Evidence that older birthers need more intervention?

Hi all,
I am just wondering if anyone has read anything about older women giving birth, especially for the first time, needing more intervention as their body is not as able as a younger body to labour properly.
I am on a site with a few over 40 women and they all have doctors that encourage c/s but there does not seem to be any hard evidence why. One Ob. said something like"musles don't know how to push". Others are having one as this is their last chance at having a child and a c/s seems to be seen as less likely to have something go wrong while giving birth.
the main reason I ask is that my sister is 35 wks pg. with her first child and is 40 and her Ob. specialises in high risk cases. she is perfectly fine but 40 and it is an IVF pg that they tried 3 years for and the doctor has said he will not let her go more than 2 days overdue! (as it was IVF they do know exact dates)

Well I was 35 having my first and had more intervention than having my second at 36! I think it's no different to all births actually - doctors are too quick to jump in with intervention that causes more harm than good in many instances. I am not sure if the studies include maternal age, but I know that the statistics currently show that the maternal and baby mortality rate is two times higher with an elective c/s than vaginal birth. I had friends who had their much awaited IVF baby by c/s as they wanted to take the "safe option", sadly people are just not made aware that the risks are actually greater with a surgical delivery. I personally do not think age alone should significantly change this. It would really have to depend on the individual situation I think.

I was 35, 36 and 37 for my births: all vaginal, no intervention.

A close GF of mine has 2 children through AC. She is 45 now, giving birth at 41 and 43. No intervention at all. She gave birth to both totally naturally. I might add that she was open to intervention, but just didn't need it.

Personally, I think it is a load of bollocks and just one way that doctors make women doubt themselves and feel inferior.
I find it hard to believe there is solid evidence for such an approach to birth.

My ob is very low intervention (lowest caesarean rate in Melbourne) and he never once mentioned my age and I was 38 when I gave birth.

I have no evidence for this but I think it may be a self-fulfilling myth. Older women are probably (told you I had no evidence) more likely to have private health cover. Private obs and hospitals are more likely to favour interventions and caesareans (30% caesar rate compared to about 20% in public hospitals).

I had a vaginal birth with epidural and forceps. The epidural made it more likely I would have forceps but I don't think 'needing' the epidural was anything to do with my age - just a long labour with a posterior baby. Posterior babies can happen to anyone!

I was 41 when I had my DD by CS. My Ob would have been happy for me to have VB and encourages this. As I am little (under 5ft) and have small pelvis I had no option but CS. this would have been the situation regardless of my age!!!

Well they got pregnant didn't they!!!!

Anecdotely, I know some midwives have found that some older womens' labours can be a bit sluggish sometimes (not always) but sometimes need augmentation. I had an older client whos water broke after acupuncture and we could not get labour going after days of stairs, walking, the works - and the hospital luckily gave us a decent amount of time to get it going.

But this is no reason for anyone to think they need to or should accept any form of augmentation, older women should be treated like any other woman and intervention only if it's a medical emergency. Not 'just in case' a woman doesn't labour well because she is older - that is ridiculous. If the Ob doesn't want to be patient and give mum a go, its time to change Obs - or the Ob needs to change careers. Labour involves patience, time and it is so important to a woman, it can't be written off like that.

My Mum had a home birth 10 days overdue at 40- no probs at all. She had already had 2 children when she was 24 and 27 though so it wasn't her first time.

Just another example of how obstetrics generalises, lumps women into categories, and tries to head off problems that don't yet exist by intervening without cause :angry: .

It's just so ridiculous to pretend that you can predict the course of a womans labour based on her age.

That's no different to telling a mother aged in her 20's that she will have a textbook labour because she is of "perfect" child bearing age.

No one would argue the above to be stupid logic, yet this premise that women over 35 can't birth without help is taken at face value all the time.

I also agree that older women are more likely to have private health and be using private OB's.

So true Tobily!

I've been wondering about this as I know someone who is pg at 53. Her OB suggested a c/s as 'the safer option' which she has accepted. Obviously that is in age at which it is pretty uncommon to be giving birth, and not many would be experienced in it!
My SIL had her children at 41 and 43, she delivered them both vaginally, with no intervention.

Three of the mums in my mum's group were 39 or 40 when they first had bubs. The eldest had a drug free birth, one an emergency c-sec (she was fully dilated so not sure what happened) and another a c-sec (not sure reasons why for this one).

It's annoying that age can strike fear in someone. Like Kelly said, they got pregnant already! So why shouldn't their bodies follow through with a normal labour?

And with the 'muscles dont' know how to push'....are these women incontinent? Do they still enjoy sex? Have they not been told about the foetus ejection reflex? Your body knows how to move bubs down the birth canal without your muscles help if needs be!

