"a rather worrying trend of births to [older] women"

[TheFourYearOldDrankAllTheMilk]

So say "experts" quoted by the Guardian.

https://www.theguardian.com/society/2025/sep/11/more-than-half-of-uk-births-now-involve-medical-intervention-audit-finds

What a crock of nonsense. Women have been having babies into their forties since God was a lad. That there are more interventions is down to doctors getting involved where a midwife wouldn't.

Just to give myself as an example. So far this pregnancy I've been told I am high risk because I have

Rhumatoid arthritis (I don't and never have, so that came as a surprise)
Had a small baby (previous kid was 7lb 7)
High blood pressure (BP is consistently 117/75 or thereabouts)
Liver disease (news to me)
Obesity (bmi of 30.3. Not exactly in the Roly Polies, to be fair)

And that I am old. I'm 41.

I live in an area with no midwife-led unit within a sensible distance (it was closed down; I understand it failed some inspections) so there will be doctors nearby when I give birth, and I'm not a hippy so if I do require intervention I will accept it, but they have been trying to book me in for an induction since I was barely mid-way through this pregnancy.

I am immensely grateful that the doctors are keeping an eye on me, but honestly it has taken some sorting out of all of the mistakes on my record.

Now, to read an article that lazily quotes "experts" and informs the public that British mothers are struggling with an unassisted, vaginal birth because they are old and fat is a slap in the face. Perhaps what they ought to be doing is writing articles encouraging women to empower themselves against intervention, like extolling the virtues of practices such as perineal preparation. [Buy an Epi-no, ladies, do it!]

I won't even comment on the fact that the journalist, described as their health policy editor, no less, feels the need to clarify that a caesarean section is a birth "in which the baby is delivered during an operation". OK, yes I will. Who exactly has this article been written for, four year olds‽

Already women in the west are pushed towards delaying or not having children, largely because of the need to establish a career to pay for the massive jump in house prices compared to even as recently as the 1990s. Let's make them feel even more shit about themselves if they dare to have a child over the age of 40.

Please do better, The Guardian.

This article made me so angry. A small increase due to mum's being a bit older/heavier? Maybe. 50% increase in C-section rates over less than a decade? No eff-ing way.

I never thought of that. Interesting point.

Could this also be because NHS policy has changed and they can no longer refuse maternal request C sections? Which is surely a good thing.

Probably a small contributor and obviously that would be a good thing. I honestly doubt it's contributing very much though as the rate has gone from 25% of births by CS in 2015 (including emergency and planned) to 29% emergency and 13% planned in 2023.

According to this report I found the emergency/planned split for 2015 was 13% Vs 14% (27% total as opposed to 25% in the article because the report is for England only whereas the article includes Scotland and Wales). Therefore the increase is pretty much entirely due to emergency CS.

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2015-16#:~:text=The%20number%20of%20deliveries%20for,pdf%2C%20size:%20143.0%20kB%5D

Yes, that's bound to have made a difference and is an unequivocal positive. The previous CS percentage excluded a cohort who would've wanted an ELCS, but for whatever reason couldn't successfully navigate the system well enough to get one.

The induction policy has changed since Ockenden, which will result in more c-sections as well. Although you can refuse, you are strongly pushed to have an induction from 41 weeks, and if the induction doesn’t work then you’ll end up with an emergency c-section. While there were good reasons for changing the induction policy, it’s had consequences.

As I've commented above, the ELCS rate doesn't seem to have changed much, if at all. The difference is mostly because of EMCS rates.
Agreed that if the change was due to women's choices that would be unequivocally positive.

Your comment above said it was a small contributor, which means like me you thought it had made some difference. I agree that the change is mostly due to greater EMCS rates, but that aspect of it is not what I was commenting on there.

Great detective work!

I also wonder the maternity scandals and the Ockenden report, followed by removing the C section target limit for the NHS had an impact on EMCS rates. If so, that’s also a good thing.

