If You Go Past 40 Weeks
If You Go Past 40 Weeks
Section titled “If You Go Past 40 Weeks”📄 Download PDF: If You Go Past 40 Weeks · 4 pages · 3 tables extracted
Page 1
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Why does age matter?
Many people 40 and older are in excellent health,
and they experience uncomplicated pregnancies
and births and deliver healthy newborns. However,
research shows that people in this age group have
higher rates of such interventions as induction,
caesarean section and assisted delivery with vacuum
or forceps. They are also at a higher risk of giving
birth to a baby that has died before or during labour,
also called stillbirth.
Risks of stillbirth
Research shows that about one in 1000 pregnant
people under 40 experience a stillbirth at weeks
39-40, while about two in 1000 pregnant people 40
years and older have a stillbirth at the same stage.
A note about fertility treatment
This handout does not discuss the use of assisted
reproductive technologies (ART), such as in vitro
fertilization (IVF) or implantation of donor eggs or
fertility drugs. If you used any assisted reproductive
methods and you are 40 or older, talk to your
midwife about your specific individual care.
Risk of stillbirth by age
In Due Time…
Pregnancy Beyond 40
and Induction of Labour
If you are 40 years of age
or older, your midwife will talk
with you about your options for giving
birth as your due date gets close. This
handout explains the research about
the risk of stillbirth for anyone who is
pregnant and age 40 or older. It will help
you make choices about either using
medication to start your labour around
your due date or waiting for labour to
begin on its own. This handout does not
replace the informed choice discussions
between you and your midwife.
2 in 1000 pregnant people
40 years of age and older
experience a stillbirth
at weeks 39-40
References for information included in this document can be found in the accompanying
document Pregnancy beyond 40 years: A clinical backgrounder for midwives.
1 in 1000 pregnant
people under 40 years of
age experience a stillbirth
at weeks 39-40
What does a two per 1000
risk really mean?
To put this into perspective, examples of other
occurrences that have about a two in 1000 chance
include:
•
Being born with 11 fingers or toes.
•
Your lifetime chances of dying by getting hit by
a car as a pedestrian.
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Does it make a difference if I’ve had
a baby before?
The risk of stillbirth is lower if you have already had a
baby, regardless of your age.
At 38-39 weeks, the risk of stillbirth for pregnant people age 40 or older is double the risk for those under 40. At
weeks 40-41, the risk of stillbirth for pregnant people age 40 or older is triple, compared with those under 40. Some
research shows that at age 40 or older, your chances of having a stillbirth around your due date are similar to the
chances of someone under 40 having a stillbirth at one or two weeks after their due date. This research has led some
care providers to recommend starting labour with medical methods techniques earlier than if you were under 40.
What are my options?
To manage the risk of stillbirth, two approaches are discussed most often: monitoring (waiting for labour to
start on its own) and induction (using medication to start your labour).
Monitoring
Many pregnant people prefer to wait for labour to start on its own. You may feel that
labour will begin when the baby and your body are ready. It may be important to you
to labour naturally and avoid medical interventions, if possible. Because the chances
that a baby will be stillborn tend to increase past the due date, your midwife will usually
suggest ways to check on your baby’s well-being. If you decide to wait for labour to start
on its own, your midwife will offer to monitor your baby’s health, usually via ultrasounds;
or a non-stress test, where an electronic fetal monitor is used to listen to the baby’s
heartbeat. Monitoring usually takes place at a clinic or hospital. Regardless of your age,
it is standard practice for midwives to offer clients an induction sometime between 41-42
weeks, because of greater risks to the baby after that point.
Induction
Many pregnant people choose induction to get labour started. You may feel impatient,
anxious or uncomfortable waiting for your baby’s arrival. With an induction, labour is
artificially started using such drugs as prostaglandins or oxytocin (versions of natural
substances in the body that start labour); or by breaking the bag of waters (amniotic sac)
that surrounds the baby, to encourage the uterus to contract. Because the chances of
a stillbirth tend to increase as your pregnancy gets further along, health-care providers
often offer induction to pregnant people 40 and over, starting at around 39-40 weeks.
Conversations with your midwife about timing of induction may change as your pregnancy
progresses. Because some methods (prostaglandin gel, oxytocin) are only available in
hospital, choosing induction may limit your options for where you give birth.
Risk of stillbirth as pregnancy progresses
for every 1000 births
Does it make a difference if I’m past
my due date?
