Help welcome....about inductions/sweeps when an older mum

[MelissaCeleste]

Hi all, I'd appreciate any insight into this subject and all experiences welcome.

I am currently 36+3 and very elderly at 43yrs . Today at a hospital appt. the doctor offered me the option of being induced from 38wks. This isn't my preference at all so he then suggested that I have my midwife give me a sweep from 39wks. He framed all of this advice in the context of my age. When I told him that I don't fancy being induced or interfered with, he then said he is naturally a 'hands off' type of guy so had some sympathy with my view. He didn't apply any pressure on me to agree with him or to make any decisions. After he had examined me externally, he was happy that everything is fine thus far.

Soooooo, my preference (although I fully realise that these things are not completely under my control) is to go to term and then see about my midwife giving me a sweep (although I don't really relish the thought of it tbh).

I'd love to hear about others' experiences, particularly older mums, when in this situation.

Many thanks in advance.

Hello, I can only offer an experience of a sweep if thats any use. I had one with my last daughter, after going over my due date by 9 days. It really wasn't that bad at all. Only slight discomfort, it was done at home, and sure enough, babay arrived under 24 hours later. Good luck!

Thanks for your reply expectingno3 - may I ask if you are over 40yrs old because age seems to be playing a big factor in my care atm.

Hi - I gave birth to my first last year at a couple of months short of my 42nd birthday and no-one ever mentioned anything about my age at all. Might be worth asking your doctor why he thinks you should be induced early.

I saw a consultant at 39 weeks (routine appointment as I had antibodies in my blood) who wanted to give me a sweep there and then but didn't offer any reason. I refused and I'm glad as I had a great birth (well in relative terms!) at 41 weeks. I'm not sure this would have happened if I'd had a sweep kicking things off before my body was ready.

Just my experience but hope it helps.

I wonder why he felt the need to examine you internally at 36+3 - what was the indication? PS Obviously if you do go 'post dates' take all the sweeps offered prior to the formal induction in hospital

Hi, I would go with with your 'gut' instinct on this issue. Obviously, if the Dr informs you that you need to be induced, then it's best to listen, but if he's offering you a choice at this stage, then it may be best to go with your own feelings. I say this, because I had to be induced at 39 weeks because my baby was in distress (leaking fluid and baby not growing), therefore I was induced as a matter of urgency. However, the induction did lead to a 3 day labour, emergency forceps, third degree tear and a haemorrage. I don't know about the age issue, but one thing to bear in mind is that a long and difficult induction can result in the mum having less energy to look after the baby. Something to ponder on anyway... Good luck with your pregnancy, I hope it all goes well.

Thank you for all the replies, all interesting.

thefatlady - all the advice given to me today by both the doctor and the midwife who took my blood pressure was definitely within the context of my very advanced age! They kept alluding to 'bad outcomes' (without being specific) although the midwife did say that all doctors are bound to be influenced by their own clinical experiences and it could be that the doctor I saw has had such with ancient women. The doctor wanted me back in two weeks at 38wks but I said no thanks cos I know what he'll say - same as he said today! I am seeing my own midwife in two weeks though so I can ask her some questions then.

Angie - the exam was external, so just the usual tape measure, prodding, listening and so on. All to the doc's satisfaction.

Frolie - that sounds grim I have to say but of course, where medically indicated, there is little real choice in the matter. I guess I'm just wondering whether my age is a 'medical indicator' or not...

I do feel, at this point, that I do still have choices open to me and my gut feeling is that I would be OKish to have a (term) sweep rather than an induction...

Ive been researching - a bit manically :) problems with older Mums as I will be 46 whe my first is due
I think - we are more likely to be early or late than other Mums, and are more likely to have health issues such as pre eclampsia - which they should be checking for, I have no intention of letting anyone furtle about in my nether regions unless I want them to, or the bairn is in any distress.
I would like minimum intervention and will hang on as long as possible.
Have already entered into battle with consultant (a minor scuffle - I think I won, but have two extra growth scans as punishment :) )

violetwellies - great to hear from another elderly mum . Interesting to hear about the reading you've done and it's great that you already seem to know your own mind about how you want your pg to evolve.

So far this pg, everything has progressed smoothly and there has been no raised blood pressure (or even close to raised) but my DC2 (term +1) did have shoulder distocia (a 'mild' case according to the doctor) which may be another reason why they don't want me to go beyond 40wks, although as I said earlier, all the advice today was firmly framed within the context of my age.

