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?

Penguins, what's a proven cervix?

Mumsnet has made me terrified of inductions now!

Means that you have given birth vaginally before. Basically your cervix has stretched before and knowa the drill.

Thank you, turns out me and my cervix are more accomplished than we realised!

It doesn't seem to me like this point has been made enough to OP:

It's YOUR CHOICE whether you get induced or not. All the consultant can do is recommend what they think is best. You are always free to disregard his advice. I don't know what's best and I think it's fine if you want to go with their advice, but don't take it as "must happen".

if it were me I would ask for clear evidence about why because of my age it was so valuable to induce at X many weeks, and what the statistics are for negative outcomes if you let yourself go Y many weeks later. Odds are they won't have any stats, mind, but I couldn't make a decision without at least trying to find them.

ps: I was 40yo & 40+12 when my youngest born. That was a home birth & I asked the MWs specifically if the placenta looked overcooked (it didn't).

It's not necessary, it's based on our dared research and it varies from 1 nhs trust to the other - I am an 'older" mum and it wasn't even mentioned to me and I'd have refused if it was.

They toed to make me be consultant les for no apparent reason (age I'm sure). I told my midwife I was having a natural home birth (in my 40s) unless I physically couldn't.

And that's what I did.

It's a dreadful policy with a far higher chance of creating a cycle of intervention.

Of course if it's what you want thats different.

Thank you for all the continued replies.

I feel like i would need a couple of months of heavy duty research to get to the point of having a real ''informed decision''. Which i don't have time for! Arrgghh. Another reason why i'm cross this has been presented to me so late on.

Very interesting to hear women's real experiences of being induced. I feel like i'm forming a more coherent and confident attitude to present to the MW/consultant next time. Rather than just fear and panic.

izzy - i lay in bed after lights out last night waiting to feel baby kicking. NEVER done that before. I thought she had been stiller than usual during the evening, and i told DH i couldn't sleep till i'd felt her usual booting in the bladder tricks. He said baby is fine, that damn consultant has you all stressed now!! About 15 mins later she did her usual kicking. I slept ok after that. But i thought of you when i was waiting!

Worry, worry, worry ...

Op do keep a close eye on baby's movements. Not because of your age but because ALL expectant mothers need to do that and it isn't talked abut enough.

In your shoes I would think about the labours you've had previously. I know I cook my babies for longer and so I would not accept indcution at 39 weeks but probably would at 40+ weeks.

Thanks northern.

My 1st baby, 6lb 7 was one day late. My 2nd 10lb was 5 days late, my 3rd, 7.5lb, was 3 days late.

I knew about the baby movement monitoring - and have been making a mental note of the fact that i feel her nearly all day on and off. Now i'm literally worrying myself. But then again there's getting to be less room for her to wriggle in there ... she's kicking gently as i type this.

You can get a count the kicks bracelet here if you want something to help you keep track. Looking at your labours I think there's a pretty good chance you'll labour naturally at term or close to it isn't there?

I was induced at 37 weeks with twins. I thought about asking for a CS instead because of all the risks mentioned on this thread, but induction turned out really well for me (twin 1 delivered nrmally, low forceps for twin 2, but no episiotomy or tearing and really quick recovery). I agreed with DH that if nothing had happened in 24 hours I'd ask for a section but in the event it took about 7 hours from twinge to delivery. It was very quick to get going and painful with no break between contractions, so I was glad of epidural (had to have one anyway because of the possibility I would need a CS for twin 2). Re epidurals, I think the fact you already have children is a big plus - you know what you're doing even if you can't feel it.

Only you can decide what's best - but just wanted to let you know that inductions do turn out well sometimes! Good luck.

I am 99% sure this paper is the analysis they are referring on for the policy OP & others have encountered.
It's part of recommendations issued by RCOG very early this year that has probably heavily informed NICE guidance.

It says that mothers age 40+ have 3x the risk of stillbirth as mums under 35. And that the rates of CSection don't go up among these older mothers following induction (nor do other significant negative outcomes).

I'm not sure I'd be convinced on that, but if you can summon energy to look at one bit of research, it might make you feel about taking official advice.

really not sure if I've missed out on consultant care - I have no other risk indicators, I think round here they like you to have 2/3 before you get referred on.

I had dd at 38yrs & 4 mths, she was born at 40+8 and I was told the placenta was good, so I assume had life in it yet!

I think my midwives have an agenda to push the mlu, they're still banging on about it, despite me (probably) needing anti d post birth, being gbs positive last time (no facility to stay longer than 4 hrs post delivery) and having lost 2 pints of blood last time round, so I'm a bit dubious about the level of care - I guess rationally, all they see are babies & pregnant women, 10 a penny to them, whereas to all of us, these are once, twice, handful of times events and are precious which is what makes us worry, but them worry less. Hope that makes sense.

Going to go in for a chat with them tomorrow as dp is about to look after dd.

