Older first-time mums - advised to have a Caesarean?

[Marama]

I'm about 11 weeks along (I think - scan on 8 September when I'll know for sure) and this is my first baby. I'm also an older mum at 43.

I've just read an article about Claire Sweeney, who's my age, about to have her first baby and it said that she was advised to have a C-section because of her age.

Has that been your experience?

I'm not totally against having a C-section, but I would prefer to have a vaginal delivery. I'm going to research my options more, but I would love to know others' experience.

[RedToothBrush]

dollicapax, you need to check your facts.

The difference in cost been a planned VB (which includes the outcomes of a EMCS and instrumental delivery) versus a planned ELCS is much smaller than a lot reports suggest. Reports which have completely flawed methodology.

Repeatedly you will see figures and risks for ELCS and EMCS lumped together which is worthless information as both are very different in nature and risk. Equally VBs are frequently made to look much more favourable because they do not include the risks from an EMCS which is a possible outcome from attempting a VB.

NICE compared the cost of both a planned VB and a planned ELCS and decided that on balance, especially when adding in the long term downstream costs, that there was very little difference between the costs of an ELCS and a planned VB.

When you factor in that over 35 year olds are more likely to have more costly outcomes from a planned VB (EMCSs and instrumental deliveries) then this difference is decreased even further.

There are huge misconceptions about this, even from within the medical profession, and unfortunately there is a lack of joined up thinking which fails to properly understand the overall economics of health care - they are far to simplified and shortsighted to reflect the reality of how costs are not just price tags, but much deeper and complex considerations which don't just end at the doors of the maternity ward.

'Medically necessary', is a very loaded phrase too. Many women are classified as making maternal choice, and the disgusting phrase 'too posh to push' is used about them. The reality is that this is often a result of mental health not being universally recognised as a legitimate health issue. The majority of women who ask for an ELCS do so for reasons connected with mental health and are some of the most vulnerable women out there, yet they are totally vilified by the media and ignorant HCPs. NICE has done much in their updated CS guidelines to break down this outdated belief, but unfortunately there is a significant amount of work to do, to convey this throughout medical circles, the public and press.

Given that NICE are the body in the UK which draw up cost effectiveness models and recommend the guidelines for the NHS, this should be the information that is considered the most authoritative. I am aware that there a number of flaws in the current guidance - most notably that they do not consider the costs and risks for subsequent births - but in this scenario with a group of women who are most likely to only have one or maybe two children at most, even this criticism is only fair to a certain point.

[todayisnottheday]

I honestly believe it doesn't matter what your age or previous cb status is. You should look at the situation as a blend of factors and feelings. You've mentioned your bmi and your age. They're both factors but not the be all and end all. Inform yourself about both of those as objectively as possible then look at how you feel after that information has been taken on board. The thing with celebrity is that you have to justify everything. You're not a celebrity, you don't. If you have decided that your risks are x and you want y then be prepared to argue that. You may find your network totally supportive, you may not, it is pretty variable but ultimately you have the right to make the decision so long as you're realistic. At this stage relax and enjoy being pregnant (congratulations btw ) by the time you're 7 months you may feel differently, you may not. Use this time to inform yourself and prepare!

[dolicapax]

That's all very interesting Red, but the thing is you are pretty much saying that older mums will have problems. Why? I'm an older mum, I have had completely text book pregnancies and a normal VBAC. As have my 'older mum' friends. Weight, blood pressure, fitness, all that stuff is just as important, and if you look at it that way the older women who conceive easily tend to be the ones who are generally fit and healthy as fertility is also affected by these things.

Ironically it is my younger friends who have had EMCS, for all manner of reasons, which goes to show statistics are no substitute for real life, as we are all individuals.

Here's an interesting fact from my obstetrician. Why do you think amnios are only offered to women over 35? Is it because this is a cut off for a massively increased risk of Downs? No. Actually it was a budgeting decision. At the time the decision was made the NHS had budget to offer an amnio to 5% of all pregnancies. Back then over 35s represented 5%. Obviously over 35s represent far more than 5% now, but once the rule was set it stayed.

So in a long winded way my point is if you are an older mum, in good health, generally fit, healthy blood pressure and no risk factors there is no need to be afraid of trying for a VBAC, and my original comment on cost was related to private birth, where the patient pays, so there are obviously the service provider is completely neutral on the point.

[RedToothBrush]

Perhaps you would like to read my posts. I said v clearly that if you are in good health there is no reason to have an elcs based on age alone and the real reason for more over 35s having a cs is underlying health issues which inevitably are more common the older you get.

[mrsnec]

I'm going to be a first time mum at 36 and I've been recommended a cs. This is for many different reasons and they did include my age in that but I've ignored that reason and agreed on the actual medical grounds only. If they'd said my age was the only factor I would be saying no.

[squizita]

Dolic amino isn't offered to over 35 as standard. They're offered to anyone with a combined blood/nf risk of over 1/150 - regardless of age. That's how it is in London, Sussex, Essex, Exeter anyway (places I know recently pregnant women).

[squizita]

Mrsnec at 36? Where in the country are you? In London both my hospitals wouldn't bat an eyelid re birth under 39, and the average age for vb in one labour ward IS actually 36. I wonder why they mentioned age at all? Historically it isn't even "old" ... It would just be the youngers of a larger family.

[mrsnec]

I 'm in Cyprus. I asked around a few mums I know here and they had all had the same experience of being treated like a geriatric mother at my age! One had a section at 36 just because they recommended it because of her age and no other reason.

I know it's less of an issue in the UK. 2 of my sils had babies last year in the UK. Big nhs hospital in Surrey, one is 39 and the other 43 both had vbs. Hospital didn't bat an eyelid over their age so my family are quite shocked by the attitude here.

I did research the pros and cons of a c section. I'm not even sure my medical history is valid reasons either but I know the fact that she's been in unfavourable positions is and I know the Cpd is genetic (my mum had it and had a difficult birth with me) so that's why I've agreed because also here it's no gas and air it's pethidine or nothing and you only get an epidural for a c section so with a breech baby in my situation that's why I think it's the best option.

[mrsnec]

Just a thought and referring back to the op regarding Claire Sweeney, did she have an Mc fairly recently before this pg? One of my doctors said this would be a factor too in my case but I'm not sure why.

[squizita]

Depends on the lateness of the loss. If she had to "birth" her baby as opposed to a small sac, that can be like the body going through birth too close together (ie no body is designed to do that less than 9 months apart ever!) And causing cervical damage.

1st trimester losses are different. They shouldn't make a difference (unless an op was botched).