Like you, I just dislike the thought of being interfered with if it's not absolutely necessary - but there's the rub I guess...and as the midwife said, 'pg/labour is an art not a science' aggghhhhrrrr

Hi there, I am 40 and asked my midwife last week about this. It does seem to be dependent upon where you live. I border across two counties and in the next county they give women 40 and above a sweep at exactly 40 weeks but she said that at my hospital they are not so bothered and will just see me every 2 weeks from now (am 35 weeks) and then work out what to do if I go over (as I generally do). Last time I was 38 and I did reflexology on my due date and gave birth the next day (they do say if it is going to work it will do so within 24 hours), I'm gonna book one for the week I am due this time too!

Hello MelissaC I had my last baby at very near 43 -just squeaked in under! I too had a straightforward pregnancy and my midwife felt no intervention needed. However she warned me the consultant would- because of my age- probably advise me to be induced at 40 weeks and have sweep at 39 weeks. This did come to pass..at my oap appointment at 38 weeks..
Apparently, in older women the placenter is more likely to get less efficient and there is a tiny extra risk of still birth. The consultant agreed that all looked well and unlikely but I got scared. I had 2 sweeps in my 39th week and baby born naturally bang on 40 weeks. It was purely because of my age I was given this advice - nothing to do with any test results during pregnancy. Good luck whatever you decide.

Janus, it's interesting how different ideologies exist in neighbouring counties, wonder why - I mean who decides what goes?!

OfftoNarnia - this: '...but I got scared' yep, that's a bit how I felt today when they all started referring to my age because until today, every healthcare worker I've come into contact with during this pg to date (from midwives, sonographers, FMC docs, etc) has not even blinked an eyelash at my age..yet all of a sudden, it's major news!

I will see what my own midwife suggests at my 38wk appt, although the hospital midwife told me, 'well she won't have all the information at her fingertips, blah blah'

Interesting thread! My own experience...

Had DC1 aged 38, no problems and went into labour spontaneously at 39 weeks.

Had DC2 aged 41 last year. Different hospital and consultant. Scanned at 36 weeks because "older mum" and baby showed mild asymmetrical growth restriction (abdominal girth less than head or femur size etc) by comparison with previous 20 week scan i.e. baby not just small overall but probably not getting quite enough nutrition to put on abdominal weight. As OffToNarnia says this is likely due to poor placental function, which is more common as we age. I think there was a second scan at 38/39 weeks showing same but no worse.

So they said they'd sweep me from 40 weeks or so and then induce at 40+4. I had two sweeps: both uncomfortable and caused over 24 hours of irregular contractions and therefore no or poor sleep during the week before birth, aargh, but no active labour. Ended up going in for induction at 40+4 which was painful but very swift. I personally would definitely have another induction but not the sweeps.

The baby was beautiful but definitely slightly "post-mature" with wrinkled, dry, scaly skin and very little subcutaneous fat (can be indicators of "post-dates" or poorer placental function) so I'm glad we got her out when we did. If I ever have another I would do the same again at the same time or even a week or two earlier. The 36 week scan was a great warning, at least for me.

Hope this helps. Good luck with your birth: hope all goes smoothly!

Lots of different experiences. My midwife suggested I was an ideal candidate for a home birth next time (said when she did the home visit the day after DS was born ) so she was hardly hung up on my age!

I agree with the comments about trusting your gut. There may be sound medical reasons to deliver early and of course you should listen to them - but equally I would want my doctor to explain in concrete terms what his/her advice is based upon.

Personally I found midwives to be far less interventionist - so could be worth getting opinions from both sides so to speak.

Good luck and keep us posted. Those early weeks are so magic (misty eyed hormonal expression!)

Katherine, thanks for posting. I thought the purpose of my doctor's appt. today was to be scanned to check the baby's weight (due to a previous history with shoulder distocia) but because the doctor was quite satisfied that everything was fine from the 'outside' and that the placental flow was also fine when he listened to it(at least I think that's what he said he was doing!), then he didn't bother scanning me.

To my mind, it just seems that all this talk about induction and sweeps is not actually specific to me at all but that it is rather a combination of hospital policy and research. All well and good but I think I'd feel happier about being induced if there was something personal to me that indicated it.

I am 44 and expecting baby number 6

Have been advised due to my age that they would prefer to have me in hosp to have baby but will support me whatever I choose so I am planning a hb. I am 37 wks tomorrow so all systems go from now.

