Anonymous wrote:The thing is you can't be sure of how many weeks you are unless you did IVF. So there is the risk of inducing early which is what I think happened with my first son. Regardless, I've been induced, had a natural birth, a C-Section and then, at 43, an induced VBAC. The best was of course the natural birth but the last induced VBAC was also great - for me, the worst was the c-section.

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Anonymous wrote:

Anonymous wrote:Change your providers. Being treated like that is not okay and not normal.

If they're discussing induction it's likely too late to change providers. Most OBs won't want to take a switched patient super late.

It looks like the ACOG does recommend induction at 39 weeks for moms 40 and older and they will base that on statistics and science. So if you have any other complicating factors, at least have a conversation about it. But they shouldn't just be telling you, they should be laying out stats and reasoning.

OP here - my biggest problem is that there have been no complications. Stress tests, ultrasounds, blood work - everything has been stellar. I understand the need to inform but it just seems beyond that at this point

Anonymous wrote:Pregnant with our surprise fourth baby at 39 and had the other 3 before I was 35. I feel like going to my appointments is doomsday every single time due to my age. I get that I’m considered geriatric but the way I’m talked to and constant push for interventions like an induction every single appointment just depresses me. Had a doctor today tell me a story about a patient above 40 losing her child because she decided to wait until her due date for baby to come naturally. This is now becoming routine where every provider is telling me a different horrible scenario because I have opted not to be induced yet. Just venting I guess but it’s been night and day experience being pregnant with this baby then it was with my others and it’s made my pregnancy so sad for me.

Anonymous wrote:My sister lost her baby days before her due date. I would heed all of my doctor’s advice on reducing the risk of stillbirth without second thought. I will do everything in my power to avoid such a devastating outcome.

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Anonymous wrote:I waited until 41 weeks to induce with my first, and the induction took forever and then still didn't work, and I had her by c-section at 41w4days (at almost midnight, so almost 5 days!). I remember at my PACE group people being so deeply sorry for me for having a c-section, but she was only 7 lbs at birth, the placenta was degrading, and there was meconium in the fluid. When I said that a C wasn't my worst case scenario, a stillbirth was, the reaction was still a shocked gasp that I would "scaremonger" about natural births.

A lot people are really, really deeply emotionally connected to the idea of vaginal births with no interventions. Science can't really stand a chance against emotions like those.

I hope everything goes well for you, OP. But I do think it's misleading that you started a thread about how nuts it is that they brought up induction at all of your appointments when your most recent appointment was literally for your 39th week. Of course they brought it up. It's the recommendation.

I agree with this. I was 39 when I had my last child and had to be induced. This was years ago and they let me go to 41 weeks. I can remember at that time people on this board would say it is better to induce earlier but the evidence was not there yet. Now it is. Consider it is not some effort to age shame you but them giving you best medical advice. You can choose not to follow it but they'd be bad doctors for not advising you to do it.

Anonymous wrote:Pregnant with our surprise fourth baby at 39 and had the other 3 before I was 35. I feel like going to my appointments is doomsday every single time due to my age. I get that I’m considered geriatric but the way I’m talked to and constant push for interventions like an induction every single appointment just depresses me. Had a doctor today tell me a story about a patient above 40 losing her child because she decided to wait until her due date for baby to come naturally. This is now becoming routine where every provider is telling me a different horrible scenario because I have opted not to be induced yet. Just venting I guess but it’s been night and day experience being pregnant with this baby then it was with my others and it’s made my pregnancy so sad for me.

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Anonymous wrote:Change your providers. Being treated like that is not okay and not normal.

If they're discussing induction it's likely too late to change providers. Most OBs won't want to take a switched patient super late.

It looks like the ACOG does recommend induction at 39 weeks for moms 40 and older and they will base that on statistics and science. So if you have any other complicating factors, at least have a conversation about it. But they shouldn't just be telling you, they should be laying out stats and reasoning.

OP here - my biggest problem is that there have been no complications. Stress tests, ultrasounds, blood work - everything has been stellar. I understand the need to inform but it just seems beyond that at this point

My sister had zero complications whatsoever. Completely smooth pregnant. Baby had no heartbeat at 39 weeks and 3 days.

Follow the evidence.

The evidence was someone didn't do their job right or they didn't know the reason for stillbirth. So they're pushing for induction and/or C-section at 37th or 39th week without following the medical science.
Scare tactic is their way.

Her stillbirth had an unknown cause despite genetic testing of embryos, fetal autopsy, and pathology of fetal and placental tissue. Somewhere between a quarter and half of stillbirths have no known cause, so her situation is not anomalous.

The risk of stillbirth increases, particularly for older mothers, after 37 weeks. Of course, that risk has to be balanced against the risk of complications from being born a bit earlier. The recommendation of induction at 39 weeks for older mothers is a reasonable one that’s evidence based and balances protection of neonatal health with reduction in the risk of stillbirth.

