Anyone out there 37, 1st time pg? Need to talk! (it's long, sorry)

[phdlife]

At our first (8wk) meeting my mw asked where I wanted to give birth - I said how should I know??? I'm foreign, I don't know anyone who's given birth here, and BTW OMG just found out I'm PG!!! She said oh well plenty of time to decide... In same convo she said she'd have to refer me to "Early Birth Clinic" or somesuch given my advanced age (37) so I toddled off and had a nice chat to lovely consultant about my cervix and about losing my job. No mention whatsoever of "booking" for delivery anywhere.

In the intervening weeks, I've read lots about birth, visited the local MLU, gone for 3 ante-natal and one BF class, booked in for active birth workshop there (tonight), etc. I fell in love with small, local MLU, met and liked several MWs from there, and pretty much decided that's where I want to go - the other options being a MLU or consultant-led ward at large hospital 6mi away. MWs explain that if anything makes their "labour antennae" twitch, they pop me in an ambulance and send me over there anyway, but "70% of births don't need any intervention" that they can't give.

But no-one has ever raised the question again, until last week when I mentioned it and MW said I should just check with consultant at scheduled 37-week checkup. I have been fit and healthy throughout (apart from that bastard headcold) so as far as she's concerned if I "want to give birth swinging from a chandelier that's fine" by her.

Instead I see young dr who is adamant that given my advanced age and 1st-time pg, that I am at "greatly increased risk" and must go to consultant-led ward on other side of the city!! It is impossible, she says, for me to be transferred in an amublance during labour!!! And further, according to her, this has all been sorted since day I first saw consultant!!!!! She is not articulate enough to explain what "great risks" are so I wait another 1.5hrs to see lovely consultant again and he says sensible things, but it boils down to: 25% higher chance of needing some kind of assistance (augmentation or intervention), slightly higher risk of distressed baby if my labour fails to progress, very slightly higher risk of haemorrhage, and really it's not very nice to have to go for an ambulance ride when you're in labour.

Well, no, it's not, but it's still only a 1 in 4 chance of that happening, which is no higher than the ante-natal class MWs quoted for all deliveries anyway! And frankly I am nervous that if I am in reach of dr's they will, by training, be keener to intervene sooner rather than as a last resort.

Finally consultant agrees he'll be happy if I go to MLU at big hospital, but he won't, he says, "lose too much sleep" if I decide to stay at small local MLU.

I know the whole point of this process is to have a baby at the end of it, but I came home last night , , and at being given so little info so late in the game. And now I have to re-think this decision - and fast!

Do I stick with plan A and hope for 75% chance that things'll go okay? Or do I go off and book busy, big hospital MLU where I've never been, never seen anyone, notoriously bad for parking and on the other side of town? Are we just feeling complacent because it's all been so easy so far? (sorry, not bragging!) Anyone out there given birth for 1st time at 37? Or know anything good I can read about risks?? Input please!!

Phdlife - I didn't choose a c-section but at 37/38 weeks it became clear that the chances of the baby being delivered via the traditional route were very, very small. His head really was very large, I'm not, and my mother had 3 c-sections in the 60's for exactly the same reason.

Its interesting you say that about what the doctors are used to seeing. I had both of my deliveries done privately and I guarantee you at no time did I see a person under about 30. I was seeing a specialist recently about a non-pregnancy related issue and he asked if I was likely to have any more children (it would impact on the treatment). I pointed out I was 42 and he said that in his practice he saw lots and lots of people having babies up to the age of 45 without any significant problems and was entirely relaxed about it.

PHDLife - I'm 39 (nearly 40) and having my first baby - I'm having a home birth!

Like you my pg has been absolutely problem free, so the MW's are fine about a home birth. I've never seen a consultant at any time during my pg as all my symptoms and scans have been normal.

I would say stick with your original plan.

Apparently transferring to the MLU is quite common - of course you have to get someone to drive you, but think that is the least dh can do! Only problem is that the peadiatrician needs to sign off on the baby which if you give birth at 3.00am is lcearly going to take a while.

oh MI, I don't think she was quite that bad -but certainly not used to seeing over-educated, thinking, assertive woman in her office saying "but WHY?" or "GIVE ME EVIDENCE". Think she just expected me to accept that Dr knows best!