Hi girls,
bit late on this but thought I would say that my sister ended up going into labour naturally on her due date and birthed her baby with minimal intervention that day. Her usual Ob. was away on a conference so she had a fill in that did not need to do anything. Yay.
I should have said that I had my first when I was 40 and did antenatal care through the public system and not once did they mention a c/s. I went into labour naturally but ended up with a c/s but may have done that even at 30.

I became a mum at the age of 42. I was not considered high risk.

I was going to be allowed to go 10 days over - just like everyone else at the hossy I went to. I gave birth at 38/4. I went into labour spontaneously, had a 17 hour labour with almost 2 hours of that being 2nd stage. In the end they had to give me Syntocin as my contractions were receding. Bub was vacced out a few minutes later.

It was never suggested that I'd need a C section. I am only 5 foot 1 & still managed to deliver a 7 pound 13 ounce bub vaginally - yes with a little help but I was exhausted by then and needed it.

My 1st birth was the one with the most intervention and that was 17 years ago!! My last birth was induced but no other intervention and only gas for pain and that was 14 yrs after my 1st so I don't think its right to say older women have more trouble.

Anney, that is wonderful news. Congratulations to your sister!

I think it has a LOT to do with the care provider you choose, and not a lot else... :wall:

Wonderful news, Anney!

BTW, I think that older women need more intervention. As do younger women; first time mothers; mothers with previous interventions; mothers with big babies, small babies, long-term medical problems, short-term medical problems; mothers with a mother who needed interventions for ANY birth... oh hang on a minute, I'm no longer working for the health service.

No, women don't need more intervention for any weird arbitary reason. Obstetricians may like to give it, though.

I agree that it has a lot more to do with your care provider than anything else. If a woman at any age is told constantly and made to believe, whether through opinions or actions, that she will not be able to birth her baby without help or intervention, then she will believe it herself and it becomes a self-fulfilling prophecy. If she is made to feel, through words or actions, that vaginal birth is dangerous or scary, then those thoughts will stay with her - making it all the more hard for her to have confidence and belief in herself when the time comes.

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But this is no reason for anyone to think they need to or should accept any form of augmentation, older women should be treated like any other woman and intervention only if it's a medical emergency. Not 'just in case' a woman doesn't labour well because she is older - that is ridiculous. If the Ob doesn't want to be patient and give mum a go, its time to change Obs - or the Ob needs to change careers. Labour involves patience, time and it is so important to a woman, it can't be written off like that.

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Well said, Kelly.
I think it is ridiculous and actually unprofessional to suggest a planned C/S because the chances are slightly increased that labour might be prolonged or ineffective. How about letting it get to the point were you see whether it is working or not and then make a decision based on facts rather than statistics.
How about a woman's ability to heal and recover from a C/S? As we age, our bodies get less effective at healing and recovering from trauma. A c/s is major surgery. If anything, c/s should be discouraged the older the woman is. I'm not saying that 40 is old or that in every case a c/s will make for a long recovery. Just making a statement to counter the opening statement.

Ok, crucify me here, but maybe there is another point to consider. Of course it is not true in all cases, but I have noticed this tendency with friends whose parents were older.
Often when women have children at a later age, it is for a reason other than choice. It might be because they didn't have the right partner earlier in their life, or because it took them a long time to fall pregnant or even because they never thought they wanted children, until the biological clock set in full force. These parents can have a feeling of this being their last chance and as a result being extra cautious. Now, if a caregiver tells them that this intervention or the other will make it safer for their baby, then they won't argue with that, but go along to give their baby the best chance.

On the flip side, older mother's are often more self-confident and find it easier to defend their ideals. But if you de-moralise them by constantly labelling them high-risk and pointing out how lucky they are to even be pregnant, then this self-confidence can be undermined.

Ok, I'll stop rambling now.
And just for the record, I know at least 2 women who were over 40 who have given birth with relative ease and no interventions.

Saša

How odd that a doctor would tell someone that a forty year old's muscles 'don't know how to push'?! Perhaps that could almost, almost hold if, say, you were eighty-five years old and pregnant (!), and your body was slowly failing on you, but really...does that mean that leg muscles don't know how to work at forty? Arm muscles? Tongue muscles? How absurd!

Wouldn't it be nice if there was some encouragement to believe in the body's ability to birth, rather than the assumption that a woman over a certain age will automatically fail at this? It's nice to hear stories of medical professionals encouraging 'older' women to birth vaginally, rather than just deciding for them that they have to birth via caesarean section based on a number. I completely understand the need for intervention in the event that mother or baby is in danger (I was a c-section baby born two months early due to my mother's placenta abrupting), but that just seems strange.

My friend just had her first at 38 and all was fine, 12 hour labour, no more eventful than mine when I was 24. xo