Induction at 39 weeks due to maternal age.

[fluffyraggies]

I am an older expectant mum, 34 weeks + 2. I have 3 teen DDs, so not first time mum.

Went for a consultant appt. yesterday and she suddenly started talking about how they 'like to induce at 39 weeks with AMA (advanced maternal age) and that i should expect to be booked in for an appt. for medication, a sweep and waters broken' in early Jan.

It's to do with lowering the risk of a still birth.

I know what's best for baby is paramount, but i'm in shock as no-one has mentioned this at all up to now! I knew nothing about it. I'm now worrying myself about still birth, C sections (which are more common in induced women apparently) and the fact that i can't find any firm info about risk to baby with induction at 39 weeks vs risks if i say no and try to go into labour naturally. I'm inclined to 'do as i'm told' and let them induce me, but i'm fretting.

Any wisdom? Anyone else been told this, or been through this please?

seatfor5 - thank you so much! :) Genuinely. One time i'm happy to say yes, i probably am a bit baggy down there!

Poppy i read the document. Interesting stuff. What jump out is that it seems that induction does not lead to c section so often as is commonly believed. That was comforting. It seems to say there is an undeniable link between simple maternal age and still birth likelihood. Even in healthy pregnancies. These two facts alone help to clarify things for me.

shelly same with me. I noticed the RCOF document in the link presses home the expectation that the mother is given the opportunity to discuss the risks with intervention. Hmmm. Not much discussion went on.

I do appreciate all replies. This is helping :)

I don't know masses about this, but what I would say is that the risks of section from failed induction are quite different depending on whether you have had previous vaginal births. Do factor that in.

Thanks seatfor5 for the positive induction story.

fluffy The way I understand it is that the usual sequence of induction is membrane sweep, and if that doesn't spark you into labour you have hormonal pessaries, and if they don't work you go onto syntocinon drip, and if that doesn't work (or results in foetal distress) then you would have an emergency CS. I think the success of induction may have a lot to do with how ready your body is for labour already, and if it is not then the more likely it is to fail, thus ending in emergency CS. Obviously the earlier induction is done (and they are suggesting 39 weeks which is early) the less likely your body is to be ready for labour. I really don't like the sound of the syntocinon drip as it likely results in the need for epidural, and carries a higher risk of foetal distress, and instrumental birth. So, my hope would be that If the first two methods fail, thus proving my body is not ready for labour, them just go straight to CS. Recovery is much quicker following non-urgent CS which is obviously beneficial when you have a baby to care for.

Anyway, as I say, I am trying to gather the relevant facts and figures, and hoping that by the time I come to give birth, I will have a reasonable plan which keeps the baby, me and the medics all happy. This is a great thread, and I am learning lots, so thank you.

Motorcycle- Both of the situations you describe would be considered an 'emergency' section. Actually, for this reason, there is a move away from that terminology.

But a planned section is just that - mother not in any form of labour and pre-scheduled.

Anything else is emergency.

In a failed induction, a section is most likely for failure to progress. Which is pretty much the same category of medical priority as you'd be in if in hospital trying to kick off established labour and failing. Even foetal distress isn't necessarily that different in time scale. My DD1 was forceps for 'foetal distress' but they allowed an hour of pushing and then about 30 minutes to delivery before she was out. There was no immediate risk to her health or life or mine.

For the benefit of a 'non urgent' section you really want a planned one.

Thanks penguin - that's helpful.

Thanks again :) Everyone's thoughts experiences still very very welcome.

I have read a little bit about the drip, and found quite a few women say it was a painful experience, they felt less in control, and the labour accelerated very quickly (too quickly) or not at all etc. That's as far as i've got, lol. I'd like to try and avoid an epidural, as it comes hand in hand with forceps or ventous.

Perhaps i'm thinking more kindly now about the idea of waters being broken after a sweep and pessary, rather than being put straight on a drip. Which is the opposite of what i thought 2 days ago.

I'm learning loads too ^motorcyclemamma* :) In my heart i know it's all ''my choice'', but without a clear picture of it all there's no real choice is there? I wouldn;t feel at all confident in rocking up in a couple of weeks and just saying - 'nope! no intervention for me thanks'.

