First baby @ 49, need advice on what to ask the consultant/obstetrician

[Easter2020]

Hello MN,

Other than being a medical miracle, I'm considered low risk as have no complications other than a large anterior fibroid and being old. We have our 21w anomaly scan tomorrow (at 21+2) and the first appointment with obstetrician next week.
I met with the high risk midwifery team a few weeks ago and was brushed off pretty quickly as my overall risk factors are low. I asked when they would start thinking about the birth and was told there was no reason I couldn't go to 40w or beyond. No one, including the midwife team that I'm assigned to have batted an eyelid about my age, which in itself if a bit of a concern.
I'm worried about the placenta starting to fail towards the end of the pregnancy, and also that the fibroid might interfere with a natural labour. I have no fixed views on how to get the baby out, I just want both of us to be alive! I've waited a long time for this and I don't want to take any unnecessary risks.
All of the research on pregnancy and delivery for older women focus on the risk of deformity due to the age of the eggs (risk has been mitigated), the risks due to pre existing conditions (I don't have any) and then there is the stillbirth statistics (increasing from 39 weeks)
Are there any ladies out there (or gents if you are medically trained or personally experienced) who have had their first baby in their late 40's, and if so, what questions should I be asking?
Many thanks for your comments, they are really appreciated. x

No advice I'm afraid but congratulations and hope the scan goes well.

Congratulations.
I'm surprised you are low risk as they usually consider you high risk if you are older' especially if it's your first. I was mid 40's and had my fourth and had to be VERY assertive about being treated like a person and not just an 'elderly risk'. I found the midwives and sonographers lovely, the obstetricians were very medical model. There was a clear treatment pathway for women over 40 where I lived so maybe its different depending where you live?

Congratulations! Amazing! Do you mind sharing whether you conceived naturally or with some help?

No tips I’m afraid. Would love to be in your position as an elderly TTC-er.

Another with no advice, just wanted to say congratulations and I wish you a healthy happy pregnancy, birth and beyond.

Hi @Bluegreengrey - we had 3 rounds of IVF (not sure if I'm allowed to say which specialist ladies clinic on Harley Street :) but you can message me directly if you like) The expert was Stuart Lavery - can't recommend him enough - so calm and straightforward to deal with. 1st go failed, 2nd had missed miscarriage but this gave me the encouragement that I could be pregnant and stay pregnant, and then this miracle! Neither of us can actually believe it, but as long as everything is still ok tomorrow we agree we'd better start making proper arrangements and buy some stuff or the baby will be here before any kit!

Hi @Snowmonster thanks for your comments. I'm at St Georges in SW London, but have told the other half that if the obstetrician brushes off the risks I want to go private, I don't care that its madly expensive.

St Georges delivers 5,000+ babies a year and has a well regarded fatal medicine unit: I almost think this makes it not a great place for a healthy older women to deliver as 1: its a super busy hospital and 2: if you aren't actually at risk, the smaller but real risks like placenta failure might not be addressed upfront. This is the main thing I want to speak to the consultant about.

Lucky you having 4! This baby does have 4 grown up siblings who are surprisingly enthusiastic about their growing baby brother or sister - that was a relief of a different magnitude lol.

A good friend had her first at almost 47. Conceived naturally and no complications. Didn't Cherie Blair have her last at 48?
Trust the doctors- if they aren't concerned then don't stress yourself.
By the way I had both of mine in my 40s and other than a brief 'you are entitled to further testing if you wish' there was no emphasis on my age at all.

Don’t believe them. I was told the same thing despite having 2 conditions that the NHS doesn’t recognise as risk factors for placental failure (but other countries do). I pushed for an induction on my due date and was so grateful for it as my placenta and consequently my baby’s heart started failing on the day - the consultant in charge of my delivery on the day said quite bluntly the baby would have died had I been left to go even a day over and if I get pregnant again I will need a c-section at 38 weeks. I am not even 40 and so imagine your risk for PF would be far higher.

