Induction for women @ 40 yrsThread
Nov 20, 2011 11:07 AM
I have just turned 40, pregnant with my first baby. I am in BC, Canada, and my OB is telling me that "new research out of BC Women's Hospital" is indicating that there are risks involved with letting women of my age go past their due date. She is telling us that she will begin to induce at 38-39 weeks, by sweeping the membranes if the cervix isn't ripe yet, and then the usual IV interventions if that doesn't work. This all seemed fine until I attended a Lamaze birthing class and found out all that you say on this site about induction. I plan to talk with my OB about this, but it may be hard to convince her and I want to know if you've heard of this "new research" and if you're aware of what risks she might be talking about for women my age. Specifically, I want to be able to distinguish between induction for precautionary reasons and induction for medically necessary reasons, because when she first presented this to us, it sounded like she was saying it was medically necessary - at least she didn't present it like she was asking us.
Nov 26, 2011 03:49 PM
There have been some studies suggesting that women aged 40 or more are at higher risk of stillbirth, but those studies are flawed. Here is a critique of one explaining that the study did not consider certain health factors that are more likely to be found in older women. To the ones listed in the blog post, I would add that these studies also do not adjust for having had a previous cesarean, which would be more likely in older women in that older women would be less likely to be having a first baby. Several studies have found that prior cesarean increases the risk of unexplained stillbirth late in a subsequent pregnancy. In other words, while there may be slightly increased risk in the population over all, it is unclear what excess risk, if any, would accrue to a specific woman aged 40 who had none of those risk factors.
On the other hand, inducing labor in a first-time mother roughly doubles her risk of the labor ending in cesarean surgery. In 16 studies looking at this issue, this amounted to anywhere between 3 and 31 more women per 100 who were induced compared with first-time mothers beginning labor spontaneously. I should add, too, that while cervical ripening agents do a good job at ripening the cervix, they do nothing to reduce the excess cesarean rate associated with induction, which, of course, is the point of using them. Cesareans are not risk free for mothers or babies, as you can see by this fact sheet. Any decision should take into account the risks on both sides of the equation, not just one side.
I hope this helps.
All Times America/New_York
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