I am resigning myself to the fact that this birth is unlikely to be 'natural', like my other 3 (youngest is 15) and there will be some intervention. I just want to understand exactly what is going on and what my options are, how they might change on the day and how, in my own mind, i feel i am following a path with the minimum likely hood for a c section. Or epidural. The trick is knowing what questions to ask - i feel this thread is helping loads with that. 2 days ago i had no idea how much i didn't know!

I can see me going to my appt. on the 6th with a list of questions as long as my arm. I just hope to god the consultant can answer them properly, as by then i'll only 7 days away from 39 weeks!

I'm seeing my MW next Thursday. But i honestly don't think she'll even try to go through induction questions with me. She's very 'hello, give me your arm, give me your pee sample, quick - there's baby's heartbeat, goodbye'!

I was 40 in Sept and am 38 weeks today, nothing has been said to me about early/term induction, nor about additional monitoring. I also has gbs last time and noone is interested in that this time round either.

I have asked about even getting a sweep at 40 weeks but I've been told unlikely.

Reading these threads about differing policies and about there being a clear link to age & stillbirth is making me increasingly anxious. I'm not under consultant care, so anyone got any ideas about how I get to speak to somebody appropriate??

The only midwife who has been vaguely sympathetic to this is off on holiday at the moment. Typical!

I'm 26 weeks with second DC and will be 41 when this one arrives. I've also been on consultant led care due to my age only. And they've said I'll be induced at 39 weeks. I think it's a mad policy which will lead to many more assisted births. I want to avoid an assisted birth as my first was a very traumatic ventouse delivery with pph and cervical tearing. So I'm going for a c section (privately) which will also be at 39 weeks but at least a quantifiable risk.
I was told I could refuse induction and be monitored every day. You could go for that option? But be ready to fight your corner.
I had to have a uterine blood flow ultrasound recently due also to my age and the sonographer was talking about how crazy this policy is and it doesn't make sense even taking into account the stillbirth stats.

onedog - it's bad isn't it? I don't understand how one area/hospital can have such a well established policy about something which another area/hospital has no stance on at all! This intervention is either useful or it isn't. Which way is right? This stuff is not all that new either. When you google about it there are the same questions about it popping up from 2008/9.

When you say you are not under consultant care ... until a week ago i would have said the same about me. However it transpires i should have been all this time, but no one sent me a bloody letter and the MW never picked up that i'd never been seen by a consultant Maybe check?

The only thing i can think of for you to do is to ask your GP or hospital who your head of midwives is and approach her with this.

I'm sorry my thread has caused you to worry.

xposted floppops. Thank you. Interesting stuff.

Ahh fluffy don't apologise, it's hardly your fault. I was talking to DP about it yesterday and we were saying how ridiculous NHS policy is, it's so disjointed depending on where you are geographically, I completely agree that either it's best to do something or not, so why it's not the same everywhere is beyond me.

I shall call the midwives as well as the hospital where they are doing the trial on induction in over 35s (first timers only).

I just feel a bit panicky as I'm already 38 weeks...in the meantime I'll keep scrubbing floors & skirting boads to try to encourage it out!
I may even have to brave sex at this rate my poor pelvis!

Can I just ask why they have you under consultant care - purely age? No prev preg complications?

And thanks for the thread, even if it means I end up paying for a private scan to check all is ok, better that than total ignorance

onedog - i began the preg. with the MW saying oh no you wont need to be under a consultant. Now i find i should have been because i have a history of diabetes in the family (my mum), coupled with a history of high blood-pressure toward the end of my last 3 pregnancies, plus I had a rather dramatic bleed at 15 weeks with this preg. (blood over the kitchen floor amounts ) and although baby was perfectly ok, oblivious even :), and my blood pressure and glucose tests are all fine so far, i think all this coupled with my age meant they wanted me monitored more closely.

Just as well that apart from that bleed i've been fine!

Keep me posted as to how you get on with your investigations.

Lol'd at braving sex. A hearty bit of bedroom activity near your due date seems to be the only bit of DIY induction that isn't completely dismissed as folk lore by MWs and Doc's as far as i can see

I was shocked to find out in the area I live they offer all women regardless of age, a sweep @ 38 weeks! I am 44 & had my perfect little baby girl 12 weeks ago, she is my fifth baby & this is my second marriage so I have children, 24 years, 19, 18, 2 & a half & now 12 weeks. Had all normal & natural births with the first three, just with gas & air & a wonderful home birth with my 3rd.

