over 40 risk of stillbirth..how late did u leave induction?

[Monkeybrain10]

I'm 40 so have been told the risk of stillbirth is higher if i go over 40 weeks. I'm due tmrw...booked for a sweep on Fri, and the consultant actually said he is happy for me to go 7-10 days over...but he then impressed the increased risk of stillbirth on me and said it was my choice!! This is my first so would rather have had the medical professionals tell me what to do as lovely as choice is!
We're thinking of asking for induction maybe on Mon (4 days over due) but would love to know what u think?
Btw...he's showing no signs of coming out yet...he's not even fully engaged let alone any plugs or waters!

I had a CS at 39 weeks, recommended due to previous CS and due to my age (42). My consultant would not let me go over 39 weeks regardless of CS or induction if that's any help?

Hi, my consultant is already telling me 'we induce from 37 weeks' due to risk of still birth & complications. At this stage (22weeks) I don't want to induce but want what's best for my baby. Saying that, you can ask for daily monitoring if you're concerned.

Try not to get stressed though this close to due date.

Perhaps at your sweep you can ask for advice and raise your concerns?

My consultant was brilliant (I was 42). He had a decent and nuanced understanding of statistics, and realised that the statistical mean is not the whole story - the shape of the distribution, where you as an individual are on it, and why matter too (in my first meeting with me, he said "how do I, as a doctor, weigh up the relative risks of a healthy weight, non-smoking woman in her 40s who exercises regularly versus a woman in her twenties who smokes, drinks and is overweight?"). He explained carefully about the changes in statistical distribution for placental failure with maternal age...

Then things got more complicated - scans showed DS was small for dates. (Again, the "why" came in there - he said "There's an outside chance there's a problem with IUGR - but, given that you're small, I think genetics is a more likely explanation" - hence why I mentioned the "why" of where an individual is on the distribution). So then it became a question of two competing needs - the longer we could leave him "in" the bigger he'd be, but the higher the risk of placental failure. In the end the consultant let me go to 41 weeks, with doppler scans of cord blood flow and monitoring of amniotic fluid every couple of days (the placenta apparently tends not to fail abruptly, so providing you spot the start of things going wrong, you have a window of two or three days in which to deliver). He also opted for a CS on the grounds that he didn't want to put a small baby through the stress of an induction (he was happy about a VB if I went into labour naturally, but 41 weeks and the booked slot for the theatre time rolled round with DS only about 2/5 engaged and my cervix too closed to even attempt a sweep).

CS was very good in the end - a calm and lovely way of meeting DS and I was lucky in that the healing process was very good.

So, message to NHS - clone my consultant so there's several of him in every maternity unity in the country. Also clone my community midwife who said at the booking visit "consultants vary - some are sensible, some are very old fashioned" then carefully picked me a sensible one. But I guess from your perspective, the message is: read up on the risks, and talk to the consultant about what sort of options are available in terms of monitoring. (And Missus - I'd really ask for a second opinion - 37 weeks seems very early to insist on an induction).

Thanks for your replies. Honestly i feel like i've fallen through the cracks in the system...have had 6 midwives so far due to them retiring/leaving/being temps/ going on holiday etc. I have no idea who the mw is who will give me the sweep on Fri. The last one booked me in for sweep after due date due to misleading the consultant notes (realised this yesterday so called hospital ...no consultant available but spoke to helpful mw). He wantedme to have sweep before term then induction from term onwards. But yesterday she asked me if I'd had a recent scan...no...not since 20 weeks. It was only after i got off phone that i wondered why she had asked? Oh yes and also i only got to see the consultant once a couple of weeks ago after querying it ...once again there had been a cock up and my request had been lost! So my faith in the nhs is strained to say the least!
Apologies for the moan (feeling worried as a first timer) and thanks much for your advice!

Misreading rather than misleading ! (my phone likes to make a nonsense of my sentences!!)

I'd definitely ask for more details on the stats. The risks are obviously higher for some pregnancies than others but is your only risk factor age? I'd rather be 40, normal weight, fit and healthy with an uncomplicated pregnancy than 25 with a high BMI, SPD (so no exercise), gestational diabetes and numerous other complications to worry about.

Also beware of phrases like 'doubles your risk'. If you have a 1 in a million chance/risk of something happening, doubling your risk makes it 2 in a million. Even with this 'doubled risk', you'll have 999,998 women undergoing unnecessary induction to prevent 1 stillbirth. Or it might be a 2 in 10 risk, which doubles to 4 in 10, so induction is probably worth it. Once you understand this you can make the best decision for you and your personal circumstances.

I would be the same as you and totally get your worries and concerns.

I agree with Lurcio that a lot is based upon a sliding scale and is determined by your general health and well being. Whilst you've been unlucky with your mw has your pregnancy been straightforward and hence no need to see consultant?

I ask because I've had complications which is why I am consultant led. Everyone is erring on the side of caution and possibly why I was told they like to induce from 37 weeks (early but lungs are developed)... If all's going great, we'll be fine if not, then we'll induce.

Can you ring the helpful midwife or hospital tomorrow to discuss your concerns? Maybe you can pop in for a quick scan and listen to the heart beat to ease you're worries?

xx

My consultant wouldn't let me go over 39 weeks ( I am 40) but I had to have emcs due to other problems x

I'd say the pregnancy has been pretty straight forward. I have had spd so not been exercising but I'm naturally slim with low blood pressure so medical folk always seem to equate that with being in good health! I am apparently consultant led but that is due to (old!) age and it should have happened earlier but request was lost...so just had onemeeting with him and that's it.

Might just aim to drive bumpy roads, have sex, drink raspberry leaf tea and eat a vindaloo tomorrow :-D

The induction for age rule varies from trust to trust. Mostly it's accepted now that the risks for women giving birth over 40 who have no additional health issues are not that different to women under 40. So as a low risk but over 40 year old, I did not have consultant-led care and my daughter was born at 40 + 8 without induction or even a sweep or any extra monitoring. I moved from a trust that was insisting on induction at 39 weeks midway through my pregnancy to my current one that does not have that policy for women over 40.

It's up to you of course, but don't let yourself be pressured into anything you don't want, purely for age-related reasons. Additional monitoring might be the way forward if you're not sure what to do and you can see how you feel in a few days. Things can change very quickly and you may still go into labour without intervention. Good luck!

Thanks all!

Friend of mine had a stillbirth at term when she was 40. She went on to have another baby and had a csection at 37 weeks. She's now pregnant again and that's the plan again. I wouldn't go over just to be safe.

You can always request frequent monitoring, that's what I did.

Don't buy this "my consultant won't let me...."

It's your choice. If you look at the risks (which are pretty minimal) and decide that you want to wait then do so. Particularly considering the potential risks of early (37 weeks? Really?) induction.

Have a sweep and see what happens. Is it really the end of the world if you have to be induced? Obviously everyone wants the "perfect" birth - and at this stage it is hard to see beyond that, but at the end of the day the birth is just something have to get through one way or another for the real joy which lies ahead. Maybe my opinion is swayed by having two aquaintences who had stillbirths which might not have happened had they been induced a few days earlier. I had a sweep and then went into labour 24 hours later, but if I hadn't I know what I would have done. Obviously all the advice you get on here is anecdotal - I'm certainly not an expert - in fact no one can tell you for sure what will happen - all I'm saying is induction is not the end of the world where a stillbirth would be. Good luck.