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?

If all three of your previous babies have been back to back no sitting on a sofa for you from now till d-day.

Either sit on a dining room chair or ideally on a birthing ball. A more slumped posture on a sofa is meant to be one of the leading causes of a back to back baby. Of course it might be that you have a uterus or pelvis shape which inclines a baby to be back to back but its worth trying.

fluffy, I am coming late to this and don't have much 'new' to say (yes, induction should be offered and discussed with you, not a fait accompli; yes, you can request sweep and rupture of membranes, but no drip and straight to CS if nothing happens - you are likely to have a spinal anaesthetic which I found a v strange experience).

Just to add, I had DS4 a couple of weeks before my 44th birthday; he arrived on his due date and was my 2nd VBAC (no induction). Delivery earlier that 40 weeks had not even been mentioned to me.
May I ask: are you a smoker? I am just wondering whether they feel that your placenta is at risk of reducing in function earlier??

I've also had an induction with DS1 (T+15 aged 37) and it was fine. Highly medicalised (drip and epidural - I could move my legs, but could not have walked around I don't think) but a nice experience all round.

To add to my collection I had an emCS at 31 weeks with DS2 (Placenta praevia) and even that was ok - well, apart from the worry about DS2 of course. But the actual delivery was not at all unpleasant.

All of which has led me to the conclusion that how a baby is delivered is such a tiny part of being a parent that as long as it is a positive experience it does not really matter how they arrived.

viva - more good advice! Our current sofas are a bit squashy and deep and bed-like! After reading your post I spent allot of the evening perched on the edge of the chair sitting forward (legs akimbo - so elegant) with my laptop on the big pouffe (sp?) in front of me, instead of having it on my lap and gradually reclining further and further. (sitting up now too ;)) Cant remember how i sat with the other 3. But i was working full time on my feet with DD1 right up to birth and she was still B to B :(

pacific - wow DS4 arriving on due date with no induction. That's great! No, i'm not a smoker. Never have been. Not much of a drinker either, even when not preg. No drugs ... boring healthy life!? lol.

chunda - wow, no episiotomy OR epidural with your ventous. Good to hear.

Chunderella, I've not read any research on retroverted uteruses and OP position but it wouldn't surprise me if there was a correlation. An OP position needs space at the front of the front of the uterus to turn to OA. So anything which causes there to be less space at the front of the uterus could be a risk factor, so anterior placenta, fibroid. A retroverted uterus I believe is normally slightly concave at the anterior aspect so personally I'd say yes its a risk factor.

Fluffy, there is more research coming out saying that maternal position in labour doesn't influence baby's position as much as what used to be thought. So it may well be that it doesn't matter what you do it won't make a difference.

In labour if baby is still OP try to lie on your side if you're going to lie down rather than on your back. Also if your waters are intact then a baby is more likely to turn. Nothing you can do if your waters break on their own but if you've got an OP baby and an amnihook happy Dr or midwife ask them to fully go through options with you. Sometimes I've had to break waters on an OP baby, I'm not saying it should never be done. But I especially hate doing it on OP babies as I think it lessens the chance of them turning. Saing that some will still turn. Childbirth is an amazing thing.

Viva - Thanks for that. I have always semi-blamed the MW who basically bullied me into breaking my waters for the fact that OP DD1 didn't turn and my contractions immediately all-but stopped. She hadn't told me that DD1 was OP and just said it always speeded things up. Thinking about it after, it made such sense to me that if DD1 wasn't well positioned, at least the waters gave more room to move about and the general pressure of the baby+waters to do its thing. But I've never seen anyone with professional experience back up that instinct before and everyone I asked told me that there was no link.

There's a proven and research backed link between intact membranes increasing the risk of baby not turning into an OA position.

I think sometimes if a woman isn't dilating well its because he contractions are focusing on turning the baby instead of dilating. Once the baby has turned then dilatation will progress better. Your average obstetrician only cares about dilation though and if a woman isn't making "partographic progress" than as a midwife you're told by the Dr or labour ward coordinator to break the waters.

I had this situation the other week and I politely informed the coordinator I wasn't going to break the waters as I wanted to give the baby more of a chance to turn. Coordinator wasn't overly impressed but said she could see my argument and it was up to me. Tense few hours and I knew everyone was waiting for me to be proved wrong at the next examination. But my instinct was right, baby turned, she whizzed on and had a normal birth a few hours later. Of course if she'd had a long labour, got tired and had an instrumental and a pph it would have been my fault.