When I had my 4th @ 41 I wanted another home birth but was so terrified by what the medical professionals were telling me with the risk to still birth, I ended up changing my mind @ 40 weeks & agreeing to a sweep, I went into labour 3 days later whilst waiting at the hospital to be induced, which I fully intended to refuse but was told to attend the appointment anyway. I was so terrified of my baby being still born, I couldn't cope with the pain & had the pain relief meptid, this just took the edge off, not much of a difference for me & made me feel out of it & out of control, baby ended up being delivered with the crash team because his heart rate was declining, all in all the labour was less than 3 hours but for me the whole thing was just horrible.

So for baby no 5 we hired a doula for some hypnobirthing & support & told my consultant I did not want to be induced under any circumstances. My doula was lovely & would provide me with information on older mothers & research on placental failure which showed this was not a risk in the older mother or after 40 weeks, which was all very reassuring but I still was reluctant to ignore my consultants medical opnion as she really did seem to care, my consultant also put me at risk for postpartum bleeding & clots from varicose veins, purely due to my age & even though this worried me some what, it made me feel that if they were looking out for these things then that could only be a good thing & I felt more cared for unlike my previous pregnancy, I was told about the stillborn risk @ 16 wks with no extra care & sent home to worry about it.

This time I made sure I was under the care of obstetrician Penny Law who is my gynaecologist, but also has obstetric clinics at the Portland & my local hospital. With this pregnancy I reassured myself that I was fit & well, I am very fortunate never to have had any major medical problems, baby related or otherwise, ( I only saw Penny Law for bladder weakness due to having four babies) & I didn't see why I was more at risk than a pregnant woman half my age who might be overweight who drank & smoked.

I was adamant I was not going to be induced. From 38 weeks I went in for regular monitoring but still hadn't delivered by 40+3, so agreed with consultant that if I hadn't delivered by 41 wks then she would give me a sweep & in the meantime I was monitored ever other day on daycare & told to keep a check on the baby's movements, this was fine to do during the day but my anxiety seemed to rise at night & hardly slept as I wanted to check baby was moving, twice I ended up at the hospital early in the morning because baby hadn't moved during the night, staff seemed really pleased that I did this & were really reassuring, although I was in a state of sheer panic at the time, turns out baby likes her sleep, especially at night & still does!

So by the time I got to 41 wks I'd had enough & although the consultant was happy to do whatever made me happier, ie: constant monitoring, I requested a sweep, I ended up with 3 sweeps & nothing! I was admitted & booked in to be induced for the next day, I was terrified but felt it was the best thing to do, I didn't want to put my baby at risk & I couldn't carry on as I was, so anxious, in the end it turned out to be the best decision, after some research & against my doulas advice I asked my consultant for an early epidural, never ever having or wanting one before, believing them just to cause more problems, but I knew that with inducement, the pain is worse & does not build naturally like a labour should.

My cervix, probably due to previous pregnancies & the 3 shows was ready for my waters to be broken without the need for pesseries. & because I was confident in & knew how my body labours, I knew once my waters broke everything would happen quite quickly, so an hour after my waters were broken, the pain was becoming unbearable, had the epidural, all that faffing around with that seemed to take ages, but once sorted apart from a side effect of itching, it was great, could still feel pressure from the contractions & my baby moving down but no pain, my midwife was brillantly supportive as was my doula & my husband & I really enjoyed the experience of breathing my baby out, it was like it all happened in slow motion.

She was born just over 2 hrs from water breaking, happy throughout labour & birth & latched on to feed beautifully after birth. Had no post partum heavy bleeding & have suffered no clots since or ill effects from epidural & due to pushing slowly, no further, damage to pelvic floor.

Apologise for epic post, just wanted to cover everything that might be relevant to you, but to sum up, being induced is not necessarily a bad experience, although I managed to avoid drip (but pessaries can also do that job & then have waters broken) & being older is just a one small factor & is not always relevant if you are fit & healthily.

