I don’t want to fight.

As most of you (hello Caroline!) were already aware, I’m pregnant. I’m also 40 – I’ll be 41 before due date, but only by a couple of months or so. Well, OK, three. Apparently this is just *too old*. Accordingly, although my midwife at the booking visit had marked me down for midwife led care I’ve since had a letter from the hospital giving me a consultant appt, at which point apparently the consultant “will plan the birth”.

Hm. Not liking the language here at all. Have also heard that this means not even the midwife led unit, but the full on medicalised ward for giving birth.

Setting aside the question of how precisely they expect to achieve this if I just decide that I’m staying home (which actually I *hadn’t* decided in this instance, but was reserving the right to decide later) I find this whole thing really rather wearing. So today I set out to do some research to find out what risks I’m running by being pregnant at such an advance age.

I can’t find anything. I find repeated references to higher risks of complications, but can’t actually find anything out about these complications. Although I did discover a couple more strikes against me – I’ve had three miscarriages in a row, and this is pregnancy no 7, which presumably mean I should have a medical team following me around from about 36 weeks just in case. I certainly can’t find out what the real risks or options are – and asking on twitter got me a whole load of RTs and some very outraged conversations but absolutely no links to any research at all.

If anyone *has* any links to anything that would explain all of this, I’d really appreciate it. I think I’ll go mail on radical midwives again – I’m sure there will be someone on there who can explain this to me. I’ve also applied to join the Redtent group on FB on recommendation of a twitter friend.

I’m ready and prepared to arm myself for battle. It’s nothing new. I was very well behaved in my first pregnancy, and it resulted in being unable to convince hospital midwives that I was actually in labour, and them giving me sleeping tablets that I think were directly responsible for Big requiring resusc at birth.

Second time around I became very knowledgeable about haemodilution and iron in pregnancy when my homebirth was threatened towards end of pregnancy as they said I was anaemic. I wasn’t. Homebirth was lovely, and a great improvement on the hospital experience.

Third time I was under consultant care due to the intervening three miscarriages. Right up until a registrar started talking about booking me in for induction in the hospital and I explained I was having a homebirth. Poor boy, he was terrified. Couldn’t run to his consultant fast enough. Give her her due, she couldn’t see any problems, and homebirth it was.

This time I was optimistic for a pregnancy and birth without NHS related battles, especially as the midwife I’ve been seeing is the one who delivered Smallest. She booked me in, took full medical history and couldn’t see any reason to advise against homebirth – we were waiting to decide nearer the time. I’m sure she’s on my side – I just wish there weren’t sides at all.

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  1. I think it’s important you feel confident in the care you receive and my advice, for what it’s worth, is don’t assume a consultant necessarily means over-medicalised care and a specific outcome – I had consultant led maternity care and found it really, really helpful and very supportive. So, it may be better than you think.

    Second, there’s quite a bit of research around on complications in pregnancy over 40 and also over 45 (extreme advanced maternal age) – and yes, there are increased risks for all sorts of things, from the incidence of autism and downs syndrome to low-lying placenta, diabetes, hypertension, premature delivery and stillbirth, among other things.

    It’s currently advised in the UK that women are advised on the basis of absolute risk rather than potential risk – and the absolute risks are relatively small, particularly in women with previous pregnancies (although I understand previous miscarriage elevates risk to some degree)

    There is lots of research if you feel it would be helpful to browse – the NHS Library does an amazing job of pulling together research from all around the world – you can search for advanced maternal age studies here: http://www.library.nhs.uk/booksandjournals/default.aspx

    Some links you might find helpful:




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    • Thanks for those links Sally. Most of the references I’ve found so far just refer to higher complications, but not what those could be. Autism doesn’t affect pregnancy or birth, I’m not at elevated risk for Down’s (less this time than last, oddly), placental positioning they’d pick up on the anomaly scan anyway, diabetes is checked for in all women, a bit of hypertension would probably do me good! (I have low blood pressure. Ludicrously low. Apparently in Germany I’d be medicated.) As for the premature or stillbirth, I couldn’t find any stats on these.

      The thing that is annoying me is that a fully qualified medical professional who knows me well and has seen me giving birth took a complete medical history and made a professional judgement on the basis of that. This was then overruled by a box ticker at the hospital who looked at one factor and one factor only. S/he didn’t look at my GP records which have a full MOT in terms of heart rate, blood pressure, blood oxygen etc as I went in for a full checkup a couple of weeks ago when experiencing breathlessness. (Again, this was at the recommendation of a midwife – just to rule out anything amiss. As it’s worn off, we’re assuming it was hormonal.)

      I am very very fit and healthy. Other than the unexplained miscarriages, which were all missed miscarriages so early pregnancy failures that my body didn’t cope with, there is nothing untoward in my medical history or pregnancy and birthing. And therefore no reason for any medical intervention.

      I am not negative towards consultants. In fact, one of my best friends is a consultant πŸ˜‰ and if it was her I was referred to I’d enjoy the chance for an extra chat. But she’s out of my area, and I can see no reason for this referral at all. In fact, as far as I can tell, it’s absolutely against NICE guidelines, certainly in the wording of the letter which takes none of my wishes into account.

