Induction or c section to combat age risks

[KangarooKaz]

hello
Im 37 weeks and expecting first baby. I'm 41 and fit and healthy with so far a good pregnancy for me and Bubba. We were blessed with this baby following our last frozen embryo under IVF.

At 18 weeks my consultant told me that because I am over 40 that I would likely be induced or c section at 39 weeks to overcome risks of still birth for babies born after 39 weeks in women aged over 40 being the same as a younger mother delivering at 42 weeks.

At the time I said OK but over the following months I have focused on what these options mean and what birth I want. Above all I'm looking for a healthy baby rather than a birth experience. I doubt we will get another chance and we so much want to have our baby with us safely.

Ideally I want to deliver vaginally and am hoping big time for a spontaneous labour pre 39 weeks and will do what I can to bring it on and have a plan for using hypnobirthing techniques and maximising on my home environment until its time to go in to hospital to deliver.....but if baby has not come by 39 weeks I am still struggling with what to do.

What I want is my baby to be delivered without being forced or suffering distress. And for me I believe that if I am in the best place mentally I will help that. What I therefore fear is an induced labour where syntocinon is used with really strong contractions or a lengthy contraction period, where forceps are used and where I may end up after a long period in emergency c section anyway.

I wonder can you help me with your experience. Did you choose c section over induction and how did it go? Did you choose induction and it work well? Did you choose induction and it end up like the one I saw on TV the other night where the contractions were so strong the woman was sent for emergency c section.

It feels like a weight of a decision and I have to make it in next few days and I'm wondering if something might come back to me that helps me get totally clear on what to do.

Thank you x

[onedogandababy]

Out of interest, what are the rates of stillbirth for over 40 vs someone who's 39?
No-one has mentioned this to me at all. Thanks.

[42andcounting]

I think your consultant may be being a bit misleading. I am 43 and expecting my first in 5 weeks. I was also pushed towards the induction at 39 weeks, and it was made to sound as if I was endangering baby if I didn't. Then I moved to a different area at 20 weeks, and was told that it's not compulsory at all, it's actually a research study that they are doing in various parts of the country with 40+ mums to try to establish whether its better to induce at 39 weeks to avoid placental breakdown. Half of volunteers would be induced, half would be left for nature to take its course, and results compared; anyone starting off naturally before 39 weeks would be excluded from the data.

I am now going to be induced at 40 weeks, assuming that baby isn't already here by then. This is because the risk of placental breakdown in older mums is apparently much greater after 40 weeks.

There is a website for the research study but I can't remember the name of it, and I'm afraid I've chucked the leaflet I was originally given. However, I think it might be worth asking a few more questions of your consultant before you make your decision. HTH.

[NoComet]

Neither, I'd tell the consultant to sling his hook.

[curlew]

Neither. I was 44 when I had my second. The consultant said that because there was a higher risk of placental breakdown over 40, I should be monitored frequently after 39 weeks, but there was no suggestion of induction or C section.

What does your midwife say?

[KangarooKaz]

Thanks everyone. Really appreciate you responding :-).

Hi onedogandababy I recall being told that the risk under 40 at 42 weeks is the same as over 40 at 39 weeks of still birth. I did probe further and was told that the risk is 1-2 babies every 2-3 years so its small................ but with a question about would I want that to be my baby. I have also been told that I can ignore the advice and carry on beyond 39 weeks if I want to.

I find it hard when they generalise on age as there as so many other factors so yes what is the difference between 39 and 40 or 40 and 41. I suspect it is a number so unless you personally have other factors you will not be categorised as an older mother with higher risk potential and not be given this advice.

Thanks 42andcounting I haven't heard anything about placental breakdown at all and haven't seen any leaflets. I will have a browse online. Are you happy to be induced beyond the first pessary through syntocinon etc if you need further induction intervention. At your hospital trust can you go home after the first stage pessary or do you have to stay in for 24 hours?


Hi Curlew The midwives I have seen are all very relaxed about me and my baby. They were all disappointed that I was told so early that this was the situation as they said it has hung over my pregnancy when it didn't need to. They have advised reflexology to get me started plus all the other stuff and they will give me sweeps at 38 weeks though they are not convinced they will work. Baby will come when baby's ready and you want a baby not a birth experience have been the kind of messages they have given me. I have also been to,d it would be great if I can deliver vaginally for me but they support whatever I intend to do.


I think there are pros and cons to knowing. I do feel more informed and ready to assert myself but I'm just not 100% which direction.

Hi starballbunny I know what you mean i would love to say im doing it my way though i have to say my consultant has been great and practical and will support my decision . i just feel frustrated probably that my age is leading advice and hospital protocols when I just don't feel old and at risk. I do trust the experts know more than me, I just don't want advice and decisions made on generalisations rather than generalisations applied more specifically to me if that makes sense. The trouble is they fear litigation so much these days.

Curlew what happened in the end for you?

Good luck everyone else with your own deliveries.