Sometimes you have to hope and keep your fingers crossed!

That is really interesting. It certainly fits with my (horrid) experience with DD1, lots of pressure to show progress on dilation. In my case it came from an awful locum midwife rather than the doctor, though I don't know what had been said to her outside the room (she was hardly ever with me, just stormed in and out tutting at me).

DD2 was also back to back, my contractions were very irregular right up to the last minute and then I progressed very fast. My waters going was the sign my body was about to start pushing (I say it that way because we just sort of realised I was pushing, it wasn't a feeling of being ready, and I'd had no internals). It was overall very positive.

I'm now pregnant with no. 3 and what you've said has strengthened my resolve that I won't allow my waters to be broken simply to try and speed things up if they are slow (unless this baby is in a better position, which I'm not particularly expecting. I have a slightly wonky pelvis which I think encourages them OP).

Yes! Thank you viva this all makes allot of sense in hindsight.

DD1 B to B - i labored for days. On my back. Waters were broken i believe by a well meaning MW, and the pain doubled. More hours of prone laboring came to nothing and i had ventouse. Tearing and awfulness. One pethadine injection at some point.

DD2 B to B - Stayed more upright at the start, waters went naturally as i sat on the edge of the bed in hos., but encouraged to then laying down (again! ) and 5 more hours labor. I refused pain relief as pethadine had made me feel totally out of control with DD1, gas and air makes me heave, and i didn't want epi.

DD3 B to B - stayed on my feet/leaning forward from the first twinge at home until my legs could hold me up any longer (6 hours ish later in hos). MW wanted me on the bed but i refused to lay back - the pain became unbareable in that position - and instead i got on all fours on the bed and refused to budge 3 contractions later DD3 was born, still in her waters. Much much less pain. No pain relief. Same reasons as above.

Viva -can you sneak into Northants' hospital in 4 weeks and be my MW??

Penguin, just remember though nothing's black or white. Sometimes it doesn't matter how long you leave it, the baby just won't rotate and there's no dilation. So in these cases there's a good argument for leaving for a bit and assess progress but if still nothing happens sometimes breaking the waters can be a good choice. The waters break, baby's head descends a bit and hits the perineal floor. Then as there's something more solid to pivot against this can help the baby rotate. I'm not totally against breaking waters with an OP (or any) baby, I'm against doing it as the first thing and not exploring other options.

I think the best thing is to explain to your midwife at the start that you're reluctant to have your waters broken as a first choice if you're not progressing well and that you'd like to give the baby more of a chance to rotate.

Remember if you do feel the need to lie down then been on your side is better. If you're upright with an OP baby you can try doing lunges! No research on this but a very experienced midwife I know swears by it for OP babies and it seems to get good results!

Fluffy, sadly am nowhere near northants or I'd love to be your midwife.

Good luck both of you. Chances are with both of you as its third and fourth babies you'll push an OP baby out no problem even if they don't turn.

I have never felt the urge to lie down in labour. In fact, even trying to sit on a birth ball has been agony! The only positions I can tolerate are on my feet or kneeling vertically. I spent a lot of time lunging, squatting and leaning in undignified positions like a dog doing a wee up a lamppost!

No, I realise it isn't black and white. Sorry, that was what I meant by simply to try and speed things up. As a last resort if other things haven't worked is a different question.

That's ok then. Didnt want you refusing to listen to your real life midwife because of what I'd said!

So, just to update, went to see the midwife yesterday, they just don't seem that into early induction - particularly as it all falls over Xmas (am due 27th), this is despite being one of the hospitals involved in the induction at 39 wks for first timers over 35.

She did say she'd sent a message to the consultant that it was causing me anxiety. She also said that a few of them would be happy to sweep me at 40 wks & as had a vb with dd, that I'd probably be more favourable than a first timer.

In the meantime it's 4 mile dog walks daily, bouncing on the ball and 'enjoying' the braxton hicks & stabs to the cervix...

onedog - xmas does rather throw a spanner into the works re; hospital.

Well done with your 4 mile walks!

My MW appt. is tomorrow afternoon. I think the most i can hope for is for her to dip my urine sample and tell me (fingers crossed) that my infection has cleared up and the protein is no longer showing! (just finished AB's) I will ask her about induction policy at the hospital though.

Wow!! Read your post, mulling over having 5th baby, I have 4 girls so far 20, 13, 10 and 4.I'm 39 An. Worried a little too old!!