Induction after 35? 40?

[willyandcourt]

I've read somewhere that women who are of advanced maternal age have a higher risk of stillbirth. What are your thoughts? Do you agree or disagree with an induction at 40 weeks?

 

[jeniwi]

I think babies have a time that they need to incubate for. Its different for everyone. My last little one arrived at 41.5 though I had to get checked every other day past 40. 40 weeks is just the norm.

Though I suppose there are risks.

 

[Samantha675]

I don't think women should be induced at any age.

 

[Mummytofour]

I had my midwife app last Thursday and noticed on one of her forms that I was high risk!

When I queried it she said it was because I'm 40! No other reason whatsoever! I have had 4 completely normal vaginal births even after my pelvic fracture, no inductions, no bleeding, no pregnancy complications etc. So why all of a sudden at 40 am I high risk?!!!!

She just hummed and haahed and changed the subject.

I have been forced by her to see my consultant tomorrow, even though my consultant didn't need or want to see me again, so I am going just to shut her up and get something in writing that says I'm NOT high risk.

 

[jeniwi]

Hope you get something in writing.

 

[Moti]

Well, my son was stillborn at 38 weeks, 5 days. I was 36 years old but it had nothing to do with my age. Because of that, I will be induced with this baby at 37 weeks. I will still be 36 years old when this baby is born (right before my 37th b-day).

Because of my history, I'm glad I will be induced early. If there was a reason for me to be induced with my last pregnancy, I'm certain my son would be with me today. Unfortunately, that was not the case and his death happened very suddenly and unexpectedly.

I'm being highly-monitored by my OB and high-risk group and I'm comfortable with the plan that has been set in place with this pregnancy.

Best of luck to all of you.

 

[jeniwi]

So sorry for your loss Moti.

What frequency of monitoring will you have?

 

[willyandcourt]

Moti - sorry for your loss. I know you said the stillbirth didn't have anything to do with your age, but did you find out why he was stillborn? I don't need the answer to this question as I'm sure it's personal for you. I am just wondering if you were able to find out why.

Stillbirth is of great concern to me as is with all of you. I've only had a miscarriage, but it took many, many years to get pregnant (we did find out my husband has a slight defect affecting sperm counts and quality). Out of the complications to have or things to happen, MC and SB are two things that I fear greatly.

Mummytofour - wow! i could see being labeled high risk if you'd had previous complications with pregnancies, but due to age??? i know many doctors default to the high risk after a certain age, but I think other factors should be considered as well... not only age.

Most of all good luck to you all with your pregnancies.

 

[Moti]

So sorry for your loss Moti.

What frequency of monitoring will you have?

Thank you.

Starting in about 2 weeks I'm going to have weekly ultrasounds to keep an eye on my fluid level along with non-stress tests twice a week. Just to make sure that everything is going well. I just found out that I have gestational diabetes as well so of course I'll be watched for that.

Up to this point I've been seeing either my regular OB or the high risk group every 2 weeks with ultrasounds about every 4 weeks.

 

[Moti]

Moti - sorry for your loss. I know you said the stillbirth didn't have anything to do with your age, but did you find out why he was stillborn? I don't need the answer to this question as I'm sure it's personal for you. I am just wondering if you were able to find out why.

Stillbirth is of great concern to me as is with all of you. I've only had a miscarriage, but it took many, many years to get pregnant (we did find out my husband has a slight defect affecting sperm counts and quality). Out of the complications to have or things to happen, MC and SB are two things that I fear greatly.

Mummytofour - wow! i could see being labeled high risk if you'd had previous complications with pregnancies, but due to age??? i know many doctors default to the high risk after a certain age, but I think other factors should be considered as well... not only age.

Most of all good luck to you all with your pregnancies.

Thank you. I can answer your question, that's ok.

Well, we don't know for sure honestly. Maybe me saying my age had nothing to do with it isn't 100% accurate. I can tell you that my age was never brought up as a possibility by any means....let me put it that way.

2 red flags were noted.

#1 When we had the final u/s to confirm that he had died, I had no amniotic fluid left. My water never broke, I never leaked. It was just gone.

