Being pressured to have early induction due to age

[curlyLJ]

have already posted this in Childbirth, but there's more traffic over here...

Basically, I am high risk due to 'advance maternal age' in this pregnancy - I'm 40. Saw my consultant a couple of months ago when she explained the risks / their policy to me re age (I have also seen the research). I told her about my fears of induction/intervention (after last time) and she said that as long as I was aware of the risks, it was my choice and that I could have daily monitoring from 39-41w instead if I prefer. Agreed we'd discuss at 37w.

Have thought about this a lot and unless there is a real reason ie something showing as being wrong with me or the baby, I don't want to be induced unnecessarily. My midwife thinks it's over the top too and she quite rightly said that there are risks with all pregnancies/births and that I am a 'young', fit and healthy 40 - she said she's seen women in their 20's who were much less so!

Anyway, just been for my 37w appt - only it wasn't same cons I saw before, it was her registrar and he just wouldn't listen to anything I had to say. He was insistent on trying to book me in for an induction at 39w and gave me such a look when I said thanks, but no thanks.

In the end we agreed that I would see the cons again at 39w instead, to have a sweep then if favourable, and then go from there (am getting DH to come with me for that one so he can help me stand up to them as I tend to back down around medical professionals which is what happened last time).

Am really hoping I go spontaneously in the meantime though as baby is already engaged and I have had a bit of a bloody show. I really want to deliver in the birthing unit, in the pool if possible, but he said I can't if I'm induced...

Has anyone else had this?

I've never heard of this and I would have thought that an induction would be much more risky than a 40 yr old mum at 40 weeks gestation.

If mum is well, baby is well and placenta is well then I would leave well alone.

Your consultant's approach seems much the most sensible. You know the risks / benefits. You're making an informed decision, and you will be monitored daily. It sounds like you need to insist on dealing with her rather than teh registrar. At least she's prepared to discuss matters rather than dictate to you.

YOUR wishes, as long as you can make an informed decision based on an honest assessment of the risks, are what count here. Not a registrar's whom you've seen once or twice and who clearly is more interested in pressuring you and discounting your balanced decision.

Im 44 and having a pretty difficult preg btw. They've said that if I want they will induce at 40 weeks and if I want, if my body is gearing up for the birth already, they'll induce from 38 weeks. I'll admit I'm biting my consultant's hand off to get induced but even with the risks I've got they arent pressuring me.

that's just it Meerka, I was expecting to see her and to have a discussion. I was in with the registrar all of 6 or 7 mins and he just started out saying 'OK so we'll book you in for an induction on such and such date'

This pg has been fine with no issues, in fact better than my last one, and so this is why I just don't see the point in ending it with an induction and possibly risking all sorts of intervention that I don't need or want.

Sorry you're having a difficult pg - hope you get the induction you want - all the best!

Yeah I had one registrar with dc4 who bullied me to come in at 41 weeks despite having been booked in with the consultant at 42 weeks (I have long pregnancies). In the end I walked out, burst into tears, got home and rang my midwife who cancelled it and resinstated the 42 week induction.

Taking your dh with you sounds like a great idea.

Are you being deemed 'high risk' just because of your 'advanced maternal age' (isn't that just a lovely label?! ) or is there another reason?

I'm 41 and 36+1 and I've asked two midwives about this in the past week and they both confirmed it isn't the case at my particular NHS trust. In fact they looked at me like I was a bit mental and didn't seem to have heard anything about it! So I was quite reassured. But to be honest, no one has batted an eyelid about my age; I've got no other risk factors and they are just treating me as they would every other low risk preg. Bit confusing, though innit?!

And good luck, too!

I think you simply came up against somebody with not a lot of experienced just going down the 'party line' rather than having learnt to actually listen to you or whoever was sitting in front of them (there are women who might jump at the offer of an 'early' induction').

I am sorry you had this stress and hope you have a more productive conversation with your consultant.

FWIW, I had DS4 at 44, I would not have been able to have an induction (due to previous CS) so would have been offered CS again if I had not gone into labour myself. At no point was I pressured into agreeing to early intervention, although risks were pointed out to me in monotonous regularity. Thankfully DS4 appeared without drama on his due date . I was double relieved as my pregnancies in the past tended to go to 42+ weeks…

Good luck. Hope you can take a less-than-perfect consultation not too much to heart.

dats Very interesting that you aren't being offered induction. It does all seem to be down to local policy.

I am only 'high risk' because of age. I answered no to all the other questions, and have had a trouble-free pregnancy. I am fit, healthy and active, never smoked, not a big drinker...
Midwife said last week that it's changed since she did my booking in and I wouldn't now actually be classed as high risk based on the age factor alone.

Pacific no I haven't taken it to heart, I just hate the attitude that they tell us what they will 'allow' us to do - it's my body and my baby FFS!
Trouble is there's no guarantee I will see the actual consultant at the 39w appt I guess, but I will stand my ground nonetheless - I just hope it's not him again!

