Article in Slate: Women are "too old" for vaginal births.. .

[EBeth0000]

. . .so it's not obstetrics' fault. Oh, and we shouldn't try to lower the rate, anyway.

ugh. And I usually really like this writer. Can anyone help me figure out if this study is legit. My first thought was--is there a link between higher maternal age and higher rates of obstetric intervention i.e. inductions, etc. because they are classified "high risk" and thus MANAGED more heavily, resulting in higher Cesarean rates? Anyways,

http://www.slate.com/id/2195305/

[leila1213]

Well, one flaw in the article is that the social forces theory posed at the beginning includes scheduled c-sections for mom or OB convenience, but then the study only looks at the rate of emergency c-sections. So of course it's going to look less like a social phenomenon and more like a biological one, because you've just ruled out all the scheduled c/s. Just at first glance that's what I see.

[Ruthla]

It sounds to me like all the "medical reasons for more c/s in older moms" translates into "c/s for physician failure to wait." So what if an older mom takes longer to dilate and push out her baby? Just because it can't happen in the hospital's time frame is NOT an indication that she's incapable of doing so in her own time!

What a shame that a really good article about kids and cholesterol guidelines was tied in with this bunk.

[holly6737]

Yeah, so what if older moms take longer? Birthing women do not spontaneously combust after 'X' number of hours in labor. I wonder how this would look differently if these were homebirths attended by midwives.


Edited to add: This bothers me:

In addition, the researchers found that as women age, the muscles of the uterus change, and contractions decrease in strength. All of these changes make successful vaginal delivery a little less likely for older women.


Ok, the researchers may have found that the muscles of the uterus change and that contractions decrease in strength. Fine, fine. That doesn't mean that successful vaginal delivery is less likely. Perhaps these women just take longer, but have comparable outcomes to younger women when in a setting that is supportive of normal and natural childbirth. You can't really take data from hospital births (with a myriad of interventions) and extrapolate it to normal, natural, non-intervention childbirth.

[holly6737]

I'd really love to see the actual study.

[sapphire_chan]

Isn't there also more genetic testing in older women leading to more chances for false positives on things that might make c-sections appear to be necessary?


Also, if the muscles are weaker, then fighting against gravity is going to be even harder. So an older mother on her back is going to have even less chance of having a vaginal birth inside the arbitrary time limits.

Plus, as mentioned above, I'm pretty sure that being over 35 is equivalent to being high risk in the minds of the people who like to monitor everything, so an older mother's going to be more likely to be flat on her back strapped to monitors.

As usual, it would appear that the best way to handle an arbitrary designation of being more likely to have a c-section would be to avoid the places where they perform c-sections.

[leila1213]

Originally Posted by holly6737

Edited to add: This bothers me:

In addition, the researchers found that as women age, the muscles of the uterus change, and contractions decrease in strength. All of these changes make successful vaginal delivery a little less likely for older women.

Ok, the researchers may have found that the muscles of the uterus change and that contractions decrease in strength. Fine, fine. That doesn't mean that successful vaginal delivery is less likely...

Yes, actually, it DOES mean successful vaginal delivery is less likely. The doc is more likely to take the baby by c/s in these women - hence, the chance at having a normal vaginaly delivery take its course is much lower. However, I'm sure that's not how most pregnant women would read it. They would think that they CAN'T have a vaginal delivery, so when the doc suggests c/s, they won't be surprised and will think it was inevitable anyway. :

[PassionateWriter]

oh just great. another article to convince women they cant do it.

as a mom over 40 this just makes me go insane. there havent been any good studies done in over 30 years. i would love to see the actual study. argh!!

[AlexisT]

There's some truth in it, I think, as well as the increasing use of fertility treatments.

However, the writer doesn't seem to pay attention to the site of the study--Scotland. While there's upward pressure on the CS rate, it's nothing like as bad as it is in the US. I suspect that medical issues account for more of the increase in the UK than the US.

[holly6737]

Originally Posted by leila1213

Yes, actually, it DOES mean successful vaginal delivery is less likely. The doc is more likely to take the baby by c/s in these women - hence, the chance at having a normal vaginaly delivery take its course is much lower. However, I'm sure that's not how most pregnant women would read it. They would think that they CAN'T have a vaginal delivery, so when the doc suggests c/s, they won't be surprised and will think it was inevitable anyway. :

It doesn't necessarily make vaginal delivery less likely from a purely physiological standpoint. That's what I meant.

[maiaminna]

Well, personally, I've been toying with the idea of getting my tubes tied sometime around my 35th birthday for a while now, anyway.
But absolutely, it doesn't help matters to give older mothers the impression that they are doomed to c-sections, and the reasons for having them are almost certainly influenced by the doctors' behavior, anyway. I would be interested to see a study of outcomes for homebirthing mothers in their 20's vs. in their 40's - it would probably give far more reliable information.

[notjustmamie]

Study Link

http://medicine.plosjournals.org/arc....0050144-L.pdf

Page 1 is the summary and the study itself follows