Anyone participating in 35/39 study?

[GreatSoprendo]

I've been invited to take part in a research study of women aged over 35 who are having their first baby. Basically they are trying to see whether all over 35s should be routinely induced at 39 weeks in order to reduce the likelihood of women over 35 needing an EMCS.

If I sign up I will be randomly allocated to one of two groups - a group who will be induced at 39 weeks (assuming LO has not already made an appearance) and a group that will be induced at 41 weeks.

I think participating in research studies is really important - this is an IVF pregnancy and I'm very conscious that I have benefitted from the women before me who have participated in research.

Any ideas on what the pros and cons for me would be if I participated? Is induction a particularly unpleasant process? If I participate it seems to me that at least I know I will be induced if needed at 41 weeks at the latest. Equally, I'm finishing work at 36 weeks so would be happy and ready for LO to arrive at 39 weeks.

The info about the study is here

What would you do.....?

I wouldn't do it unless there were medical reasons for me being induced at 39 weeks. I can't understand how they are getting away with inducing women at this stage when it may be unneccessary but maybe I'm missing something!

If it was me I'd like to know WHY there is a higher likelihood of women over 35 needing an EMCS. I agree it's important to participate in research but I'd be a bit wary of participating in research that requires active medical intervention as part of it. On the other hand, I was induced at 38+1 for medical reasons (obstetric cholestasis) in my last pregnancy and it was fine, apart from 1 gel and having my waters broken I had a natural birth, so I'm not against induction as a rule. I was 26 at the time though so not sure how relevant my experience is.

I was induced at 42 weeks with DD1 and ended up with a mergency CS. This time round consultant has told me that if DC2 has not arrived by 39 weeks I will be given a CS. I am 42 and had DD when I was 37.
Would like to have taken part in this study! Here's hoping research will help other mums in same position as me. Saying that DD was in a weight study from pg through till she was 2 and my bloods have been used by UCH to include in a study exploring non invasive amino and cvs alternatives. Research is good .

I was invited to take part (I'm 39). But I'm very unwilling to be induced for no reason, and told the research midwife this. As i had strong feelings about this she decided I wouldn't be suitable.

I agree that research in itself is important, but like PandaWatch I'm wary of being induced if there is no medical reason for it. I've heard mainly bad things about inductions and I'm not prepared to put myself at any more risk than most of having a difficult birth.

I'm a midwife and I know of a unit taking part in this study and I genuinely have no idea how they got ethical approval for this study and the research midwife I asked couldn't answer me either.

Wow that's really interesting Armadillo! I must admit as a layman I was puzzled as, when I read the literature, it just said "We don't know whether it's safer for older women to be induced, but we'd like to find out" - or words to that effect. No information on why they think this might be the case. Very strange.

I must admit I'm a bit crap with interpreting research and usually read the abstract and that's enough for me but the way I understand it, you are at a higher risk of having a section if you are induced so I'm not really sure what they are hoping to achieve with this study. You have group A (the control group) who the researchers hypothesise (that's a word?) will go into labour when the time is right and will have a naturally occurring proportion of EMCS, then you have group B) who they are using to try and prove you should induce at 39 weeks to avoid EMCS, except in trying to prove it they are using a tool that is shown to increase the instance/likelihood of requiring an EMCS. It just seems to be a bit counter productive if you ask me, plus at 39 weeks, some babies aren't completely cooked and depriving them of that extra Inutero time for no medical reason also seems a bit, well, stupid.

I have seen the literature for it in my local hospital when I have been there for MW appts. Must admit I read the leaflet with enthusiasm (I'm 41 and due tomorrow) until I read the bit about being randomly allocated to a group and induced at 39 weeks!

I know that this research is related to the raised risk of stillbirth in older mothers, as well as CS (stillbirth risks get mentioned a lot during my appointments) but have struggled to see what the point of this research really is.

Armadillo - if my brain was working properly, I think I would have drawn the same conclusions as you did about the study. I understand that more research needs to be done around older mothers and CS/stillbirth risks but think it needs to be better than this. Especially given that I get stillbirth risks stated to me a lot, but this information is never backed up with any statistics/information. The NICE guidelines on induction make no reference to older mothers either!

Also, I ignored the poster for months as thought that the 35/39 bit referred to women aged 35-39 years old and therefore I would be too old. Maybe they should have road-tested the name of the study

I'm intrigued to read this as the midwife vaguely mentioned this at my booking in appointment. She didn't elaborate, I was too overwhelmed by the amount of information being thrown at me to ask for fyrther explanation, however she seemed to imply that induction at 39 weeks was the norm anyway.... Afterwards this struck me as odd as surely it depends on your baby's individual development?
I've had a look at the link and maybe I'm being an over sensitive older mum but the very first para wound me up
'British women are increasingly delaying childbirth. The longer they wait the greater the risk of pregnancy complications. One concern is the increased risk of stillbirth (baby dying before birth).'

Thanks for all the replies - as ever MN offers sounds advice

On balance I'm not going to participate in the study. It just seems insufficiently clear on what they are trying to achieve and how this study will really help and what the potential implications for participants are. I agree that it's surprising this has been approved from an ethical POV.

Thanks again!

I thought the literature was pretty badly written, lozster. I agree that some of it was quite scary, and I didn't think the reasoning for the research was explained at all.
On your point about induction at 39 weeks being the norm - well no-one's mentioned it to me at all, and I'm 36 weeks now.