Last baby came spontaneously at 37 wks after previous pg's had been induced due to pg probs. Laboured well, no probs post partum

I always have big babies, (baby number 5 was 9lb 5 at 37 wks born) so am having growth scan next week at 38 wks. It won't change anything whatever they tell me as it's just how I cook em but it keeps the hp's on side.

Sweeps will not work no matter what stage of pg if your body was not almost ready to labour anyway.

Good luck op, (and anyone else waiting)

thanks thefatlady, I am currently trawling the archives on induction and sweeps and have so far learnt that in Scandanavia, 'term' is defined as being 42wks, not 40wks! Also that sweeps only seem to work if your body is close to labour anyway.

I am looking forward to having a chat with my midwife in two weeks' time.

I joked with the hospital midwife today that for all the discussions that we had today, I could end up in labour tomorrow and she thought that would be lovely! It was like, the earlier the baby comes out the better!!!!

Lia, I admire your choosing a homebirth and it's great that the medics are supporting your choice - I think they'd laugh at me if I asked for a homebirth (my midwife has already said they wouldn't allow it due to the previous shoulder distocia) but it wouldn't suit me anyway so that's one argument I don't need to worry about! Good luck with your impending delivery but out of interest, if this pg did go beyond term, would you go for an induction?

Only if it went beyond 42 wks, as the gestation of pg is actually 42 wks, not 40.

However, I would still think carefully about it as the science of what starts labour is so unknown that we don't know what is term for us. My first dd, (16 yrs ago) was 18 days post dates, my last 21 days "early" if you like

Your menstrural cycle plays a part too, conception late in cycle usually means longer pg, we never actually know when conception took place. It's all so hit and miss.

Having said all that, I would listen to medics and make an informed choicebased on their findings AT the time

I'm not an "older mum", but I had a sweep when I was 6 days over, he was born exactly 24 hours later.

Bit uncomfortable if I'm honest, but it's a lot less "interference" than an induction.

Are you taking raspberry leaf tea/capsules regularly?

Thanks Lia and interesting that you would wait until 42wks, I don't think I've got the 'balls' (if you like!) to wait that long because I'd be concerned about placental function (though I do realise that being monitored daily is an option to alleviate this concern).

Lady - no, I'm not actually doing anything like that although I did have a 25mins swim today!!!!

I recently asked my consultant about this issue. Her opinion was:

• with increased age comes increased risk of certain problems (high BP, pre-eclampsia etc)
• age in itself is not an indicator for induction or any other medical intervention for labour, age just means that antenatal checks may be more likely to show issues that then lead to the decision to induce

So basically, yes with advanced age there may be a reason to induce, but the reason is not age itself, the reason to induce should be through clinical indications.

This is just an example of how treating people as individuals shows a variation from the norm when you look at the group as an average- 40 yr olds in general may have lower fertility than 20 yr olds, but you can still find a healthy 40 yr old who has better fertility than a particular 20 yr old.

I was swept at 39 weeks because I had gestational diabetes. In some areas they would have let me go to 41 weeks before induction but in most they woo't let you go beyond 40. Initially I was very keen to go to 41 but a consultant at a research hospital told me research strongly suggested that still birth increases after 40 weeks due to deterioration of the placenta. So different situation but very similar outcomes! I had three sweeps. Or rather three attempts. First didn't happen because my cervix wasn't ready. Second was very favourable. I went into natural labour 24 hours after the third (at 39+3). They are a bit uncomfortable but not that bad and for me worth it because no induction was needed. Incidentally I'm 37 so pretty old by baby terms.

I was swept at 39 weeks because I had gestational diabetes. In some areas they would have let me go to 41 weeks before induction but in most they woo't let you go beyond 40. Initially I was very keen to go to 41 but a consultant at a research hospital told me research strongly suggested that still birth increases after 40 weeks due to deterioration of the placenta. So different situation but very similar outcomes! I had three sweeps. Or rather three attempts. First didn't happen because my cervix wasn't ready. Second was very favourable. I went into natural labour 24 hours after the third (at 39+3). They are a bit uncomfortable but not that bad and for me worth it because no induction was needed. Incidentally I'm 37 so pretty old by baby terms.

Sorry! Phone induced double post!

Thanks Lion and allyfe for your posts and it's interesting to hear that age, in and of itself, doesn't necessarily mean that induction is a foregone conclusion....one to ponder and ask my midwife about, see if she has the same view! Allyfe, good that the second sweep got things moving for you, it seems they work when you're close to labour but not if you're not!