Hi, I am 42 and 30 weeks. I had dd aged 39 and was induced at 38 weeks - it is standard procedure in our hospital if you are over 38yo. I asked if it was because I had had a stillborn baby in very late pregnancy previously and the consultant said no it is blanket for everyone over 38yo due to detoriation of the placenta. Will be having this baby earlier again but for different reasons.

I was told by consultant that the placenta deteriorates very quickly after 39 weeks in older mums (I'm 42). I had DC3 by CS at 39+1 as I didn't want to take any risks, but it's a personal choice

Oh, I know what you mean re 'being allowed xy and z^ .

There are increased risk with increasing maternal age and increasing length of pregnancy. It's all about what level of risk an individual is comfortable with once the also very real risks of early induction/elCS have been taken in to account.

Like I said above DS4 thankfully appeared spontaneously on his due date, but interestingly he was the smallest of mine (6lbs6oz) by over a pound and as I had a good pregnancy with him I can only assume that it was reduced placental function due to my age IYKWIM.

The risk is disproportionately higher in smokers btw.

It is a shame that it is not more clearly communicated to many women that early induction/CS if offered at x number of weeks, not imposed.

I fully accept there are risks, but to be honest aren't there risks in all pregnancies and births? Inductions themselves also carry their own risks and also increase the chances of extra intervention.
Surely someone who may be younger but who is overweight, a smoker, not healthy in terms of diet etc is more at risk proportionately?

They really make you worried saying that the risk doubles, but the numbers really are so low, you have to take everything into account when making a decision like that. I am not going to be pressured into doing what they say this time, it will be my decision.

Ironically, I have had less issues in this pregnancy than my last when I was 36 when I had several episodes of unexplained bleeding which to me was more worrying. This time I feel fine, have had no probs - I just can't get any of my shoes on as my feet and ankles are so swollen they are like elephant's feet!

I had an amazing, planned induction with dc3 at 39 weeks. Controlled, pain free (epidural sighted before proper contractions started) and stress free. It wasn't without having to stand my ground though.

Childbirth is a small part of motherhood. Personally, I would rather be safe, have my baby arrived safely then risk the unknown and sometimes terrible consequences of waiting.

It is difficult to make a decision when you are hormonal, but please also consider the bigger picture: healthy mother and healthy baby.

Firstly, I don't think 40 is old !
I'm also booked in for induction due to advanced maternal age( I was 46 last month and am 36 weeks pregnant).
I'm booked to go in on my due date, though my daughter's friend's mum who is a midwife at a different hospital 10 miles away said their policy is no later than 39 weeks for older mums, so it obviously differs quite a lot depending on where you go!
I had my last scan two weeks ago and all was well,I'll see the consultant again next week and he'll rescan me.
I've had normal deliveries with my last three babies, though all were overdue and it was a while ago, but to be honest if the medical professionals suggested inducing earlier for any reason I would rather do so that than take any unnecessary risks,even if I need more intervention, as long as baby arrives safely that's the most important thing.
A mum at my DD's school (prob only in her late 20s/early 30s) had a stillborn baby a few months ago and it really brings home that it can happen and it's so devastating when it does.

But if it's such a specific risk associated with AMA, then why isn't it policy across all trusts? - this is what I don't get (and I realise that's a simplistic statement). I understood that the study group was not particularly large and that the identified risk was really small - which is why the policy differed so much across PCTs.

Completely agree that ultimately it's up to the individual and their attitude to/perception of risk etc but if it wasn't for Mumsnet, I don't even think I would be aware that a study had even been done - whereas some of you are of the mind that increased risk of placental failure in old birds is a real possibility and something that definitely should be taken seriously (and I am not disagreeing at all - just don't really know what to think at this point).

I think I need to do a bit more research. Until now, I was of the mind that I am deemed low risk, I've had a relatively easy and healthy pregnancy, was in the best shape I've ever been in, when I conceived etc and that avoidable intervention would be the best choice, ergo it's a good thing that I am not being pressured into having an induction. But what do I know? I've not done this before! If I was advised to have an induction, I would probably decide to go along with it.

I'm really glad we're having this discussion, it's come at exactly the right time!

I had an induction due to being overdue and having SPD. No one mentioned any risks due to my advanced age of 42 years at all!

dats that is what I just don't get, there was one study, there was evidence that there can be a higher risk for older mothers, but this risk was still small. There is however also a lot of research re stillbirth suggesting that they don't really know what causes it in relatively healthy mothers/babies. As irishmammy mentioned above, it clearly also happens to much younger mothers so why intervene based on age alone?

If I were told there was a 'real' risk based on something on a CTG or ultrasound scan then of course I would listen to the consultant's advice, but when they are basing their recommendations on a policy rather than looking at each case individually, it just doesn't make sense to me to just blindly accept what they are saying.