I’m thrilled that presenting the risk of stillbirth to a mother sounds like a “scare tactic” to you. There have now been two stillbirths in my family (same generation) from two different mothers despite no prior family history. Both stillbirths had no known cause. Both had healthy pregnancies. Both had two other live births. These outcomes were totally devastating and, in my opinion, should be avoided at all costs.

I had absolutely no idea about any of this during my geriatric pregnancy - I knew one person whose sister had a stillbirth at 8 months but my understanding was that this was anomalous. Then mine stopped moving at 37 weeks. Emergency C-section saved him. Doc was spooked and told me a similar thing had happened on the ward with a different practice the week before, and the outcome was not so lucky. I’m seeing so much more literature about this in the past few years, and wish I had known. I hope you’ll be absolutely fine Op and that kind of this is relevant to your scenario in any way, but they aren’t telling you this just to randomly try to bum you out

I feel for OP and get where she’s coming from. Stillbirth is scary and the doctors are right to present evidence and recommendations. I will say that the evidence pretty clearly does show that a 4th time older mom is at lower risk for stillbirth than a young first time mom, and yet only the former would normally get the induction recommendation. That’s current ACOG guidelines but it’s not exactly evidence based.

For many women stillbirth is frankly a fairly remote but yes totally real possibility. It can happen to anyone, and it can happen before any doctor following sound practices would ever suggest an induction. It’s reasonable to have informed conversations about these things.

What? Stillbirth risk is much higher for older moms at more than 39 weeks than younger moms, regardless of prior births.

I was trying to quickly retrace where I remember reading this and only did this quickly.
See table 1 here.

Maybe there’s contrary evidence out there (I’m open to it), but for conversation’s sake this is what I was thinking of.

Here’s one study showing that stillbirth risk doubles at 39 weeks for mothers 40 and over. At 40 weeks, it increases more than 7-fold.

The study also says: “Overall, the risk of stillbirth increases a term of pregnancy in all maternal age groups, especially in older mothers.”

https://pubmed.ncbi.nlm.nih.gov/33228416/

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Change your providers. Being treated like that is not okay and not normal.

If they're discussing induction it's likely too late to change providers. Most OBs won't want to take a switched patient super late.

It looks like the ACOG does recommend induction at 39 weeks for moms 40 and older and they will base that on statistics and science. So if you have any other complicating factors, at least have a conversation about it. But they shouldn't just be telling you, they should be laying out stats and reasoning.

OP here - my biggest problem is that there have been no complications. Stress tests, ultrasounds, blood work - everything has been stellar. I understand the need to inform but it just seems beyond that at this point

My sister had zero complications whatsoever. Completely smooth pregnant. Baby had no heartbeat at 39 weeks and 3 days.

Follow the evidence.

The evidence was someone didn't do their job right or they didn't know the reason for stillbirth. So they're pushing for induction and/or C-section at 37th or 39th week without following the medical science.
Scare tactic is their way.

Her stillbirth had an unknown cause despite genetic testing of embryos, fetal autopsy, and pathology of fetal and placental tissue. Somewhere between a quarter and half of stillbirths have no known cause, so her situation is not anomalous.

The risk of stillbirth increases, particularly for older mothers, after 37 weeks. Of course, that risk has to be balanced against the risk of complications from being born a bit earlier. The recommendation of induction at 39 weeks for older mothers is a reasonable one that’s evidence based and balances protection of neonatal health with reduction in the risk of stillbirth.

I’m thrilled that presenting the risk of stillbirth to a mother sounds like a “scare tactic” to you. There have now been two stillbirths in my family (same generation) from two different mothers despite no prior family history. Both stillbirths had no known cause. Both had healthy pregnancies. Both had two other live births. These outcomes were totally devastating and, in my opinion, should be avoided at all costs.

I had absolutely no idea about any of this during my geriatric pregnancy - I knew one person whose sister had a stillbirth at 8 months but my understanding was that this was anomalous. Then mine stopped moving at 37 weeks. Emergency C-section saved him. Doc was spooked and told me a similar thing had happened on the ward with a different practice the week before, and the outcome was not so lucky. I’m seeing so much more literature about this in the past few years, and wish I had known. I hope you’ll be absolutely fine Op and that kind of this is relevant to your scenario in any way, but they aren’t telling you this just to randomly try to bum you out

I feel for OP and get where she’s coming from. Stillbirth is scary and the doctors are right to present evidence and recommendations. I will say that the evidence pretty clearly does show that a 4th time older mom is at lower risk for stillbirth than a young first time mom, and yet only the former would normally get the induction recommendation. That’s current ACOG guidelines but it’s not exactly evidence based.

For many women stillbirth is frankly a fairly remote but yes totally real possibility. It can happen to anyone, and it can happen before any doctor following sound practices would ever suggest an induction. It’s reasonable to have informed conversations about these things.

What? Stillbirth risk is much higher for older moms at more than 39 weeks than younger moms, regardless of prior births.

I was trying to quickly retrace where I remember reading this and only did this quickly.
See table 1 here.

Maybe there’s contrary evidence out there (I’m open to it), but for conversation’s sake this is what I was thinking of.