[Dh2812]

Hi Kangeroo, I know people say neither but if your options are induction or c section then I would say c section. Many people have great experiences with inductions but I didn't and would opt for c section. Of my friends who had a planned c section it was a very calm and positive experience with smooth recoveries.

[curlew]

Kaz- I had a sweep at 40+5 and ds was born the next day, 4 hour labour with no pain relief, since you ask. You surely don't what to know the weight,....no, no honestly.....oh all right, if you insist. He was 10lbs6.......

[KangarooKaz]

Dh2812 thanks that is really helpful. I'm sorry your experience wasn't right this time. If you do it again then I hope you get the choice and experience you want.

Curlew great outcome from the sweep - I would love that outcome and I am impressed by your baby's weight at birth - you have my respect :-).

[NoComet]

I'm a scientist by training, with a DH who understands statistics. I'd want to be very very sure of the statistics before following any course of action. Inductions and C sections are not without risks.

Consultants are only called in to deal with high risk women, they see what can go wrong a disproportionate percentage of the time.

As a friend who's work took her up to SCBU said when she was PG, "I keep having to remind myself the odds are my baby won't be that tiny and vulnerable. It's just that's the babies I normally see".

Good luck whatever you decide

[maggiethemagpie]

I had an induction for my first child at 38 weeks (due to diabetes, they won't let diabetic mothers go much past 39 weeks) and I ended up needing an emergency section as the baby got into distress due to the syntocinon making me contract really strongly and compressing the cord. However, he was fine and that was the main thing!

I've just had my second child and I opted for a planned section as I was told there was a 2/3 chance a VBAC would fail (for me, these are not the general statistics) so thought I'd rather be in control of the whole thing. Plus I had other medical reasons which meant a vaginal birth was not a good idea.

The section went fine, but the consultant did say there was a lot of scarring from the first one which made me glad I'm not planning on having any more.

I'd say you need to prioritise the healthiest, lowest risk way to get the baby out. a positive birth experience is a 'nice to have' whereas a healthy child is obviously a necessity. If you went over 39 weeks chances are you'd be fine but what if you were one of the unlucky ones? That's why theses consultants make theses recommendations> Personally I'd have preferred to go into spontaneous labour but wasn't prepared to take the risk. But its totally your choice if it is a risk you'd be prepared to make.

[MinkyWinky]

Hi! I've been told the same thing by my consultant and did some research on this. The royal College of Obs & Gynae published something in Jan this year around the increased risks for women over 40. If I can find the link, I will post it.

My pregnancy has been problem free to date too. I'm 39 + 2 today and due to see the midwife for a sweep and to be booked in for induction next week in case it doesn't work - the potential for a CS wasn't discussed.... Not my ideal birth plan, but logically it seems to be the best thing for baby minky.

[MinkyWinky]

Found it...

www.rcog.org.uk/files/rcog-corp/1.2.13%20SIP34%20IOL.pdf

[KangarooKaz]

Hi Minkywinky good luck with your birth of baby Minky who already sounds gorgeous with that name :-).....and thanks for posting the research which was helpful in that it confirmed what I had been told with greater depth and also why I might be asking the questions I still am now as a nulliparous older woman!

Thanks maggiethemagpie for sharing your experience and your advice and im glad you made the right decision for you. I feel the same way as you re spontaneous labour and risks. One thing that is relevant to me is that in my family history I have a paternal history of stillbirth that I cannot research directly with the women it happened to anymore. They were younger than me when pregnant, smokers, heavier set than me which may have been among the factors but I'd do not know if they went to term or over it. Maternal side all has been fine. I had tried to put this to the back of my mind so I could enjoy the pregnancy and look forward to our baby. Having had this advice from consultant I feel personally i should reduce the risks by delivering at 39 weeks. How I do it does matter to me ( in a birth pool with Hugh Jackman serving me strawberries and champagne as i enjoy the feeling and empowerment of my surges and the overwhelmingly amazing feeling of the actual birth) but its less important than baby being here and ok. My internal dilemma is to plan my next stage purposefully rather than through avoiding what I am scared of as naturally a woman might be when facing birth and being ok with my decision.

Thanks again all of you - your comments have helped Xx

Ps if I don't get to use Hugh and anyone else wants him let me know and I will give you my voucher code lol xx

[maggiethemagpie]

Glad you have reached a decision. Remember there are advantages of knowing when you'll go into labour, you can meet your baby earlier and you'll probably be fed up of being pregnant by then ( I know I was). You won't have to be waiting over your due date which although I have not experienced myself have heard of it driving other ladies crazy not knowing each day if this will be it! I think some ladies on another pregnancy board I was on were quite jealous of me knowing the exact date. It was also easier to plan life/OH get time off work etc. So it's not all bad. Best of luck.

[NoComet]

Looking at those figures, the risk of still birth is still less than 1% a risk I happily took to have an amnio with DD1.

But I'm guessing, despite having an older DC my DF wouldn't have taken any risks when she got PG again with her last frozen embryo.

In the end the figures aren't that important, you have to be happy with your choice.