using midwife led unit at 40 yrs old

[hoorayforharoldlloyd]

I'm going to be using King's for the birth of my first baby and will be 40.5 years old at the time. Saw my midwife yesterday and asked about how to book that in - she didn't think I'd be allowed on my age. I'm six months pregnant and this has not been mentioned before.

I saw a consultant once who said I was fine but that they would like to induce on the due date - I would like to push back a day or two but otherwise happy to go with that. So using the MLU is a moot point - however, at Kings the midwife unit and the labour ward are on the same floor so easy transition - I really don't see why I couldn't start in the unit and move if I need more drugs/safer for me and baby.

I have a meeting with a consultant at 38 weeks to discuss this- has anyone argued to use a midwife led unit successfully before? I prefer the space and it feels calmer and safer.

I was going to argue to use mine. Was consultant led but none of the issues they monitored for ever came to anything, so I couldn’t believe I wouldn’t be allowed to use the MLU for that.

When I got to the hospital in labour, they just took me straight to the MLU. I told DH that I felt like I’d broken in! The midwives agreed that there were no risks and were happy to have me there.

Unfortunately, DS decided to poop in the waters, meaning an instant transfer to the consultant led unit. C’est la vie.

My point is - there’s no harm in asking. You might stand a better chance if you’ve turned 40 whilst pregnant, but I’m not sure xx

I had both of my children over 40 and one was a home birth. If you have a healthy pregnancy with no issues, using the MLU should not be a problem. You also don’t need to be induced on due date if everything is fine with the baby. The inducing on due date for older mothers is basically a process and some
NHS Trusts do it and other’s don’t - there’s no firm evidence that it’s better/safer and can lead to a worse experience in labour. I swapped whilst pregnant at 41 between an NHS trust that was insisting that I was induced at 39 weeks to one that had no such policy, due to moving house in the middle of pregnancy. I planned to give birth in the MLU, but there were no staff available when I went into labour. You may need to be assertive with the consultant, but don’t get pushed into anything you’re not happy with and ask for evidence to back up why inducing on your due date is being suggested or having a consultant lead birth.

And good luck!

Thanks for replies - I was 39 and 11 months when I got pregnant!

I've had no issues at all except that the umbilical cord only has one artery (1% of normal pregnancies have this, should I feel special) - giving them a much stronger argument for induction around deterioration.

Will do some reading up and push for the MLU. Annoyingly the first midwife I saw was really encouraging me to consider the unit whereas this one was a bit like well the consultants won't like it.

the umbilical cord only has one artery (1% of normal pregnancies have this, should I feel special) - giving them a much stronger argument for induction around deterioration.

Why not just go with their recommendation? The high risk policies and age cut offs aren't randomly arrived at and you do have an extra issue already.

I was forty when I had my last and there’s no doubt that forty isnt twenty five in childbearing terms. They’re not just thwarting you for fun, honestly

I pushed back against consultants trying to lead me down a medical/induction/hospital birth because I had just tripped over 40 when I got pregnant.
I asked for what evidence I was personally showing that I was high risk - I had no blood pressure issues, no growth issues (I had extra scans because of the 40), no movement issues - in fact no issues at all so I refused the induction - which quite frankly they made it sound like it wasn't an option.
But only because I had the support of friends and was widely read on mumsnet that I had the confidence to do this. DS was born safely at 8 days past due date in the midwife unit.
It really depends on your confidence and attitude - if you are worried and trust the doctors especially given the artery situation then you may feel safer following their advice. If you want to be midwife led then you need the support of your partner/family and midwives otherwise they will make you feel bad and that will put you in a headspace that is sad and scared and isn't good for giving birth.

Obviously there isn’t a magical change that happens in your body the moment the calendar rolls over on to your 40th birthday. But since nobody has a crystal ball to know exactly what will happen for you, they have to make recommendations based on the generalized information we do have available. And that information strongly points to older mothers being at greater risk. It also points to the fact that one way to reduce the very high rate of stillbirth in UK is to more readily offer inductions at term. And it points to the fact that as the bang goes past term and becomes overdue, the risk of the placenta failing grows.

Added to all that is the fact that your baby has a specific feature with just a single arterial cord. All of the risk factors above impact on placenta and cord function, and your baby has a specific cord condition, so you can see why they are making the recommendations they are.

You should also know that the default standard of care is consultant-led and midwife-led should only be offered as an option for low-risk women. Unfortunately your profile doesn’t suggest you are low risk, so midwife-led care may not be appropriate for you.

I’d suggest you talk it all through with your doctor on the next visit and ask lots of questions.

Best wishes

Because it's not based on the umbilical cord, it's based solely on my age. Yes, I would listen to evidence on the cord but that is not the policy they are following. The cord can lead to growth reduction, in which case I would change my take on it but it currently isn't. In fact he is doing very well with head, abdomen and leg measurements.

Yes they have to have a cut off age point but as I am only just 40, the risk is very very low for me as the risks are covering women up to 50.

