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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Mar 21
    2011

    Maternal Age and Stillbirth

    Archived User

    Henci, you somewhat addressed this in a previous message I wrote to you about maternal age and placentas aging and doctors suggesting induction. I now have a client  who is older and her doctor suggests induction at 40 weeks because she is at greater risk for stillbirth.
     I have done some checking on line with various studies and found a systematic review from nbci. and they conclude that older women are at risk for stillbirth. http://www.ncbi.nlm.nih.gov/pubmed/18195290

    An excerpt from this link: 'INTERPRETATION: Women with advanced maternal age have an increased risk of stillbirth. However, the magnitude and mechanisms of the increased risk are not clear, and prospective studies are warranted.'

    As well there is this link:http://www.scienceandsensibility.org/?tag=risks-of-stillbirth   which discusses a very large Norwegian study done that came to the same conclusion regarding maternal age and increased risk of stillbirth.

    Based on this information it would appear that induction should be undertaken. Is there any other more recent study or studies that have given a clearer interpretation, reducing the variables to rule out factors such as diet, whether a first or subsequent pregnancy, previous C-sec, etc..... ????

    My client wants to avoid unnecessary interventions, a C-section and induction but in light of this research, how can she say no? She is also aware of the risk of induction increasing her chances of a Cesarean. Caught between a rock and a hard place. Any other information would be greatly appreciated so she can be fully informed prior to making a decision.

    Thanks very much. Debra Woods

     

    Archived User

    Hi Debra

    This may be of no help but may be encouraging I know of two people here in the UK who have had late age pregnacey one is my SIL she got pregnate through IVF and had her baby at 40 there was no intervention or need stressed to induce her baby on all scans showed big. 90 centil but they were completely fine with this as they said these scans can be incorrect her little boy was born last August 8lb 11oz they did have to use help to turn him as he didn't do this himself. My SIL blood pressure was up slightly towards the end but no so much as to worry.

    My other friend is 43 she has had two prevous children one natraul birth, the next elective C section as he was breach and the third natraul a little girl who was the biggest of all 3 at 9lb 1oz but she says the easest birth!! He eldest is 6

     

    Sorry typing this before the school run so bad spelling grammar please forgive

     

    Sacha

    Henci Goer
    Posted By on 21 Mar 2011 04:51 PM

    Henci, you somewhat addressed this in a previous message I wrote to you about maternal age and placentas aging and doctors suggesting induction. I now have a client  who is older and her doctor suggests induction at 40 weeks because she is at greater risk for stillbirth.
     I have done some checking on line with various studies and found a systematic review from nbci. and they conclude that older women are at risk for stillbirth. http://www.ncbi.nlm.nih.gov/pubmed/18195290

    An excerpt from this link: 'INTERPRETATION: Women with advanced maternal age have an increased risk of stillbirth. However, the magnitude and mechanisms of the increased risk are not clear, and prospective studies are warranted.'

    As well there is this link:http://www.scienceandsensibility.org/?tag=risks-of-stillbirth   which discusses a very large Norwegian study done that came to the same conclusion regarding maternal age and increased risk of stillbirth.

    Based on this information it would appear that induction should be undertaken. Is there any other more recent study or studies that have given a clearer interpretation, reducing the variables to rule out factors such as diet, whether a first or subsequent pregnancy, previous C-sec, etc..... ????

    My client wants to avoid unnecessary interventions, a C-section and induction but in light of this research, how can she say no? She is also aware of the risk of induction increasing her chances of a Cesarean. Caught between a rock and a hard place. Any other information would be greatly appreciated so she can be fully informed prior to making a decision.

    Thanks very much. Debra Woods

     

    I could take a look at the studies, and I'm willing to bet there are weaknesses--indeed, Kimmelin points out some in the Norwegian study in her Science and Sensibility post. One I've found before is that investigators fail to take "prior cesarean" into account, which a number of studies have found to be associated with unexplained stillbirth. (The placental attachment complications associated with prior cesarean increase risk of stillbirth as well, although these may be accounted for by excluding women with antenatal hemorrhage.) Older women are, of course, more likely to have a prior child or children. However, I think the best that can be done here if your client is feeling anxious is to minimize the risk of an induction ending in a preventable cesarean. This she can do by refusing induction unless the cervix is ripe (Bishop score of at least 6 on a scale of 1-10 and higher is better). Cervical ripening does a great job of ripening the cervix, but it doesn't reduce the excess c/section rate. If her cervix isn't ready for labor, the risks of cesarean for her and her baby and any future babies will surely outweigh the miniscule risk of a sudden antenatal demise in a healthy woman carrying a healthy baby. If she is induced, refuse rupture of membranes. That way, if the induction doesn't take, she can go home and try again another day, but once membranes are ruptured, she is committed to delivery by one route or the other. She should also request a physiologic oxytocin (Pitocin) dosing regimen, as opposed to an "active management" one. This will minimize the chance of fetal distress, and it will get the job done, although it may take longer. The dosing regimen comes with the Pitocin package. A gentle, serial oxytocin  induction is actually a good way to go, although I doubt it will ever catch on because it isn't as cost effective for the hospital.

    ~ Henci 

    Archived User

    Thanks  Henci. I have passed info along to mom. She is at 38 weeks and doctor suggested sweeping membranes. She refused. I'll keep you posted. Appreciate the input. The study her doctor refers to is one done out of Halifax, Canada that was huge I was told.

     

    Henci Goer

    Can you get me the citation for it?

    -- Henci

    Archived User

    Henci, sorry, I didn't see your request for the citation until now. I will need to search for it.

    Thanks for your input. I am trying to find more information about this connection with older women and stillbirth. I will also seek out the reference to the Halifax information.

    My previous client decided not to be induced, went into labor on her own and her baby was healthy.

    Debra Woods

     

    Archived User

    Henci, I am part of an email group, listserve, that has been started by a Doctor Michael Klein here in Vancouver BC. It includes numerous medical professionals and others who are interested in maternity care practices and either offer information or are looking for it. Right now there is a discussion going on regarding maternal age and still birth studies. If you would like to become a part of this listserve, you can contact Dr. Klein directly and he will add you to the list.

    The last entry was from someone who cited the Canadian studies that I mentioned to you were out of Nova Scotia. So, here is the address for Dr. Klein. [login to unmask email]

    Hope this is helpful. Perhaps you could join in on this conversation as there are those on it who believe that these studies are definitive and all women over 40 should be induced at 40 weeks. It would be good to hear some other perspectives.

    Happy New Year! Debra Woods

     

    Henci Goer

    I have known Michael for years and have great respect for him. I appreciate your suggestion, and, in fact, I was on the list for awhile; however, I was feeling overwhelmed with the number of e-mails that it added to my in box. Reluctantly, I dropped off. The good news is that I have a friend on the list who sends along posts that she thinks would be of interest to me.

    ~ Henci


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