I don't agree that I am putting my baby at risk - I am happy to be monitored/scanned and will make a judgement at the time. it's just that when there is such differing policies across different trusts, it doesn't make sense. Surely if I'm high risk, I'm high risk regardless of where I live?? I'm not saying I won't accept an induction, I just don't want to be bullied into it. I don't like being told what I am 'allowed' to do. My consultants response when I told him I would prefer not to go for early induction unless there was a specific problem was 'well it's out policy'

Lots of things went wrong in my previous birth, which was an induction, and I am scared of that happening again. The recovery for me was awful and I believe DD was traumatised from being yanked out of me! I think by waiting until my due date, possibly a few days after, I am giving my body the best chance of going into spontaneous labour which is surely the best for both of us.

I moved trusts during my last pregnancy at the age of 41. In the first one, I was instantly referred to consultant-led care as high risk and was told that I would be induced at 39 weeks. As I knew I was moving by that point, I didn't say anything. In the trust I transferred to, I was deemed to be low risk and went into labour naturally at 40+8 and had a normal birthweight baby. I had no additional monitoring offered to me or sweeps. Most of the data on the problems of advanced matter age is woefully out of date. Hopefully with more older mothers around now, some more up-to-date clinical evidence will be available soon.

Good point Swan about lack of data. I read something about higher mc rates in older mothers possibly being skewed in a similar sense. That sounds a bit half-arsed and anecdotal but I can't remember exactly what I read. I'll shut up

curlyLJ Yes. Exactly that! I don't want to take unnecessary risks, of course I don't, but with such sketchy evidence it's hard to look at the 'facts' and see how they fit in with your attitude to risk. Mind you, I'm saying this and no one is even talking about induction, so...! Feel free to remind me of this when I'm (even more) sleep-deprived and uncomfortable at 41+5 and counting...

Just marking my place as am in exactly the same situation, i.e. 42 second pregnancy, 1st one induced, now being pressured into an early induction. Hope it's going well curlyLJ. Does anyone know where to find this damn research?!!

There's something i dont 'get' about this. Doesn't induction, largely, increase risks? isnt there a stat that says if you get induced you are 40% more likely to end up getting a section? A bit like dats i'm sounding a bit half-arsed and anecdotal as again, i cant remember exactly what i'd read, but certainly iw as told to avoid induction due to the 'cascade of medication interventions' (dont you just love that phase!!) it can cause..

Point taken about the placental deterioration though. I'm 38 myself, they've not mentioned early induction. Does it only get mentioned if you have the magical 4 in front of your age?? Personally, if i was viewed as v high risk, i'd nearly favour a section over early induction. but that's a WHOLE other can of worms!!

Hi, I posted here last month.
Just to report on my experience of induction, I went in last week on my due date. I'd been getting a few sporadic contractions over the previous few days and was already 1-2 cm dilated on examination. They could have broken my waters but said it might be best to have some prostaglandin gel to soften the cervix. Within 10mins of it being inserted I was getting regular contractions, labour progressed with no more intervention, DD3 (DC4) was born 8 hrs later, with only 10 mins of pushing at the end. I found the induction a really positive experience, labour was similar to my "natural" labours and I'm so relieved to have DD here safely, I was worried about placental degeneration starting, though having said that the placenta looked normal.

That does sound really positive in fairness. Congrats!

FWIW, placental degeneration can happen at any age, the only person i know that it's happened to was in her mid 20s.. although i'm sure statistically it does become more common with advanced maternal age.

I just had an induction for maternal age - I'm also 40. I had a fast labour with no intervention and a healthy DC. In contrast, the natural labour I had DC1 I was 11 days overdue was awful - placental abruption and a long time in hospital / recovery. I am also a control freak and it was great to have a 'final date' for labour booked well in advance rather than sitting around waiting.

Obviously your previous experience of induction is a key factor here and I think you are right to look into the evidence and make a decision right for you.

There is evidence to support women being offered inductions for maternal age (40+) - that is offered NOT pressured. Women over 40 have a higher rate of stillbirth and placental failure - you need to be comfortable with the risk/benefit ratio - there's nothing wrong with consultants telling you the options but pressure shouldn't be happening. The registrar sounds like an arse.

IIRC monitoring is more likely to lead to a c-section than induction and a previous vaginal delivery is more likely to ensure you have a vaginal delivery without interventions this time but I can't find the links atm.

I wonder why you are 'high risk' for age only though - I was low risk throughout pregnancy and would have given birth in the birth centre had I gone into labour naturally.

Anyway, I hope you get the chance to go into labour naturally - the signs are promising

You also have to remember which 'risks' you are comparing. The increased 'risk' of an urgent section or other intervention vs the increased 'risk' of a still birth. They (to my mind) aren't comparable. I'd take the former over the latter. Even if the chance of a section is higher with an induction that the chance of a still birth without, the utter awfulness of the one (sb) far outranks the (potential) horribleness of the extra intervention.
I'm being induced for other reasons but the same outcome - increased risk of still birth if I go over dates. I have no other health issues that might make it more high risk, but that's a good thing, not a reason to avoid induction. It means it's more likely to go smoothly. And although I so don't want days in hospital, all sorts of interventions and potential forceps/section delivery - the absolute numbers of which are increased with induction, I'd take them any day over the small, but not ignorable, increased chance of a sb.