For all pregnant people, the chances of a stillbirth
increase as your pregnancy progresses past 40 weeks.
<35 35-39 ≥40
4
1
2
3
7
9
<35 35-39 ≥40
If you’ve
never had a
baby before
If you’ve had a
baby before
Risk of stillbirth for every 1000 births
Age
Age
0
5
10
15
20
25
Under 35 years
35-39 years
40 years and over
at 37-38 weeks
at 39-40 weeks
at 40 weeks
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Does either approach reduce my risk of stillbirth?
Monitoring: Monitoring methods cannot predict or
prevent a stillbirth. Rather, they are used to check your
baby’s well-being at the moment of the test. If your
midwife has concerns, they may recommend an induction.
Induction: Currently, no research shows that inducing
labour sooner reduces the rate of stillbirth in those 40 and
older. However, one study in the UK shows that induction
of labour at 39 weeks’ gestation might reduce stillbirth
rates for parents 35 and older who are having their first
baby. Stillbirth rates in this study were low, regardless of
whether participants had an induction or waited for labour
to start on its own (less than three in 1000). No research
shows that inducing labour earlier reduces the chance of a
stillbirth for those who have had a baby before.
The interventions used to stimulate labour and birth
may carry their own risks. Some studies show that an
induction could increase your chances of having a
caesarean section, while others indicate that it might
not. In Ontario, data shows that people 40 and older
who are induced have higher rates of caesarean section
than those whose labour starts naturally.
What about non-medical methods
to encourage labour?
Midwives and their clients sometimes use non-medical approaches to encourage
labour. One is called a “stretch and sweep,” where your midwife puts their fingers
into the vagina and examines and stretches the cervix. Other options include
castor oil, acupuncture, homeopathy, nipple stimulation and herbs. Talk to your
midwife if you want to know more about ways to encourage your labour.
34 in 100
Ontarians 40 years
of age or over who
get an induction
have a vaginal birth
66 in 100
Ontarians 40 years
of age or over who
labour naturally
have a vaginal birth
What are my choices if I am 40 or older and my due date
is coming up?
Your choices about
monitoring are to:
Your choices about
induction are to:
• start monitoring your baby’s well-
being earlier, at around 39 weeks;
• wait to start monitoring until a
later date (around 40-41 weeks);
or
• not do monitoring at all.
• have an early induction of labour
(at around 40 weeks);
• have an induction at a later date
(around 41-42 weeks); or
• wait for labour to start on its
own.
Your midwife will help you make
sense of these factors and
understand the risks for your
own pregnancy. Different people
will make different choices
based on their own values and
preferences. Your midwife may
have a specific recommendation
for you based on what’s
happening in your pregnancy.
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How do I decide what’s best for me? There are many decisions to think about when you choose whether to have a medical induction or wait for labour to start on its own. For example, you may want to consider these questions: • How do you feel about the risks and benefits of medical induction compared with monitoring your pregnancy? • Where do you want to labour? Where do you want to have your baby? • How comfortable are you with medical interventions? • How does information about risk of stillbirth affect how you will make choices? • Are there other factors that might affect your choice (e.g., presence of other medical conditions or whether you’ve had a baby before)? As long as you and your baby are healthy, monitoring your pregnancy and the baby’s condition can be a reasonable choice. It will help ensure that your baby continues to do well, and it will help your midwife determine whether induction may be advisable. If monitoring raises concerns, choosing an induction before more serious problems develop may offer the best chances for a birth without complications. What if I have more questions? Share your questions, concerns and ideas with your midwife. Please write them down below and bring them to your next appointment.
Table (Page 1):
| If you are 40 years of age or older, your midwife will talk with you about your options for giving birth as your due date gets close. This | ||
|---|---|---|
| In Due Time… Pregnancy Beyond 40 and Induction of Labour | handout explains the research about the risk of stillbirth for anyone who is pregnant and age 40 or older. It will help you make choices about either using medication to start your labour around your due date or waiting for labour to begin on its own. This handout does not | |
| replace the informed choice discussions between you and your midwife. |
Table (Page 1):
| 1 in 1000 pregnant 2 in 1000 pregnant people people under 40 years of 40 years of age and older age experience a stillbirth experience a stillbirth at weeks 39-40 at weeks 39-40 |
|---|
Table (Page 2):
| Under 35 years at 37-38 weeks at 39-40 weeks at 40 weeks | |||
|---|---|---|---|
| 35-39 years | |||
| 40 years and over | |||