Inductions/c-sections for AMA?

ReeceFamily · December 2012

Hi ladies! I'm a frequent stalker/infrequent poster here, with a question for anyone who might have experience with this.

I'm 43 and due on Jan 20. I go to a high risk OB clinic because of my age only, I have no other complicating factors and my pregnancy has been healthy so far (knock on wood, fingers crossed). My OB has said, however, that they won't allow me to go past my due date. If my body isn't moving along with the labor process when they check me on Jan 17, they will automatically schedule me for a c-section.

Has anyone else been told this, and given reasons why? (My OB said something about baby size and AMA women not having as much of the hormone relaxin to help widen the pelvis?)?

ShellBear+ · December 2012

My ob says he won't let me go past 41 weeks. I asked about it because I have read that there are studies saying that the risk of stillbirths go up after 40 weeks for women over 35. He didn't seem overly concerned with that though. They may be even more concerned with this after age 40, I don't know. I haven't heard of any other reasons.

I don't understand why they would just schedule the c-section though and not try to induce first?

kat1221 · December 2012

Weird. Why wouldn't your OB try and induce as oppose to an automatic C/S? With my first I was only 34 and was induced at 41 weeks b/c I wasn't showing any progress AT ALL. Many hours later, I ended up with a C/S and a 10 lb. baby with meconium (SP?). My OB said it's standard to not let patients go past 41 weeks w/o induction for this reason. This time around at 38, I have a scheduled C/S but had I chosen a VBAC, they would not have let me go past 40 weeks and they won't induce at that practice with a prior C/S.

Sorry, I rambling. Good Luck!!

ReeceFamily · December 2012

PetraStonegirl:
I'm 100% on board with docs not letting AMA women go much past their due date, as the risks to baby skyrocket under that scenario. The reason is that the placenta begins it's degradation sooner with AMA moms. So, the 40 week placenta of an AMA mom is likely to look and function like a 43 week placenta of a younger mom. (Before I cause panic with younger AMA moms, please remember there is a world of difference between being 35 and being 43, 35 year olds go to 41 weeks all the time)
I certainly have not heard of an automatic c-section for AMA moms before though, less relaxin or not. I am also 43 (or will be in a week), and my OB would have been completely on board with a vaginal delivery attempt. He told me so, right up until my last ute surgery this spring. Now I'm an automatic c-section, because of other risk factors.

OK, I hadn't heard that (about placenta degradation), so that makes sense. I'm a little confused about the automatic c-section as well, except for my OBs concern about lack of pelvic flexibility. I wonder if, even with inductions, the chance of having to eventually go to c-section is so high that they just go there instead of trying induction first? I'll have to ask more questions at my appt on Friday/ask my doula.

MrsGibb · December 2012

My OB said 39 weeks unless I go into labor before that. That is fine with me. I had my only full term child at 36 weeks.

ShellBear+ · December 2012

PetraStonegirl:

The reason is that the placenta begins it's degradation sooner with AMA moms. So, the 40 week placenta of an AMA mom is likely to look and function like a 43 week placenta of a younger mom. (Before I cause panic with younger AMA moms, please remember there is a world of difference between being 35 and being 43, 35 year olds go to 41 weeks all the time)

I hadn't heard of this but doc did say I'm supposed to monitor the placenta with twice weekly u/s starting at 32 weeks for this reason. I think its excessive since its just due to age, I'm only 36.

Country Girl in the City · December 2012

ShellBear+:
PetraStonegirl:

The reason is that the placenta begins it's degradation sooner with AMA moms. So, the 40 week placenta of an AMA mom is likely to look and function like a 43 week placenta of a younger mom. (Before I cause panic with younger AMA moms, please remember there is a world of difference between being 35 and being 43, 35 year olds go to 41 weeks all the time)

I hadn't heard of this but doc did say I'm supposed to monitor the placenta with twice weekly u/s starting at 32 weeks for this reason. I think its excessive since its just due to age, I'm only 36.