Hi, congratulations! I was 46 when I had my 4th baby (natural conception when we'd given up hope after multiple losses) and was considered higher risk due to my age. I had more frequent early scans, though this was because I'd had miscarriages previously. I had a few extra scans towards the end as they wanted to monitor the placenta ( which turned out to be absolutely fine). All in all it was a straight forward and uncomplicated pregnancy. I was told as a geriatric mum they wouldn't let me go beyond 40 weeks and I was booked in for induction on my due date, went in to hospital at teatime and baby was born in the early hours of the morning ,quicker than my previous labours. I think it's less unusual now to have mums in their forties, certainly medical staff didn't make a big issue of it and there were quite a few older mums at the playgroups we went to, but I think it's reassuring to have some extra monitoring if appropriate, so I would ask about extra scans and possible induction.

I was 40 when I had my one and only DC. Perfect pregnancy, no risk apart from my age. Saw my consultant at 36 weeks and she said she'd book me for an induction on my due date is ds hadn't arrived of his own volition. I was glad, as I had concerns over what I had read about placentas degrading after 40 weeks. I didn't care less about how I had him as long as he arrived and was healthy. As it turns out, I went into spontaneous labour at 39+6, so no induction needed. We're not planning anymore, but if we were, I too would be worried about the lack of concern regarding going overdue....

Congratulations!
As an independent specialist midwife I have a lot of contact with the team at St George’s., particularly the fetal medicine team. Would be interested to know who you are seeing - PM me if you want to
Happy to discuss things with you if you’d like another perspective/support

Thank you ladies, for your kind words and encouragement, as well as the boost that I need to be proactive about risks when I meet with the medical team. All the best x

I work at St. George’s, I’m intrigued who the ‘high risk team’ you saw were?
You will be offered and advised for induction at 40weeks due to increased maternal age. You will have a 36weeks scan to assess growth, Dopplers, liquor volume.
GTT at 28weeks also.

Consultant appt, doctor will discuss risks based on your age and plan for the pregnancy.
SGH is a well respected tertiary referral unit who deals with incredibly high risk women.
You’ll be grand

hi @Mummyme87 I saw a senior midwife on the Mulbery team, and today I saw an obstetrician after having had the 21w scan last week. The midwife was very nice, and perhaps it was too early at 16 weeks to make any assessments but I did feel pretty brushed off. Today the consultant was patient and talked through the medical elements of my concerns but she still stuck to a wait and see and we'll make decisions after 36 weeks.

My issue is that at 36 weeks there is a chance the baby will be here and I won't be prepared if I take that stance, and it only gives 1 week to prepare if the baby decides to come at 37w which is the start of ''term" and further, there was no concern expressed at all about me going to 40 or 41 weeks when in reality there is a risk in my age group. When I said to the doc I hoped to deliver between 39-40 weeks she said it was my choice. I find that so irritating because if it's really my choice I'd be at home with a massive water pool and a lava lamp, but no medically trained person would recommend that one!

I find it more helpful to have choices or recommendations based on facts and evidence, and a mums netter replied to this post privately and helped me on that path!! Yay for Mumsnet.

Last week I met Angie Bowes, an independent midwife who has retired from the NHS and now has her own practice: note - private midwives can attend women in NHS hospitals as their birth partner but not in a medical capacity due to insurance and other restrictions, and not in any way replacing or undermining the team at the hospital - they are your advocate and in Angie's case she knows the team at St G's quite well so she was able to reassure me of what to expect in my appointments and walk me through how to approach the complicated elements of my pregnancy. Well, they are complicated to me lol!

So I'm somewhat resigned to a wait and see approach, but I'll get more educated along the way whilst enjoying each moment of this special time and knowing that the delivery is just an event and the main focus should be on when the little bundle arrives.

All the best ladies xxx you're awesome

Hi OP, I'm 40, consultant-led and the main differences from my first birth at 37 so far:

16w doctors appointment with the consultant's team. She prescribed a daily low dose of aspirin due to increased risk pre-eclampsia at 40
28w GTT appointment
28w follow up dr appointment
32w additional scan

I'm only 19w but I'm told I will have another appointment with the drs to discuss my birth plan