‘Geriatric’ pregnancy

Amongst the many risk labels the maternity service wishes to apply to women, this is quite possibly one of the most awful. Although I have seen this dated term being used much less frequently in the last 10 years, it feels like it is rearing its ugly head once again. You’ll have seen in the British media that older women are apparently one of the causes of an increase in the need for birth interventions - as adverse outcomes are blamed on women because they are too old, too fat or too ill. This seems to be the go to explanation offered when an obstetrician is asked to comment on why interventions are increasing - despite research not supporting this statement. Data has shown a small increase in older women having babies, but it doesn’t match with the much higher increase in the use of medical interventions. It’s important to know that if you're over 35 or over 40 (depending on your postcode!), the maternity system will use age to justify the increasing use of medical interventions. We need to face this issue and challenge the ageist origins of this label and understand what it means for your care.

Why is induction of labour offered as standard for women over 40?

The routine use of induction of labour seems to have become the default response from maternity care providers worried about the impact of a woman's age on pregnancy, despite the risks induction itself entails. If you want to learn more about inductions, you can read our blog on the risks, the benefits and your rights. It is important to understand why women are being offered induction of labour based on their age. One of the most commonly stated reasons for this recommendation is to do with the risk of stillbirth. There is evidence that women over the age of 35 are more likely to have a stillbirth when compared to younger women - although the overall risk of stillbirth is low. For this reason we need to take a close look at these figures and the quality of the research that underpins this recommendation to understand what it means for you as an individual.

What we know about age won’t come as a surprise to you. As we age we may develop other health conditions. And those with other health conditions may experience problems in pregnancy. The data from studies looking at the risk of stillbirth based on a mothers age, does not separate women with health conditions from those without. The research therefore is limited as the findings cannot be fully applied to all women in these age categories. The risk of stillbirth can be attributed to varying factors such as pre-existing ill health, smoking and alcohol use, the development of pregnancy complications, and congenital abnormalities which may be related to age of the mother. Whilst induction is frequently offered as the solution, we can’t ignore the elephant in the room: that induction of labour has been shown to increase adverse outcomes and has not been shown to prevent all stillbirths from happening. 

Age, Stillbirth Risk and What the Research Really Shows

A study published from the Netherlands in 2020 identified the increased risks for differing age categories. When addressing risk it is important to consider the way in which that information is delivered to you. As independent midwives, we mark out precious time to sit with you and look at this data together. Most of our clients want to know about the absolute risk. This is the chance of adverse outcomes actually happening. Sara Wickham has more on this here. One of the comparisons of the Netherlands study shows the stillbirth rate in the following age groups:

• 18-35 year olds: 0.17 (absolute risk: 1:588)
• 35-39 year age group: 0.22 (absolute risk:1:455)
• 40+ age group this increases to: 0.30 (absolute risk: 1:333)

When we look at the data specifically around age and stillbirth we can find that there is a difference in the rate of stillbirth based on age, but this study has used age groups in order to make sense of their findings. So it is also important to remember that your risk does not change dramatically overnight on your birthday when you jump into the next age bracket! The stillbirth rate can change once again when we begin to account for other factors that are deemed ‘risks’ such as post-term, i.e. after 42 weeks of pregnancy.

So in our attempts to understand what age means for pregnancy and the outcome for stillbirth we can see that age can contribute to the chance of stillbirth happening but that age does not exist in isolation and the research cannot exclude other contributing factors, nor single any one factor out. It’s complex and as with anything in pregnancy and birth, it is so nuanced. Without seeing yourself as a unique person with individual needs it is easy to end up within the flow of population based policies and guidelines without taking a look at what all of those recommendations mean for you.

Do Risk Labels Improve Outcomes? Why Knowing Your Midwife Matters More

A recent study highlighted the negative impact on labelling women in their pregnancies. The terms ‘low risk’ and ‘high risk’ pregnancy are used for all women accessing NHS maternity services in the UK. It is encouraged as a way to ‘manage’ a pregnancy through the maternity system. Risk can be defined in so many ways and the boundaries are forever expanding. Women are either too young or too old, underweight or overweight, etc etc. Have you noticed that the problems always seem to be women’s and their bodies, with little consideration of the effects of the maternity system? Research has shown that the use of these labels have not improved outcomes for women and their babies, in the short term nor the long term. We have seen however, an increase in health anxiety, increased use of medical interventions leading to adverse outcomes, and an increase in barriers to accessing midwifery care.

Continuity of care from the same midwives you know and trust has been shown to improve outcomes for even those labelled as ‘high risk’. The evidence shows that women of ‘advanced maternal age’ (another delightful term) benefit from a midwife they know and trust. And working as an independent midwife means seeing beyond your age and providing you with the care you want and deserve. How old you are may be an important factor in how you feel about your pregnancy and your body and that’s okay too.

Can I have a homebirth if I am over 40?

Yes is the simple answer - you have the right to plan your birth wherever you would like, whatever age you are. Evidence has shown that birthing outside of obstetric units for women of all ages with a healthy pregnancy (often with the label ‘low risk’), reduces the rates of “routine” or clinically unnecessary medical interventions that can lead to adverse outcomes for women and babies. Part of that can be to do with the support you have around you. Having continuity of care from the same midwife during your pregnancy and labour has been shown to improve health outcomes and result in greater birth satisfaction. As independent midwives we get to work and care for people throughout this entire journey and that time spent with a woman and her family directly translates into a strong therapeutic relationship where we can support individuals to make the right choices for them be it at home, a midwifery led unit or an obstetric unit.

You’re not getting older, you’re getting better

What the research into age and pregnancy has failed to take into account is who you have become at 40. In the words of Dr Sara Wickham, “There are advantages to being an older parent, and when we focus only on the possible downsides, we miss seeing that”. The life you have lived can bring about experience, confidence and security, something you might not have had in abundance throughout your 20s and 30s. These characteristics that make you who you are can have an impact on your physical wellbeing. Something that the medical research has been slow to pick up on.

If you want to know more about women’s experiences of induction then I recommend reading about that here. How you experience labour and childbirth can have a positive or negative impact on you and your new family’s journey into motherhood and beyond. Using the BRAINS decision making tool can help you make the decisions that feel right to you.

Independent Midwifery Care in Kent

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