#2 3 days prior to his passing I went in to see my doctor for an unscheduled appointment. I had horrible itching on my feet and hands. They tested me for obstetric cholestasis, but the result was negative. The doctors still think I may have had something going on there.

Like I said, we don't know for sure. We'll never know. I had a uneventful pregnancy up until the very end. No complications, good scans, great heartbeats. He just stopped moving one day. High-risk told me what ever happened, it happened suddenly. He had no on-going growth restriction or anything like that. He was average size for his age. It just happened.

I don't want to scare anyone with my story by any means. I hope I haven't done that.

 

[TiggerToo]

I had my midwife app last Thursday and noticed on one of her forms that I was high risk!

When I queried it she said it was because I'm 40! No other reason whatsoever! I have had 4 completely normal vaginal births even after my pelvic fracture, no inductions, no bleeding, no pregnancy complications etc. So why all of a sudden at 40 am I high risk?!!!!

She just hummed and haahed and changed the subject.

I have been forced by her to see my consultant tomorrow, even though my consultant didn't need or want to see me again, so I am going just to shut her up and get something in writing that says I'm NOT high risk.

I can't speak to the UK, but in the US you'd have a hard time getting that because of liability reasons. Our age (I'm right behind you, I'm 38) makes us high risk for everything, whether it's correct or not. And any medical professional here would be required, based on his/her malpractice insurance coverage, to list you as such, no matter how much of an insult it's perceived to be. An insurance company (I know NHS is different - DH is a Brit - but even our national and state health plans would do the same) would also "stamp" you, so to speak, as high risk - and they could even dictate what they will pay for as a result (another sick topic, but I digress).

Here they can put in writing that certain things have been refused by the patient even though she's been advised of otherwise (and that is to cover their homes, boats, and butts in the event of a suit), but they are still going to list the woman as high risk.

I'm sure your consultant can say the appointment is not needed, but I'm also sure he'll realize the MW has procedures she's supposed to follow to protect her own practice and her own credentials.

 

[TiggerToo]

Moti - sorry for your loss. I know you said the stillbirth didn't have anything to do with your age, but did you find out why he was stillborn? I don't need the answer to this question as I'm sure it's personal for you. I am just wondering if you were able to find out why.

Stillbirth is of great concern to me as is with all of you. I've only had a miscarriage, but it took many, many years to get pregnant (we did find out my husband has a slight defect affecting sperm counts and quality). Out of the complications to have or things to happen, MC and SB are two things that I fear greatly.

Mummytofour - wow! i could see being labeled high risk if you'd had previous complications with pregnancies, but due to age??? i know many doctors default to the high risk after a certain age, but I think other factors should be considered as well... not only age.

Most of all good luck to you all with your pregnancies.

Thank you. I can answer your question, that's ok.

Well, we don't know for sure honestly. Maybe me saying my age had nothing to do with it isn't 100% accurate. I can tell you that my age was never brought up as a possibility by any means....let me put it that way.

2 red flags were noted.

#1 When we had the final u/s to confirm that he had died, I had no amniotic fluid left. My water never broke, I never leaked. It was just gone.

#2 3 days prior to his passing I went in to see my doctor for an unscheduled appointment. I had horrible itching on my feet and hands. They tested me for obstetric cholestasis, but the result was negative. The doctors still think I may have had something going on there.

Like I said, we don't know for sure. We'll never know. I had a uneventful pregnancy up until the very end. No complications, good scans, great heartbeats. He just stopped moving one day. High-risk told me what ever happened, it happened suddenly. He had no on-going growth restriction or anything like that. He was average size for his age. It just happened.

I don't want to scare anyone with my story by any means. I hope I haven't done that.

Pregnancy for anyone is risky. You'd think Mother Nature would've cut us some slack - since girls sorta need to be able to have babies to keep us on the planet! - but she didn't.

I'm sorry to hear of your loss.

 

[mafiamom]

first off, Moti, i cant tell you how very sorry i am you had to endure such heartache ~hugs to you~

to the OP, did they say WHY an older mom had a greater risk? that is an awfully vague statement. when i see something like i think it probably has to do with issues that come from being older - ie - GD, PreE, and the like. tho i have to say that i know many a young mom that has those conditions!

just curious if there was anymore detail given.