Previously, emergency c sections were denied in risky situations in which they really should have gone ahead in the name of a fixation with “natural birth” at all costs. We all know about some of the most horrific cases, in which mothers or babies died, or babies were disabled as a result. But on a lower level, I wonder how many traumatic births or birth injuries were caused by these unfortunate targets.

As an example, a friend who had had a very prolonged labour was first granted and then denied her repeated requests for a C section. She then had a 3b tear, with lasting effects, and her daughter was born not breathing and needed medical assistance. This was at a hospital that prides itself on its low rate of C sections. Our NCT teacher went on endlessly about that and about their amazing birth centre during our course. Meanwhile I had already chosen a different hospital because it had a high rate of sections. It may sound perverse, but it has an excellent maternity unit and I wanted to know that if I needed intervention I was going to get it, and quickly, irrespective of some pointless target.

That’s because of a study that showed a higher rate of stillbirths at 42 vs 41 weeks. The study was actually cut short because it was so clear, it would have been unethical to carry on with those who were in the 42 week group. I remember it well because my husband was reading about it when I was in labour with our daughter (pessary only induction, at 41 weeks, at my request).

Makes sense.

Good point.
Personally, I think that we are both too quick and too slow to intervene. For example we're too quick to go to hospital with perfect healthy pregnancies and slightly elevated risk factors when it's been shown that home birth is safer. Then too slow to intervene when women raise concerns, pushing women to keep trying when they say they want an EMCS or telling them they've weed themselves or they're having normal pregnancy pain when actually their waters are breaking and they're going into early labour.
Obviously labour sometimes goes wrong but the idea that the majority of women need medical intervention to get thorough it safely is just crazy. I'm incredibly grateful that we have modern medicine to save us when we need it but unnecessary medical intervention causes harm.

What a lot of nonsense. My dm had babies at 38, 42 and 44 in 1959, 1963 and1965. I had ds when I was 45, in 2008. My BMI prior to pregnancy was 21.5.

I had no complications throughout my pregnancy, no nausea, and worked full time until 36 weeks. Blood pressure was normal throughout. My midwife told me I had gestational diabetes (wrong), that baby was breach (wrong), that I'd need a section (wrong). She tried to pressure me into a sweep at 9am on my due date, which I refused.

If inductions have increased that's down to the hcps bullying, not mums asking.

In my case the midwife was hopeless and my GP was calmly competent.

I went into labour naturally at 40+4 went to hosp at 40+5 pm and ds was delivered at 7.50am 40+6. I required help (ventouse) at the very end, which took about 10 minutes including stitching me up afterwards.

So my need for care was an amniocentesis at the start, a ventouse delivery and being stitched, plus 2 days in a bed after ds was born. Once we left hospital we didn't need any help.

All my dm's deliveries involved her staying in hospital for a week.

Just on another note, a year or so ago my friend was in hospital with midwives and felt that her baby was stuck and labour wasn't progressing. She asked repeatedly for an EMCS and they just ignored her and told her to keep trying. This is after they broke her waters without even telling her, let alone getting her consent.
It's goes both ways, intervening when they shouldn't and not intervening when they should. The important thing is to respect and listen to women, always.

@Nimnuan I see your point, but personally I wouldn’t go anywhere near a home birth no matter how healthy and uncomplicated the pregnancy. I understand that the chances of things going wrong are, in absolute terms, low. But the consequences can be disastrous if they do go wrong and there isn’t the proper medical assistance available. And when they go wrong, they can go very wrong, very fast. Deprivation of oxygen for the baby would be by far my biggest concern, followed by the risk of PPH. On the latter I speak as someone who lost 2.9 of blood very very fast. There’s no way you can get someone to hospital that quickly.

Re the safety of home births - the numbers are skewed from the start by the fact that it’s a healthier cohort with uncomplicated pregnancies vs the hospital cohort. Also, I’m not sure if the stats compare apples to apples. If someone started off as a home birth and was then transferred to the hospital, does that count as a home or hospital birth?

@EarlGreywithLemon

I'm saying this based an a large meta-analysis published in the Lancet recently.

