In the last decade, doctors have seen considerable changes in the way childbirth is handled. More and more, mothers are able to choose their position during labor and delivery, and their wishes during the birth are given much higher profile. Hospitals may now offer birthing stools, water pools and other “natural childbirth” props. Birthing rooms in hospitals are more common. Home births may be marginally more common and accepted than they were a decade ago.
However, despite this progress, many women are still concerned that there is too much medical intervention in the process of childbirth. This is especially true for older mothers, who are considered to be at higher risk and are much more likely to receive medical intervention.
Home births are still very rare-planned home deliveries account for less than 1% of the total-and few doctors are happy about a first-time mother over 35 giving birth at home. Of course, the ultimate decision is yours, and you still have the option of a home birth if you want one, perhaps with the help of an independent midwife.
A first-time mother over 40 is likely to be offered an elective Cesarean, and this is especially true if she has had fertility problems. A high proportion of IVF babies are born by Cesarean section; first, because doctors do not want to put the baby at any risk, and second, because the whole pregnancy has become so medicalized that many mothers who could not conceive naturally doubt their ability to give birth naturally too.
This impression is backed up by a study of 195 women having their first baby over 35, compared with another 196 women in the same situation who had a history of infertility. The study showed that the women with no history of infertility were four times more likely to have a preterm delivery (less than 37 weeks), five times more likely to undergo a Cesarean section and significantly increased rates of vaginal-assisted delivery, chronic hypertension and fibroids compared with women having their first baby between the ages of 20 and 25. Those who had suffered from infertility had twice as many elective Cesareans as those in the other group, but otherwise there was no difference in outcome.
Unfortunately, in medical litigation cases, inaction can be seen to be negligent while intervention is not. So even if in a particular labor mother and baby’s chances would be best served by doing nothing, doctors may feel they have to intervene to protect themselves. When a mother is older and her baby is considered a precious baby, intervention is much more likely.
However, mothers who opt for a natural, and in particular, a home birth, do so largely because they believe it is safer:
“I had my third child at home at the age of 35. I believe that home birth is safer if there are no special risk factors, and the labor was far quicker and in every way better than the previous two. I believe that probably more babies die as a result of infections picked up in a hospital and mismanaged, extended and messed around-with labor in the hospital than would die at home in the rare event that something goes wrong. However, I do accept that at 35 with a first baby I would not have had the confidence to have a home birth, and if I had no children or had a history of infertility I would probably feel different too.”
Marianne, pregnant with her first baby at 39 after two years of infertility treatment, disagreed. “This might be my only baby. I’ll do whatever the doctors suggest. I’d like a natural birth, of course, but if things go wrong, if they suggest a Cesarean, I’ll go along with it.”
One childbirth-education teacher says that in her experience, older mothers generally feel positive about their labors. “I think they are more realistic than the younger mothers. They want a baby rather than a wonderful natural-childbirth experience.”
However, older mothers may have to stand their ground if they are under pressure to allow intervention in the childbirth process. And, like all mothers, they will have to make a choice. This means finding out what the options are and understanding what labor, both normal and with complications, involves.