Have just spoken to PILs about it - they said, "ooh well, maybe being near all the experts and facilities will relieve some stress." I said, "or, being near people who have scalpels and want to use them will add to the stress!" and they totally saw my point so at least they're on my side!

the one thing that is amusing me (slightly) about all this is my sister, who was induced because of pre-eclampsia - at age 26! It's just statistics, after all, not an actual prediction...

Fio I've just been investigating that

Dr kept saying "at least 45mins in ambulance, minimum" which sounded wrong to me

It's 6miles - or 22mins according to the AA

scare tactics, much?

oh PhD, I could have written your post - I too was the stroppy overeducated woman demanding EVIDENCE.
Get on Pubmed, NICE or the Cochrane review database and read as much as you can - a couple of weeks ago I actually handed my rubbish MW a recent review paper about risk factors re my condition and said it might interest her .

Worth a bash, eh?

I was 35 when i had my dd age was never mentioned. Now 18wks pg with my 2 and i am 37 again has not been mention, well only inrespect the triple test which i not having as i will not have an ammio.

I would go for the option a

Hi PhD I'm with everyone else who has said go for plan A, if you are where you want to be when you give birth you will feel more at ease with your surroundings, IMHO there can be moments when you don't fell particularly in control of anything when you're in labour, being where you want to be to start has got to be better.

i had my first DC at 37...was never even given the choice of MLU due to complications during pregnancy (sickness requiring hospitalisation and heavy bleeding between 12 & 20 weeks) BUT birth was fantastic - 2 and a half hrs from first twinge to delivery, no intervention and very active

Made me want a home birth for second (at 39)...but had big ante partum haemorrage so was then induced !!!

Go with what your instinct tells you....and go speak with the MLU again..... this is YOUR birth and your baby it is your right to choose where you want to give birth......

Just a thought...is the MLU in a different health care region ??? Sometimes the professionals don't like the extra paperwork involved when you choose something that is outside of your region so for eg, if MLU is part of another health trust then the money allocated to you for your birth gets allocated across to the other trust through a paperwork exercise....If you then get transferred during labour then there's more paperwork again !!! They absolutely say i's not connected, but I sat on a local MSLC (maternity services committee) for 2 years and absolutely knew that the powers that be hated when women transferred from their health region to another !!!!!

LOl MrsB - well done

like I didn't have enough to do in last 3 weeks!

I am 36 and having my first. I am in Bournemouth and set up seems pretty much the same MLU and hospital options. Age has never been an issue throughout my whole pregnancy and I am now 34+5. I have been healthy throughout and provided that continues I have always presumed that I will go to the MLU but the choice has always been mine. Have never seen a consultant and my midwife has said that same as yours that if in doubt they will not hesitate to transfer to the hospital a few miles away if necessary but you would be transferred back after baby is born. I obviously hope that it doesnt come to that but there is no reason to believe that the chances are any higher for me than for anyone younger. If anything I have felt in the majority with more and more first time mothers in their mid thirties!!! Try not to let the doctors worry you and take your advice from the midwife, I think at the end of the day they are more experienced and seem to talk more sense.

I'm not sure there's "no reason to believe the chances are any higher" for us oldies, Lucia. Think about it in terms of pure and simple performance: a younger body is both stronger and fitter (the reason we don't have too many hot 36 year old Olympians, IYSWIM) so it seems logical that our older, less flexible bodies may, as my consultant pointed out, get tired or 'stuck' more quickly. To me, that suggestion makes a lot of sense. I was also told yesterday that there's more likelihood of ante- and post-partum haemorrhage, again because an older body isn't as efficient as a younger one.

But I want more information about how likely these things are and how dangerous they are for both me and the baby, and how the MLU would deal with any of it.

TBH I am just as mad at the MW for not ever mentioning any of this, as I am at the jr dr for being woolly about the risks. Neither of them are giving me enough specific data to make an informed decision.

And of course, I want them to make up their bloody minds about the feasibility/risks of a transfer! What are the statistics for that, I wonder!

this is fascinating - it's the flow chart NICE recommend for determining who gets what in pregnancy - their definition of high risk due to age is over 40 in the first instance.

Have a read and if neccesary ask pointed questions about where your care deviated from the chart...