  2. If you want a homebirth have you looked at homebirth.org? It helped me a lot when I was planning what I wanted. It has loads of detail on there about pretty much every situation you could ever find yourself in in the lead up to the birth and will really arm you with info.
    Obviously the main thing is that you and baby are safe but I believe mum knows best and having been through my own battles to have the kind of birth I wanted no one can tell you where or how to have your baby.
    Hope that links help a bit x

  3. Sorry sorry, link is http://www.homebirth.org.uk
    Boo and Me recently posted…Silent, erm, Monday to FridayMy Profile

  4. not much for you out there, but google age related risks pregnancy and human reprod updates or western journal medicine, the obstetrician and gynaecologist, evidence based medicine [which is pretty much the same study as the western journal one]

  5. I don’t know how you’d reach her but if anyone would know why it would be Prof. Lesley Regan. She’s an expert on miscarriage (her book helped me loads–i like facts and statistics) so if that is *really* an issue she’d be able to speak to it.

    Melaina25 recently posted…Save the Children: End the Health Care Worker CrisisMy Profile

  6. As I said on Twitter, being over 40 is not a risk in itself. Most of the problems listed by a previous poster are increased risks for a first pregnancy. Most of them do not cause complications for labour either. In any case unless you have an ongoing issue it is irrelevant. Keep quoting NHS guidelines which state that being over 40 is not a risk unless you have other complications.

    If you don’t want a fight then cancel the consultant’s appointment and tell your midwife you have chosen midwife only care unless there is an actual medical reason to get a consultant involved.

    Red Tent is great. πŸ™‚

    • Wavering over writing them a letter to explain precisely how their letter contravenes NICE guidelines, and asking them what is the medical situation that they feel give them this right to cause discomfort and stress, and just ignoring them completely (but yes, cancelling the appt).

  7. As long as your pregnancy is healthy there is no need why you cannot have the birth you want and where you want it.

    You can contact The Radical Midwives who have individuals that can give you more info. You can contact AIMS (Independent Midwives), you NEED more information for a good defense. Speak to the SoM and HoM to see their views too. You will find that everyone has a different view with possibly NO EVIDENCE which means they are either guessing or deciding based on convenience. you can email me if you want ok? All the best

    • Radical midwives have been source of excellent information and support in the past. I suspect this is indeed convenience. Am seeing midwife on Tuesday, will talk to her, assuming it’s someone I know, and take it from there. Thanks – will hang on to your email too.

  8. Have a squizz at http://www.birthchoiceuk.com as they have some information. If you’re not happy, you don’t have to do anything. And I guess you could always change areas if you wanted to see your consultant friend!

    As I said to you on twitter last night, I was well past 41 when I had Missy Woo. I still had midwife care tho I did see the consultant at 36 weeks due to a fibroid they were monitoring in case it grew and caused problems. The rest of the time, it was as normal – tho the consultant made a cock up by telling me I could still book for the local midwife unit but should never have done due to a previous postpartum haemorrhage. The only issues related to my age was a) spotting choroid plexus cysts at 20 weeks but this happened in both kids and the hospital worried about this when apparently, it’s only a soft indicator of problems when there are other presenting symptoms and b) I had to have GTT both times but everything was fine in that respect. Sounds like they are overreacting and you have every right to be indignant. The medical profession don’t like to be challenged so I like to do it when they make sweeping statements. Yes, I am that awkward git.
    Kate recently posted…On a mission for healthy mouthsMy Profile

  9. I wish I could help give you some answers here but I can’t. I’ve always had consultant led care due to having kidney problems so home birth was never an option for me. Plus both boys have been in distress and nearly lost both. I just wanted to wish you all the health and hope you get the birth you would like xx
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  10. Alison Sauer says:

    AIMs is not independent midwives but the association for improvements in maternity services. They have lots of resources and will be fantastic to support you (I have been a member for a long time). There is also a home birth support yahoo group http://health.groups.yahoo.com/group/homebirthUK/ who will help with the “risks” even if you don’t want a home birth. Depending on what number baby it is (5th would be major red flag) and your age there are statistical risks but of course that is based on whole population……you are fit and active and informed and previous experience will also play a part. Good luck. A

  11. I have no idea on the age-related issues, but just wanted to say that if you do have to be “high-risk, high-monitoring” (and if you had a homebirth last time surely no-one is going to be silly enough to say that just because you’re 2 years old you can’t this time, can they?!) it still might be ok. I had L in the mid-wife led unit (was tempted by home birth but not brave enough with my first) then S and A had to be a c-s because there were two of them (that’s a whole different debate, but it’s what I was told at the time) so when it came to M, because of the previous c-s I had to be medically supervised and hooked up to monitors and have drip lines in just in case blah blah blah. I really didn’t want that, as I’d been mobile throughout labour with L and gave birth standing up and had a really positive experience with no tearing, stitches or pain relief and I really wanted that again. And you know what? I got it. I was monitored and I did have lines in, and they did make me lie down towards the end, but only because they thought I was going to keel over as I’d gone so pale, but I was still mobile and I could still control my own pain, and he still came out perfect and without doing any damage to me.

    So while I really hope you get the birth you really want, even if you don’t, and the surroundings aren’t ideal, the birth itself might still be…
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