'll find it happens quite a lot on MN as indeed it does in rl.

The sort of convo you want to have is along the lines of

“Previously I thought I’d be able to do x for the birth. Can you just run me through why y is preferred?’
‘Are there other alternatives?’
‘What are the risks and benefits of these?’
Take a notebook if it helps.

It should be a discussion - at the same time bear in mind that the consultants aim is to get you and the baby through this safely. They have a lot of experience and theyve seen a lot of things go wrong (and right.)

So have a discussion - it may be that some parts of what you want ARE available (early stage in water for example) or it could be that they have very specific evidence driven reasons for not allowing certain things. The set up of the unit you’re in may not allow some things for example.

Birth is inherently unpredictable and I don’t envy consultants having to make calls like this - they probably are risk averse but they have their reasons. At the heart of it all isvthat you can only ever guess how a birth will go - and some will go smoothly and some won’t. But you can’t tell until you’re in the middle of it and at that point every single second counts.

I’m a consultant obstetrician and I would support you in your wish for a water birth in hospital. This is your second birth so your risk is lower than a first time mum and you are highly likely to have a straightforward birth like last time.
You may wish to read the scientific opinion on the rcog website about older mothers to fully understand the issues.
I would recommend asking for a second opinion. If this is challenging, a meeting with the head of midwifery is likely to come up with a sensible plan.
Yes we want you to be safe but I do not believe we need to sacrifice your hopes for birth in order to make some weird birth factory where everybody has an elective section or an induction and an epidural...

OP, have a read of your notes. I had cause to call my midwife over lunch and was reading my notes whilst I waited for a call back. In my notes, the 36 weeks appointment outline has two columns, one red, one green with a list of questions and one answer in each column. If you tick red, you're classed as high risk and the only "high risk" birth options are the two local hospitals, if you're "low risk" you get to choose the MLU, about 10 miles away, home birth etc. Maternal age of 40 or over is one of the questions - yes is in the red column, no in the green. Our hospital trust makes it nice and easy to see who counts as high risk.

@Shegotbettedaviseyes yes I know the Op isn't a first time mother; my comment was specifically addressed to a poster further along the chain who is.

The almost double risk of bad outcomes is from NICE guidelines based on the 2011 birthplace study. Bad outcomes recorded are things like death of the baby, brain injury to the baby, broken clavicles for the baby. Not "bad experiences" like bright lights. The risk jumped from 5.7 per 1000 births to 9.3 for first time mothers at home births. And this is for women with zero antenatal risk factors, so not advanced maternal age. This is the self-same study that all home birth websites trumpet as "proving" home birth is safe.

I didn't at all say any of the posters was taking reckless gambles with their babies lives. What I said was the midwives who fail to inform patients of the facts are pushing reckless and dangerous gambles.

I really never understand why people get angry with me when I post this on threads like these. Shouldn't your anger be for the midwives who fail to inform their patients of the facts? How can pregnant women make an informed decision and give informed consent when their own care team is withholding the truth from them?

If you’re having a baby at 42, you might not get to demand the birth you want, but as you’re increased risk, do you honestly care? I just wanted my baby out safely.

^This

I am 43 (nearly 44) and due to give birth over the next few weeks.

I will be induced at 39 weeks if baby does not appear before then due to the age factor risk of stillbirths etc. (I think this is protocol in a lot of hospital trusts)

As long as I was in the maternity ward (somewhere) I think I would be reasonably happy as I would not want to give birth at home where medical intervention is not available. However, I am expecting to go straight to the delivery suite (not the lovely rooms with the birthing pools etc.)...I think they are pretty close to each other at my local hospital.

I have not had a water birth in the past (this is my fourth pregnancy) but the compromise was, as another poster mentioned a warm bath which I think helped enormously. Because I had a late loss around 20 weeks in my last pregnancy, I am more than willing to ere on the side of caution and happy to follow the consultant's instructions.

You need to talk this through with a consultant again and get hold of all of the facts relating to this.

I think things aren't set in stone if you push. I'm 40 and due in June and I've found that they are willing to discuss/compromise things if necessary. For example I'm having an elective (due to what happened with ds and 100 percent my choice) and I saw the midwife this morning to discuss what I'd like/what I'd like to avoid during that process as they were willing to make alterations from standard policy if needed.

dinosaur why do you want to push against what they'd like you to do? In whose interest is it to go against the advice of the professionals who are there to care for you?

@Whowhatwhy In my particular case because I have ptsd and my only "memories" of ds's arrival are flashbacks to the incident which caused my ptsd and I'd rather avoid that happening again (and so would they, especially the bit where I decided ds was a doll and tried to leave him in NICU).

It was actually the Consultant who suggested the meeting/altering things to make it easier for me so I'm pretty confident in saying that I have their full support in doing so. However it illustrates the point that they accept that what is standard will not work for all women for a wide variety of reasons. The entire point of informed consent is surely they explain the risks and we make up our own minds isn't it? Would I choose a water birth at 42, no but I wouldn't choose a water birth ever. I don't think arbitrary rules help anyone especially if the MLU is like ours, i.e through one set of doors to the Labour ward.

This is standard now that those over 40, and younger in some hospitals, need to deliver in the delivery suite rather than the midwife led birthing unit.

It's due to infant mortality rates in older mothers and evidence based so it's a reasonable policy.

I would suggest then dinosaur that your circumstances are quite extreme and don't negate the fact that in most cases, for the baby's sake, hospital births are safest.

I had 2 babies over 40 - first in the hospital at 41 - lots of intervention, pressured into pushing when I wasn’t ready, being confined to a bed for monitoring, midwives not listening or not there, traumatic stay in hospital afterwards without pain relief and any sleep. Lots of post childbirth complications. Second was at home at 43, which was completely the opposite experience. However I did not have any other risk factors apart from age and live about 15 minutes away from the hospital, so knew I could easily go in at any time if I changed my mind. I had to go and see a senior midwife to get my homebirth ‘approved’ but she could see that I didn’t want to go through a hospital birth again. The only way I would have given birth in hospital the second time would be via c-section as the first experience was so awful. You can listen to the midwives/consultants opinions but also discuss your options and refuse any interventions that you don’t want - like induction. There’s no reason to be induced at 40 weeks just because of age for example, all other risk factors should be taken into consideration. I moved between trusts whilst pregnant and one trust was very firm about induction at 39 weeks for older mothers, whilst the other one did not have that policy. Listen to the advice, weigh up the risks but also decide what’s right for you.

@Whowhatwhy The OP hasn't said she wants to give birth outside hospital though. "Birthing Unit" could easily be attached and the fact that she then goes on to say that "is it up to the hospital" suggests that might be the case.

I think that turning women like the OP away from the MLUs in maternity hospitals is more risky than allowing it personally as then there is the potential that faced with the labour ward or home birth, some women will choose home birth.

Of course midwife led care is safe for low risk women - there is no 'barely' about it. Read the research before making comments like this.

Maybe speak to your consultant midwife if you have one. They really helped me by getting all the research and helping me make a fully informed choice.