I would say, don't be scared, easier said then done, I know, as that can make things worse, be confident in your body & how you labour, do your research, ask to be supported with what you want from consultant, get support from doula, family member or friend as well as your partner, I was lucky to have a consultant I could trust which really helped me, I hope my post goes a little way to reassure you, good luck, I know it's scary but you will have that lovely baby in your arms in no time!

There have been earlier threads on this with lots of helpful information-have a search. I think it is not an uncommon approach, but not well evidenced. The theory placental deterioration is more common in older mothers so going to term or over carries more risk, but you will have a hard time finding any good clinical evidence of it.

The thing is induction is also cheaper than increased monitoring, so it is the solution that gets pushed.

onedog maybe you missed it because you were still 39 at your booking appt?
I am happy to be induced at 40 wks which is what the rcos document says and seems to be many hospital's policy but less sure about 39 weeks. I'll follow my consultant's advice but I'd rather give my body a chance to do what it's supposed to do. I'm at the consultant at 36wks for a decision. Hope to be offered monitoring from 37wks as some others have mentioned.

This is shocking OP - there are so many more mums to be over 40, yet we are still put under consultant care and the default consultant care option (whatever the reason for being under cc in the first place) seems to be early induction. I'll be 4 when give birth. I thought there was some research out recently that older mothers carry for longer. Off to bed now but will try to find it tomorrow. Good luck

www.whattoexpect.com/wom/pregnancy/0705/longer-pregnancy-may-mean-smarter-kids.aspx#
American research to suggest early induction not great

I agree with seatfir5. My induction wasn't bad. I was given the pessary which didn't work, then a sweep (which honestly sounds worse than it is) and then the drip. I did have an epidural which was mild and from the time of the drip to having my DD was about an hour and I could still walk around etc. hope this helps

Oops 42 not 4!

I have been invited to take part in a '35/39' trial for first timers over the age of 35. Apparently you are assigned to either a normal group, or a group where you are induced at 39 weeks. I'm going to discuss with my midwife - but my initial reaction is no thanks. If it's deemed necessary at the time then fair enough, but it just seems wrong to me to plan for it. (btw will be 38 when baby due).

Hi custard - me too. I did consider it briefly, but like you, it does not seem a good way of going about birth. If I need to be induced, I'll be induced, but I'd rather give my body the chance of doing it naturally.

Hello. I'll be 44 when my baby is due in April. I'm booked in at Kings in London and was told I'd be seeing a consultant who sees all women over 40. She told me I'd be booked in for an induction on my EDD, and no choice given. I understand the reason why this decision is made, and I'm happy with it, especially after learning of a couple if friends of friends who very sadly had stillborn babies.

My previous experience of giving birth was tough, I had the slowest labour in history I think and was monitored all the way through so I'm feeling like a planned induction will be on a similar level to before. I'm still not looking forward to it though.

Maybe if this was my first baby or if I'd had different experiences of giving birth I would be more tolerant of the idea of being induced.

This is my 6th baby. Last 2 were water births. I've never had more pain relief then G&A with any of my dc.

My first 2 dc were typical hospital deliveries. Constant monitoring, stuck in a bed, ARM, 3rd degree tear, massive episiotomy with 2nd. Physically not pleasant. Healthy babies but seriously traumatised mother. I couldn't talk about dc2 birth for months without crying. I have suffered the physical consequences on dc1 birth for 24 years.

So in my mind & experience Dr's don't know best. Im weighing up the very unlikely scenario of a still birth against the verylikely scenario that I will feel traumatised or deeply disturbed by the birth.

If this baby was conceived 17 weeks earlier I wouldn't even be included in this 'policy'.

This is making me feel increasingly nervous & over shadowing the last few weeks of pregnancy. The baby is breech & I'm actually at the point of hoping she stays breech so I don't have to deal with the whole induction thing!

What does everybody think of planned CS as an alternative to being induced? It is something I am looking into. I would much prefer a natural birth, but given that is unlikely as they don't want me to go beyond 40 weeks (age related still birth risk), I think I may favour CS to IOL.

Personally, if it was my first and I was facing induction, I'd want a planned section instead (assuming I wasn't planning a massive family). As it is, I'm 34 and on DC3, and induction with a 'proven cervix' is often a very different experience.