I'm 38 and this is my 1st pg. I had my booking appointment today (I'm 10 weeks) , and the midwife asked if I wanted a home birth or hospital birth. She didn't try to force a hospital birth on me at all.
I was chatting to her a couple of weeks ago, and she was really positive about home births, even for first timers.
I think you should stick to your guns & choose the birth YOU want.

6 miles in an ambulance with sirens and flashing blue lights will NOT take 45 minutes, even in rush-hour. Stupid bl**dy consultant - the words 'arse' and 'elbow' spring to mind

aaahh - had to be in at MLU last night for active birth class. Cornered the MW, showed notes, asked, got explanations, etc.

She was boggled that jr dr had written "elderly birth" on my notes and said that term wasn't even used any more since it was completely meaningless.

She went to see consultant midwife who said since there is no other issue besides my age, they would be happy to have me, bearing in mind that things are slightly more likely to go wrong in 1st stage and yes I might need a transfer, but they'd had other 37yos in there and she couldn't understand why I'd been referred to consultant in the first place.

Me neither.

Never mind. Am happy now, as have option of going where I want - and time to investigate the other option to see how well I can live with it. Me and DH will take a trip out there on w/end.

Oh, and this MW says an ambulance w/ lights takes 8 minutes (!) to reach other hospital, but waiting for it to arrive might take up to 1/2hr, depending on urgency. Oh, and she said that only 17% of their patients get transferred anyway, for all kinds of reasons, only a few of which are labour problems.

Thanks for support, all...

Eaglebird the MW asked me that too - she was quite keen on a home birth, though I wasn't - but she still referred me to consultant, dunno why, and without explaining that this meant he was effectively being put in charge of my care. Keep an eye on your notes. If anyone's name goes on the front, other than the MW's, ASK.

I'd like a hospital birth, but when the midwife asked me if I wanted a home birth or hospital birth, I said 'home birth' for a laugh, just to see the reaction on dp's face.
He nearly fell off his seat with shock. The look of panic on his face was priceless.
I'm not sure if it was out of concern for me (in case there should be complications) or worry about ruining the rug and getting bloodstains off the furniture

Well now I've been to the MLU at the hospital and although it's nice, it's nowhere near as lovely as the one near our house

Consultant midwife has advised she thinks, given my age, 1st pg, and slightly larger baby, that I have 40% chance of ending up in consultant-led ward anyway

So the question is, do I still stick to plan A just because I like it and it's close, and hope for the best?

Or be sensible and go to hospital MLU to minimise time/distance of transfer if I should need a Dr after all?

Hi phd, I've had to skim this a bit because I'm shockingly busy at work, but couldn't cut and run without adding my two pennies. I'm 36, 16 weeks pg with my first, I'll be 37 when I give birth. Absolutely no one has mentioned my age, and when I had my booking in appointment with the midwife, after she'd gone through my medical history she said I was "low risk". That's it, nothing else! I've chosen to give birth in a mlu at a big hospital, but that's because my sister had two very happy births there, and they're ten mins down the road from me, but never have I been refused a home birth, in fact the midwife was practically egging me on. I chose the hospital for my own reasons, but I think you should make the choice to give birth where ever YOU feel comfortable. Good luck x

thanks MrsMar - your experience matches mine exactly - right up until crucial meeting with obnoxious jr dr!

But after she put the wind up me I got more info from other MWs and now know there are some slight issues to take into consideration - it's not so much that there is a risk in the sense of danger, just that there is somewhat more chance of labour not progressing well in 1st stage as we are not as strong/flexible as we used to be! But that doesn't count as a "risk", per se, IYSWIM - it could happen to anyone, just slightly more likely over 35. If you are going to MLU at hospital it's not an issue anyway - I just wish I'd known more a bit earlier in the day.

If you have time you might check out Sheila Kitzinger's book "Birth Over 35" I'm hoping it gets to me before LO arrives! SK usually does a brilliant job combining hard scientific stats with a pro-woman viewpoint.

Good luck with it all and congratulations!

If you read the Kitzinger book (any Kitzinger book in fact) she can be v scathing of the hospital definition of 'progressing well' in the first stage as so much of it seems to be done by the clock
eg if you don't dilate at exactly 1cm/hr you are Not Progressing Well and they run in with the drugs.
Sounds like the lovely local MLU is likely to clockwatch less and be more flexible in their definitions, meaning less chance of intervention before it's actually necessary.
My gut says go with them where you'll be more relaxed and happier.