S/O How many non-stress tests do AMA women really need

[Anonymous]

GWU MFM doc is pushing weekly non stress tests from 35 weeks on, and they want to induce at 40 weeks. I am 40 (conceived at 39), have had zero complications and have a healthy 4 year old who was a result of an uneventful pregnancy. I'm pushing back on the tests (happy to go once or twice but every week seems like complete overkill in my case -- I have a home doppler and can monitor the heart rate if needed and I'll certainly call them if any fluid starts to leak out...) Is this standard with other practices? Last time I had a long labor and insisted on no intervention except an epidural, but the pushing phase was short and everything worked out. I don't really want an induction before closer to 41 weeks if necessary. I'm just trying to get ready to advocate for myself and would love to hear others' experiences.

[Anonymous]

I’m 42 and delivered last month at Washington Hospital Center through their ob/gyn practice. It’s a very similar set up to GW, where I delivered my first when I was 38 (almost 39) with no complications and pitocin to progress but not induce labor. At GW, when I was not yet 40, I had no additional AMA related care other than first trimester genetic screening. At WHC, because I was over 40, I had weekly NSTs and agreed to be induced at 39 weeks, which is their standard practice. I had another healthy pregnancy and discussed with each doctor I saw in the practice and they were all in agreement on the recommendation to induce, and in the end, I wasn’t comfortable going against their recommendations. I did do some of my own research and it seems like the increased risk was relative instead of actual (like yes, much more likely to have a stillborn at my age than younger if I waited, but still very low risk). I was wondering how they handle 40+ at GW; sounds like a very similar approach.

You could see about switching to the GW midwives, though they would want you to commit to not having an epidural.

TBH I hated the entire process of the induction, it took a very long time, uncomfortable, limited movement because of monitoring, etc. and several times during the process I second guessed my decision, though obviously there was no turning back. FWIW, I also second guessed getting an epidural, which I did not have with my first and did not like at all, but can’t do back on that one either! So was it the birth experience that I would have wanted? Not at all. But I was confident in my care team and decided to go with their recommendations, I felt well cared for during the process, and in the end we have a healthy new addition to the family. Not sure if it’s related, but my recovery was much easier this time than with my first.

As a practical matter, it was very convenient being induced so we could schedule things like grandparents coming to care for our 3yo and my last day working before leave.

[Anonymous]

Is this the standard of care for all AMA women or just 40+? I'll be 36 at delivery and already I'm finding my care providers keep bringing that up, so now I'm wondering what else is in store.

[Anonymous]

15:11 PP thanks for sharing your experience! I definitely want the epidural and don't mind the medical setting but I am a researcher and have done my homework: there is no solid evidence to support NSTs as a way to identify fetal distress or low oxygenation. The only issue where there is some seemingly reliable evidence for women over 40 is that going past 41 weeks gets meaningfully more risky than inducing before then.

20:00 PP I was 36 the first time around at GW and did not have any non stress tests...

[Anonymous]

I'm 36yo and 36 weeks pregnant. I was getting monthly growth scans since 28 weeks due to potential growth issues stemming from a single artery umbilical cord but all has been fine. Nevertheless, I'm now in every week for the growth scan plus something else, which I'm forgetting. That second reason is related to my being >35, and i recall only doing one of these visits when I was 40 weeks pregnant with DD, 2.5 years ago.

These are in addition to the weekly ob visits.

[Anonymous]

Anonymous wrote:I'm 36yo and 36 weeks pregnant. I was getting monthly growth scans since 28 weeks due to potential growth issues stemming from a single artery umbilical cord but all has been fine. Nevertheless, I'm now in every week for the growth scan plus something else, which I'm forgetting. That second reason is related to my being >35, and i recall only doing one of these visits when I was 40 weeks pregnant with DD, 2.5 years ago.

These are in addition to the weekly ob visits.

NST. That was the obvious "second thing" I was forgetting. Time for bed...

[Anonymous]

A weekly visit from 36 weeks on is standard for anyone. They usually measure heart rate. And of course you give a urine sample and they take blood pressure to check for preeclampsia. I don’t think there’s much more to the visits st that point. Maybe the strep test...I can’t remember when that is.

[Anonymous]

I was "only" 36 when DS was born, but did not have a single NST, and delivered at 39+4, spontaneous labor. I can't remember if I was supposed to start NSTs at 40 or 41 weeks.

[Anonymous]

I just delivered at 35 (almost 36). My conservative practice of OBs and midwives routinely recommend induction at 39 weeks for all moms 35+. I declined induction and agreed to their next recommendation for NST at 40 weeks and induction at 41 weeks. I did get a talk about the small increased risk of waiting but my midwife did not feel it was an unreasonable decision. All my previous pregnancies went just a few days past my due date. This pregnancy was uncomplicated. I passed the NST at 40+1 and went into labor on my own 3 days before the scheduled induction.

[Anonymous]

I was just about 40 when I delivered my first and never did an NST (although I delivered 1.5 weeks early). OB also never mentioned induction if I went past my due date at any point.

I'm 44 with my second and am 34 weeks. No mention of NSTs or induction. At a certain point, I'm sure it would come up, or if I had other risk factors. Other than age, this is a totally plain vanilla pregnancy, as was my first. This one is also from IVF, although first wasn't, but OB doesn't seem to consider that a risk factor for anything.

[Anonymous]

The MFM I saw with all three pregnancies, who was pretty chill, said that things do change once women hit 40, i.e., weekly NSTs are indicated at that point. This was a doc who didn't bat an eyelash at my refusing them at 35 and 37, so I trusted him. I was 39.5 with my third pregnancy, so had a few, if not weekly. I'm 42 now and wouldn't hesitate to get them, nor would I push back on induction once I hit 39 weeks.

[Anonymous]

Why are you so opposed to NSTs? They’re really not that big of a deal and take about 20 minutes. I’ve had them starting at 36 weeks for all three pregnancies due to white coat hypertension (I was under 35 for all of the pregnancies) .

[Anonymous]

I was 35 when I delivered and I had them. I was grateful for the check-in and to hopefully lower the risk of stillbirth.

[Anonymous]

OP here. that's the thing, I've ready up on them and there is zero evidence they help prevent stillbirth. There is also zero evidence that placental quality is the reason for increased stillbirths associated with AMA. The only thing that does have some solid evidence is that induction at 41 weeks or so, and then it would take nearly 10,000 inductions (9630 if I recall) to prevent one stillbirth.

This does a decent job of summarizing available studies, but I dug into some of the studies on top of this too...
https://evidencebasedbirth.com/advanced-maternal-age/

[Anonymous]

*read up