Twice weekly does seem excessive. I am doing once a week starting 32 weeks but mine is due to pre-e as well as age. I will be induced at 39 weeks if all goes well and we don't need it sooner but again that is because of the pre-e and not just age. My OB would not even send me to a MFM if age was my only risk factor. I would also be cautious of a c-section just for age. That seems to go against common medical proceedures unless there are other factors.

technigirl · December 2012

That doesn't make sense to me. I'd question further as to why they wouldn't try induction first. I also don't understand how your body could be "moving along with the labor process" before it even goes into labor. Not everyone starts dilating before labor actually begins, especially with their first. With my daughter, they said I was high and tight and looked like I would be coming back for my 40 week appointment. Needless to say, I never made it, as 3 days later I went into full on labor.

As someone who has had a c-section, I recommend you avoid as long as you are otherwise healthy. The recovery period is long and fairly painful.

Melissa

Momof2hopingfor3 · December 2012

ShellBear+:
PetraStonegirl:

The reason is that the placenta begins it's degradation sooner with AMA moms. So, the 40 week placenta of an AMA mom is likely to look and function like a 43 week placenta of a younger mom. (Before I cause panic with younger AMA moms, please remember there is a world of difference between being 35 and being 43, 35 year olds go to 41 weeks all the time)

I hadn't heard of this but doc did say I'm supposed to monitor the placenta with twice weekly u/s starting at 32 weeks for this reason. I think its excessive since its just due to age, I'm only 36.

My MFM is also requiring the u/s monitoring and non stress tests. They ave also told me I will be induced before my due date after 38 weeks. Fine by me!

RachelG1016 · December 2012

I have also heard about the placental degredation but my OB never addressed it with me because I am having a RCS at 39 weeks.

If I was a candidate for a VBAC (hospital doesn't allow them) then my OB wouldn't let me go past 40 weeks.

I am 39 and haven't had am NST or any other additional monitoring solely because of my age. That sounds like a little bit of overkill to do NST's twice a week for 8 weeks if you are only 36.

amandaleigh1 · December 2012

I'd be very skeptical if some of the things your ob is saying. I honestly think a lot if ob s would prefer to schedule all their patients for c sections if they could because it is more convenient for them.

It is true that there is a greater risk of still birth with post date pregnancies and AMA, but I've never heard that bit about relaxin. I call bs on that one.

Some babies really aren't done baking till they are 40 weeks. I would not want to have my baby taken out earlier than that unless there was a compelling medical reason.

I was monitored with NST and afi by ultrasound beginning at 38 weeks 1x per week. Had those been fine I would have gone all the way till 42 weeks before inducing. In any case my fluid started to tank after 41 weeks, so I agreed to an induction at 41w3 days. I still had a vaginal birth despite my miserable bishops score. I think it would be in your best interest to try for a vaginal birth even if you are induced. Be sure to get cervical ripening before pitocin if your cervix is still not effaced and open, otherwise starting with pitocin is not likely to go well.

SeaConquest · December 2012

I agree with the others that believe that this sounds like a bunch of hooey. While stillbirths are twice as likely in women over age 35 vs. women under 35, there is no indication that placental insufficiency is the reason for fetal demise.

https://www.ncbi.nlm.nih.gov/pubmed/15970865

In short, there are lots of reasons that stillbirths happen in older women, but I am not convinced that post-term placental insufficiency is the culprit.

danuli8 · December 2012

SeaConquest:
I agree with the others that believe that this sounds like a bunch of hooey. While stillbirths are twice as likely in women over age 35 vs. women under 35, there is no indication that placental insufficiency is the reason for fetal demise.
https://www.ncbi.nlm.nih.gov/pubmed/15970865
In short, there are lots of reasons that stillbirths happen in older women, but I am not convinced that post-term placental insufficiency is the culprit.

I also agree, and I call BS on your OB. An automatic c-section because you are old is just stupid. I have not researched placental degradation in AMA women, but will look into it further.

I think part of the problem with AMAs in general is that there is more variation: there has simply been more time for women to develop issues OR to be extremely fit and healthy, such that it becomes extremely difficult to make any generalizations at all about us as a group. So I think stuffing us all in one box, as your OB seems to be doing, is extremely problematic.

Pseudohippychick · January 2013

I know it's late in the game, but if your Dr. will not even allow for an induction at the least, I personally would switch OB ASAP.

Inductions/c-sections for AMA?

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