It doesn't seem right to me to experiment on women and babies with a procedure that can be downright dangerous and higher chance of emcs anyway. Why risk it I don't know.

Hi Lozster - I was wound up by that too and wondered if I was reading a Daily Mail headline

How old are you, if you don't mind me asking? There is a lot of pressure on women over 40 to be induced but it's not something they can enforce, and policy does seem to differ between individual health care professional, hospital, health authority and so on.

The increased risk of stillbirth is oft quoted by the health care profession, but not the actual figures/research this is based on (and I have tried to ask!)

You are right about the baby's individual development - I think more focus should be given to that (and the health of the mother) rather than just processing you as an 'older' person and therefore automatically at greater risk.

I personally wouldn't volunteer to possibly be induced at 39 weeks as my babies are never "cooked" until 42 and being premature by 3 weeks would be an unacceptable risk to me. Also what happens if their induction doesn't work? Do they proceed through the usual range of interventions, which might ultimately include a CS for failure to progress? I'm frankly surprised they got permission to run a study like this.

I would definitely say no in answer to your original question. Be informed and arm yourself with as much information as you can is my advice.

I should add that my last child born when I was 41, was an EMCS but that was NOTHING to do with my age and purely to do with the passenger messing around with her cord for a few weeks before birth (I guess she got bored...)

Interesting, I'm 41 and 38 weeks pregnant and no-one has mentioned increased risk of stillbirth to me. Is there any recent research on this? That said, at the first hospital I went to in Cambridge they said that they induce all women over 40 at 40 weeks as a matter of course but didn't give a reason beyond it being 'safer'. I've moved to Oxford and this hasn't been mentioned at all and they seem happy for me to go over 40 weeks just like anyone else.

Hi Swanlike - I get stillbirth risks mentioned to me all the time, although no one as yet has been anything other than vague about the exact risks/statistics. Also, I have been in great health during this pregnancy - no risks apparent other than my age.

No one can force an induction so it is likely the Cambridge hospital you mention has a policy of recommending it or offering it, but they can't do it as a matter of course without consent!

You may find this older thread useful www.mumsnet.com/Talk/childbirth/a1353115-Quick-unscientific-poll-early-induction-due-to-maternal-age as it will give you an idea of the differing experiences of women over 40, and I think it might point to some research/statistics.

Difficult to say why policies vary so much from one area to the next. I live in an area where the average age for having a baby is well above the national average, and am hazarding a guess that Oxford and Cambridge might be along the same lines but have no idea what effect this has on how a hospital manages risk or formulates policies.

Meanwhile, hope you have a great birth (before someone pops up to offer an induction!)

Eagle ray I am 40, will be 41 when, all being well, first (only!) child will be born. I am a research scientist and write proposals for human reseach. I certainly wouldn't have phrased the info like that though ethics groups can be idiosyncratic on what they deem 'acceptable' so I can see how it has gone through.

I'm not sure age is the best (only) factor for deciding to induce. I am just over 12 weeks now so when I've got over my anxiety about miscarriage and my angst about ante natal tests I can see this being a good substitute to fret about. In terms of risk my age automatically puts me in consultant led care however, age is my only risk factor. I honestly look at some young, overweight, smoking, drinking women and think surely I can't be that bad in comparison?

Meanwhile, should someone break the news to the Nottingham Clinical Trials Unit that people generally think their trial sucks? They've recruited 47 participants so far, but wonder if this number will drop a bit now? They are looking for another 600 or so women to take part!

I do wonder if they've thought this through adequately. "Older" mothers are more routinely viewed as being high risk whatever the actual state of their health (I got amazingly close antenatal care for DD3 at age 40) so are more likely to end up giving birth in a large consultant unit (vs a midwife led unit or birth centre), where potentially interventions are carried out more readily that might or might not lead to CS. Also statistically more women will deliver by CS in a consultant unit than birthing centre for obvious reasons. Have they actually scrutinised the reasons for doing CS on older women? Older mothers hence more "precious" baby as reproductive time running out may mean women more readily consent to CS or intervention. Is there is any concrete evidence to suggest that mere age (rather than medical indications) is a major factor in stillbirth and CS?

Cross-post with Lozster!

Lozster - I have been 40/41 years old throughout my pregnancy too. I have been consultant-led too, but this is for an existing medical condition which has caused no issues whatsoever during my pregnancy. I don't know if consultant-led care based solely on age is another regional variation? I got the impression I wouldn't have had one, other than for my medical condition.

You are definitely right about age not being the best factor on which to base induction. The last obstetrician I saw said they see slightly more stillbirths in older women but they don't know why, hence the lack of factors taken into account, other than age.

By the way, if you are worried about testing now that you have got past the 12 week mark, please make sure you are aware of the discussion about Harmony testing, which you will find in Antenatal Tests and Choices. Sadly, it only became available in the UK in September so too late for me to take advantage but it might offer you some reassurance and remove some of the angst connected with invasive testing.

Yes Duchesse all the factors you mentioned are potentially confounding hence, I guess why they want to do a randomised control test. I don't work in medical research so I don't know exactly how these things play out but essentially you can withdraw from any human research at any point so they may well lose all the intervention group if the baby is small at 39 weeks and the parents change their mind.