I feel like I would like to start there and then move if things change, especially as they are on the same floor. The calmness and the fact it doesn't smell or feel like hospital is much nicer.

suppose I'm just feeling a bit frustrated that I've met with the consultant previously and none of this was mentioned.

Oh well, will get my questions together, see how it goes at the meeting and also see what happens on the day anyway!

Both my deliveries were inductions on the labour ward. And my first ended up
in forceps. Despite that they still both very much felt ‘midwife led’. I only saw the consultants briefly at points where I wasn’t really aware of much other than my own pain! For most of labour I was in a quiet and darkened room with only my husband and a midwife for company.

forceps give me the fear! I mean, I know it may well end in that anyway and that induction is very likely as I don't think he'll come on his due date anyway and I'm not looking to hang on for very long.

Darkened room, me, partner, midwife sounds ok.

I agree wholeheartedly. I was 6 weeks past 40 when I conceived. According to the NHS I was about to die! I was made to feel as thought I was going to develop the most hideous complications solely because of my age.
All I can say is that I refused the induction despite some idiot of a consultant writing 'induce at 39 weeks' in my notes at my first meeting whilst talking to someone about me whilst I was in the room. He never even spoke to me! I gave him a mouthful and basically that was the start of my relationship with the NHS.
I made it to 40 weeks plus 6 and they told me that the baby wasn't growing and the placenta was failing.
I ended up being induced because they more or less told me it would be my fault if I had a stillbirth.
It was the most hideous experience of my life. I was allergic to the drugs, caused baby to go into distress. 23 hours later emcs.
At the time I believed it was because of the distress to the baby, one year later I found out that there was nothing wrong with either baby or myself and it was a preventative procedure rather than a cure!
I am furious.
I got hold of my notes and turns out the placenta was not failing and baby grew 1 lb in 4 days so it was all a load of rubbish and a ploy to get me to agree to the induction simply because of my age.
They admitted this at a meeting I had with them, even though they also said I was fitter than someone half my age and had no problems whatsoever during the pregnancy.
Section was botched and still in pain a year on. They have sent me to see a plastic surgeon (NHS funded) to see if it can be fixed. The surgeon that caused the damage won't see me because apparently I'd be too traumatised meeting him again. More like he's scared I'll kill him!
Just wanted to add that they will make you feel ancient because of the magic 40 number.
If it came close, I'd ask for an elcs rather than the induction as it really was hideous. They won't offer you an elcs as it costs more but if you ask, they cannot refuse.
Also, induction potentially causes more complications and chances are they won't leave you be anyway and you may end up with the section anyway. They call it the devil's drug and I know why now. I said explicitly no forceps and turns out they were going to try and deliver baby with forceps in theatre. Fortunately baby was too high so I was spared being sliced open but I was horrified when I found out. The doctor was an idiot to be honest and ignored every single thing I said.
I can't have any more children now because I'm too scared. The NHS very nearly killed me because of their negligence.
I just think once they have you in their grasp they will do whatever they want. They really don't care about your wishes, just their statistics. I was actually told I was a statistic and not a person!
This all happened at University Hospital North Durham, so avoid like the plague.
I am taking it further, but waiting on official report.

Just wanted to ad that the rates of stillbirth statistics I was given at the meeting were 0.75 in every 1000 under age 40 and 2.5 in every 1000 over 40.
Hardly a huge difference.
They refused to break it down even further, but I suspect the majority of stillbirths are not simply because the mother turned 40 a few weeks back.
Statistically, more damage occurs due to medical intervention rather than leaving things be if no problems are indicated.
However, they WILL find a problem ,even if they have to make it up as in my case just to keep their statistics right.
I now that Durham hospital's stillbirth is 10% higher than the national. Why? Well I'd like to know that too.

ViragoKnows

Why not just go with their recommendation? The high risk policies and age cut offs aren't randomly arrived at and you do have an extra issue already.

In my case they were!

I was forty when I had my last and there’s no doubt that forty isnt twenty five in childbearing terms. They’re not just thwarting you for fun, honestly smile

Oh yes they are!!!!!!
Age has nothing to do with fitness. Your body is as old as you let it be. Some 20 year olds are obese and diabetic and goodness knows what. How on earth am I deemed high risk when they are left alone?

Oh, to touch on a point that @joinourclub made, even though I was taken to the consultant unit, I only had midwives with me during the birth (until they had to call the paediatric team because they lost the heartbeat on the monitor).

Other than that, it was just me, my husband, the midwife and the student midwife for the birth.

I would second Orsy’s account of being treated like an age/statistic rather than a whole person. My first birth was like this and I wasn’t listened to at all and ended up with a epesiotomy, forceps and an epidural all very much against my wishes. Nobody listened to me, down to being told to push by the midwife, me telling her that I didn’t feel the urge to push yet, her insisting that I push and then being told because i’d been “pushing” for x amount of time the baby must be stuck and the chain of events happening as above. I’m still suffering the physical after effects of this birth almost 6 years later as the unnecessary episiotomy was bodged by a student doctor. (The hospital have admitted that my daughter was not stuck) but as I was treated as high risk due to age, every time I offered an opinion it was ignored, even when expressing my actual physical feelings. The second time I had a home birth as I didn’t want to go back to the hospital again. ( I live close by so could easily go in if something went wrong) and it was a much better experience and recovery was much better even though I was 43. I was refused an ELC which was the only way I was giving birth in hospital again. So stick to your guns and way up the risks for yourself.