I had a consultant appt on Friday and as per my DD my consultant suggested induction at 38 weeks. I am 42 and have had a stillborn DS when I was 37. I assumed i would be but as i had read this thread I asked if it was my history or policy and she said history and that there are genuinely more risks attached to being over 40. She went thru a whole sheet if data with me. I asked if I could have a CS and she said yes but let's decide closer to the time.

northern i have just ordered a bracelet :) Thank you. £3.50 is nothing to pay for a bit of back up. (She is kicking like crazy right now!) I googled 'How does the kick counting bracelet work' (as it wasn't obvious from the pic) and read a couple of old threads about still-birth/kick counting on MN and Baby and Bump etc. I was interested to read that you should be looking for 10/11 good kicks within each 12 hour period. So .. one good kick per hour. The bracelelt helps with this. But also that it's important to recognise your babies own patern of movement in a typical day and notice if this changes. Many stories there about women who felt something was wrong, waited, worried, and then their DPs sent them off to hospital telling them not to be silly about thinking they were 'bothering' the staff - only to find the baby in distress and needing an induction/C section.

So yes - now i'm a convert to kick counting.

onedog - good luck tomorrow. I hope you get some useful answers.

lljk - thank you for the link. I will have a good read later.

Thanks again to all giving their continued stories/thoughts/opinions.

Do remember that a change in pattern of movements is more important than ten kicks a day.

If you normally get 40 kicks a day for example then only having en kicks wouldn't be reassuring and would be a reason to get checked out. Good luck.

Also as its your fourth baby an induction has a good chance of been successful.

A failed induction in itself doesn't mean you'd have to have a section. If it completely didnt get you started at all you'd have the option of a section or saying that actually you'd rather go home and wait another week/however long, try again in a bit/wait till it starts naturally.

Obv there's a small risk that labour starts but you end up with a section for some reason.

So sorry to hear about your stillbirth panic, and reminds us all that the mode of birth is insignificant compared to the safety of your baby. Wishing you all the best.

fluffy I thought it was 10 kicks/movements per every 2 hours, not 12. Oh well, that is good - I definitely always get 10 kicks per 12 hours.

I think that any number of kicks (as Viva says, who is, IIRC a proper trained expert, and I'm not) is not the main thing that's relevant. It's not about "oh, my baby only gives me 9 kicks every 12 hours" as such. If that is your baby's pattern and he doesn't move much between 7am and 7pm and goes crazy at night, and that stays the same, it's not inherently a worry. What is a worry is if the pattern suddenly changes.

Motorcycle - 10 every two hours would be a massive number to keep on top of counting! Glad you feel reassured. For a start, quite often if you are rushing about you might not feel any kicks during a two hour period as your baby might well be taking a nap. They don't have to wriggle constantly because remember they don't sleep to the same day/night pattern you do (much like when they come out ). Or they could just be fiddling with their fingers, or lying still, or any number of things.

Just wanted to add my experience though I'm in Belgium not the UK.

I had my DD at almost 44 (first DC). Whole pregnancy was under the supervision of my gynaecologist/obstetrician - that's standard here no matter what age you are.

He never mentioned early induction. Once I went past the due date I was booked for an induction at 41 weeks. We actually postponed the induction owing to a family funeral, and even then I did not have to go for daily monitoring. I think I went every two days. I finally went for my induction at 41+3, but had managed to get labour going (slowly) by a strenuous session in the gym. They gave me a sweep anyway to speed it up. I had an epidural (as planned) but no other intervention. It was an easy birth.

I expected to be late as all my mothers pregnancies were long - 42 weeks and more.

I am sure that in your position I would feel obliged to accept the early induction even though I'd feel unhappy about it but it's clear that the risk assessment varies greatly from one health service and one medical practitioner to another.

I had my baby when I was nearly 43.
This was never mentioned as a reason for early delivery to me.

Decision was taken out of my hands by pre eclampsia and pregnancy induced hypertension. Also very common in the older mum I'm told.

End of the day, I ended up with a healthy little chunky lump. Job done

Reading this with interest in early pregnancy with my 5th child I am 41. I have been referred to the consultant due to my age and really do not want to be induced as my previous experience of induction was horrendous.

viva thats comforting, thank you. I had it in my mind that once the induction process was under way you were basically on a fast track to delivery asap and you're not leaving this room till baby's out!

Chunderars - that makes sense. It's similar to the link between induction and CS i suppose. Ventouse without an episiotomy ... well done I had to have a ventouse in the end with my eldest. I was young, it was 20 years ago, baby was back to back, i was allowed/encouraged to stay laying/sitting for the whole time ... i labored for 3 days! Sooo knackered by the pushing stage came along that i just couldn't do it. I was cut, i tore, 3 layers of stitches, ... awful. Next 2 births - much quicker and no tearing.

All 3 of my labors were back to back. I have learned to remain on my feet as long as possible to make the pain bareable. This is part of the reason i fear being on a bed, on a drip, or under epidural. (i know epidural takes the pain away - but i cannot stand the idea of not being able to move around).

Midwife this week on Thursday. I'm going to have lots to ask her!

Thanks for the continued support/stories.