It included approximately half a million intended home births.
It's comparing low risk with low risk, the home birth cohort is not healthier, the numbers are not skewed.
If you transfer, it counts as a home birth.

Link below if you're interested.

www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext

Interesting study, thank you. It’s still not something I would ever consider, but that’s me and we’re all different. And I’m also lucky to live near a hospital with a good maternity unit, which I appreciate isn’t the case for many.

Having researched my family tree I can confidently say you're talking shite.
I have documented proof of many many women in their 40s having babies going back to the early 1800s including my great grandmother who gave birth to my grandmother ( her 4th baby) aged 42.

Its weird because everyone I know recently been in there 40s and has successful pregnancies and babies. My youngest I had single at 40 and twins at 41 all home births same as my oldest children all went great

Most of the protocol for PPH can be applied at home. It starts with rubbing up a contraction, drugs, maybe bimanual compression, and delivery of the placenta. The vast majority are solved in the labour room using things that you would have at home. Women make adaptations in pregnancy to counteract significant blood loss in labour.

Every single pregnant women is seen by midwives regardless of the risk status of your pregnancy. Even if you are expecting triplets, you'd still have midwifery appointments between scans and obstetric consultations if it was feasible. I have known of people who never ever saw a midwife alone for their entire pregnancy, but it was literally because they saw the doctors every week at the hospital clinic so only saw the accompanying midwife there. Their pregnancies were ultra high risk.

For most women deemed high risk, they might have a obstetric appointment at 20 weeks and maybe towards the end and at these appointments, the obstetricians would plan the extra care they need like scans or extra appointments for check ups with the midwife.

There is no way that NHS obstetricians would agree that it is in anyone's interests for them to lead all appointments with every woman deemed high risk. They dont have the time and they'll admit themselves that they'll start finding problems that aren't there.

I had two babies in my early twenties, pregnancy was easy as was the births. My body recovered quickly and I had boundless energy that got me through the sleepless nights etc.
i had a baby in my late thirties and massively struggled with my health, mental health and weight. My body never fully recovered and I struggled with having a young child.
had the baby been my first I wouldn’t have had the comparison but it was so much harder when I was older.

I recently gave birth and was under consultant care for having had previous small babies. However a mistake had been made duplicating a record which meant I had an extra pregnancy documented and would need to correct them at each appointment. I was told I would be induced due to small babies but as current baby growth scans were fine in the end they induced me due to me being 40! That’s ridiculous as I know of women 44 /42 who were left alone and labourer naturally and were not labelled high risk due to age!

@EarlGreywithLemon no, of course it's not for everyone. As you say we're all different and if hospital is where you feel safe then that's the right place for you.
Anyway, that study doesn't apply to you personally if you've had a previous pph (or to me as I've had the same but I'm balance I still feel better staying home). I just think it's good to be aware that many things we take/took for granted as being safer/beneficial were introduced without any evidence and either still lack any evidence or have been shown unsafe. For some other examples CTG, routine vaginal exams, directed pushing, various forms of perineal protection, optimal fetal positioning/spinning babies, sweeps, immediate cord clamping, routine augmentation at hour X, elements of 3rd stage management, etc.

@LoftyRobin you might have a medical background (I don’t). My PPH was due to a suspected placental abruption, so I’m not sure if the management would be different. I do believe though - correct me if I’m wrong - that if the PPH doesn’t stop via other methods, it’s ultimately a matter of a hysterectomy, not to mention fluids or a blood transfusion on the spot. Surely those can’t be done at home?

As for midwives/ consultants, my notes had me as moderate risk due to age, with scans at 32 and 36 weeks followed by obstetric review. I saw the obstetric consultants three times as part of the joint obstetrics cardiology clinic.

As an aside I found the consultants very level headed, and not at all jumpy or keen to over diagnose. The midwives were pretty variable. I saw an excellent one two or three times, but even she couldn’t answer all my questions and told me to ask the consultants. The others were very nice, but often gave me contradictory advice which I then had to make sense of at the consultant appointments.