Someone said “Just wanted to ad that the rates of stillbirth statistics I was given at the meeting were 0.75 in every 1000 under age 40 and 2.5 in every 1000 over 40.
Hardly a huge difference.”

The difference in 0.75 and 2.5 is enormous. It is over three times greater. That is 333% more. For every one baby that dies in the under-40 group, three do in the over-40. I wish people wouldn’t blithely dismiss medical advice online like this. It’s spectacularly dangerous and misleading.

OP I hope you talk everything through with your doctor before a decision and please don’t rely on internet anecdotes.

@hoorayforharoldlloyd You can speak to a senior midwife about birthing on an MLU if you are 'out of guidelines'. They used to be called Supervisor of midwives (SOM), but have changed names. The consultant will likely push for a medical type birth, where-as you should be able to get a plan you want (with full discussion of risks/benefits to help you choose) by speaking to a SOM.

Might be worth ringing either your named midwife, or the MLU to chat about who to speak too? Good luck

Someone said “Just wanted to ad that the rates of stillbirth statistics I was given at the meeting were 0.75 in every 1000 under age 40 and 2.5 in every 1000 over 40.
Hardly a huge difference.”
sycamore54321
The difference in 0.75 and 2.5 is enormous. It is over three times greater. That is 333% more. For every one baby that dies in the under-40 group, three do in the over-40. I wish people wouldn’t blithely dismiss medical advice online like this. It’s spectacularly dangerous and misleading.

What they don't tell you is the other factors which have nothing at all to do with maternal age. There is more risk of baby dying due to intervention than of stillbirth. They use their 'statistics' to scaremonger. They are not comprehensive and do not paint the true picture. A baby is more likely to be severely/fatally injured by use of forceps than because the mother is 40!
The NHS are misleading, they don't state why those babies die.

just thought I'd give a follow up in case it's of use to anyone else.

So according to the midwives, my age isn't really that big a deal as it's only pure luck that I'm not down as 39 on my booking in appointment (literally 7 days after my 40th) - they would definitely have supported MLU and almost certainly been able to negotiate that.

However, the single artery, potential for restricted growth and now apparently strong possibility of continuous monitoring are making it almost certain that I'll be on the labour ward and can't have a water birth. I've put in a request to meet the consultant midwife to make a birth plan and have a meeting with a consultant for week 38 to talk about whether there is any flexibility in induction/what they suggest for my particular case.

Baby is growing perfectly at the moment (week 30) and had no issues raised at growth scan.

I've started my antenatal classes and talking through induction and labour wards has helped me to process this a bit more - I'm still going to see about a birth plan with the consultant midwife but am feeling a lot more accepting about everything changing. The big thing is that I wish they had told me about things in one go, not in throwaway remarks, and had given me some time to talk through what each thing meant.

So I'm feeling a lot more positive about seeing what is possible in terms of birth choices and also about accepting different paths - although now I'm thinking about being clear that I would like outpatient induction as I think it will be calmer, plus although I am facing risks, none of them have actually happened.

Thanks for the responses.

Good luck.
Make sure they read your birth plan. Mine was ignored despite 2 copies stapled to my notes.
At the end of the day, they WILL do what they like, so read up on everything you can and make sure your partner is aware of your wishes and get them to be your advocate should need be.
They're not really bothered about you as a person. All they care about is their statistics. So long as you're breathing they won't care about the carnage they (could) cause.
This is my experience. I hope you have a much better one.
Just be aware that they will do whatever, even if you say no. If I ever do it again (which I won't) I know for sure I'd have a copy of my notes at hand so EVERYONE had to read it before speaking to me. I'd also make them sign that they have. Also, I'd ensure that 'informed consent' meant myself or my partner agreeing in writing too.
I was assaulted by 2 'staff' members at the hospital, but told I must've forgot they were there. I most certainly did not and neither did my partner.
The staff were obnoxious and inept. mind you, this was at University Hospital North Durham, so if you're not going there you may be better.
My experience was truly awful, so forgive me if I sound ridiculous, but if you lived through what I have you'd probably do the same!
keep us posted and good luck!

I’ve pm-ed you OP.

Further update - spoke to consultant midwife, who was very cheery and relaxed. My age is not an issue and as baby is growing normally that will not be seen as a risk as long as he is continuing to grow normally at 36 weeks.

If all is well, I need to ask the people doing the scan to confirm in writing that I don't need constant monitoring - so all birth choices will then be available again. Don't know about induction issue and obviously who knows what will happen on the day but feel a lot better for having had the conversation.

Thanks for all the replies and stories.