 

[TiggerToo]

I think sometimes they don't really know why - they can only look at the actual INCIDENCE in a specific population/age group and see the result.

I did a quick Google and found this link on Medscape, and then I read the article on Medline. https://www.medscape.com/viewarticle/721313_5

Interesting stuff.

Get a load of this:

Interestingly, the risk of stillbirth for women aged 40–44 years at 39 weeks of gestation is comparable with women aged 25–29 years at 42 gestational weeks.

And this:

Smith and Fretts presented data from a literature search. They presented an OR for stillbirth of 1.8–2.2 for women between 35 and 39 years of age and an OR of 1.8–3.3 for women over 40 years of age. Other epidemiological risk factors were nulliparity (OR: 1.2–1,4), smoking (OR: 1.7–3.0), obesity (BMI ≥30; OR: 2.1–2.8), having had a previous SGA infant (OR: 2.0–4.6), multiple gestations compared with singleton gestations and black compared with white race (OR: 2.0–2.2).[23]

(SGA - small for gestational age, another common finding in our age group.)

Those additional factors, though, strike me as the same for everyone - they're just saying they also found THOSE present in notable percentages of the women in that age group that were studied.

If I'm getting too clinical, stop me; I'm anything but cold hearted and I'm not a bare facts person, because I believe we're all the sum total of our life experiences and everywhere we've ever been, everywhere we've ever lived, and everything we've ever done has a cumulative effect on us as individuals - probably more so than we could understand. And keep in mind we're real people, not numbers - and these are just numbers.

The entire article as skimmed led me to believe they're not exactly sure why it is, but it just seems to be the case.

Again - I know there are TONS of women on here who have been unfortunate enough to have gone through such a horrible thing - but it IS rare (I know the ones who've suffered with it don't want to hear that, and I don't blame you because I wouldn't either). PLEASE PLEASE PLEASE do not think I am in any way diminishing the horror of such an experience.

I put little faith in a lot of statistics, but the way those numbers were calculated, it leaves you little room for manipulation, and other than the "other factors" there's very little outside force that could have an effect on the figures (unlike, say, all those numbers that say older women are more likely to have c-sections over vaginal births, because I think that often the willingness of some surgical-happy MDs to just avoid labor altogether regardless of maternal age makes them more likely to just go ahead and section us and avoid the possible fallout).

But I don't think they really know. And I think it's only becoming "newsworthy" and grant-worthy now because more and more of us are doing it later, and if it's preventable, there's a heck of a market for the answer.

 

[_Vicky_]

I was induced at 37+3 - standard for twins in the UK. Fynn suffeered from NEC which is a bowel development issue linked with tiny preemies. There is sooo few full term babies that have it there was nothing for me to research but the consultant linked it with restricted growth room as they were twins. But who knows had I not been induced his bowel may have developed in that last two weeks xxx

 

[Wind]

I was induced with both my children due to pre-eclampsia. I will either be induced or have a c-section this time, according to my doctor, because I am having twins. (Barring, of course, any unforeseen circumstances such as premature labor.)

 

[Mummytofour]

Good news for me! My consultant who happens to be a woman, Yay!, looked at my notes and said, "we won't bother with a growth scan at this late stage as everything is going well". "You can follow the exact same protocol as previous births as I'm not concerned atall"!!!!

So....the only date given was possible induction at 10-12 days over date, but she did say I can request monitoring instead no prob.

She did note that I am medically trained myself in Paediatrics, but I don't know whether or not that swayed her decision?

I know I am lucky to have a brilliant consultant who cares more for her ladies than protocol. I'm certain that if she had any legitimate concerns, she would put her foot down, but for now I can relax and enjoy the last 2 weeks! Well....hopefully only 2 weeks! LOL!!!

 

[willyandcourt]

first off, Moti, i cant tell you how very sorry i am you had to endure such heartache ~hugs to you~

to the OP, did they say WHY an older mom had a greater risk? that is an awfully vague statement. when i see something like i think it probably has to do with issues that come from being older - ie - GD, PreE, and the like. tho i have to say that i know many a young mom that has those conditions!

just curious if there was anymore detail given.

Older mom's have a greater risk based on statistics which I think are based on actual data gathered over time.