Vaginal Birth
Vaginal birth is what most mothers plan on and is considered the safest type of delivery. While the odds are that you will have an uneventful vaginal delivery, some situations are more likely to occur in older mothers. It's best to be aware of them just in case.
Prolonged Labor
Older women are more likely to have a cervix that is slower to dilate. The cervix must fully dilate and efface before you can deliver. If this process is slower than usual, your labor can go on for a long time, not only increasing fatigue but also increasing the chance of infection.
Dysfunctional or prolonged labor means the labor is not progressing at an appropriate rate. First babies tend to be slower at every stage of labor. Older women are more likely to need Pitocin augmentation, have vacuum or forceps delivery, experience prolonged labor, and have a greater chance of a C-section. The exact reason for this is not known.
Your physician can increase the odds you will deliver in a normal time frame by carefully managing your labor and using Pitocin. As a general rule, older mothers, especially those who have had more than one child, can expect to have a normal vaginal birth, but they may expect to need Pitocin to augment their labors more frequently.
An episiotomy is a procedure in which your health-care provider cuts the area between the vagina and rectum to assist in delivering the baby and prevent tearing. Older mothers are less likely to undergo episiotomy than younger mothers. The rate for women over age 35 is about 50 percent.
An important thing to keep in mind is that a longer labor is really expected for older mothers and is nothing to be overly concerned about if it happens to you. Your health-care provider will manage your care to help you deliver in a time frame that is considered normal by the medical establishment.
Breech Presentation
In normal deliveries, the head is delivered first. A breech presentation is when the baby's feet or buttocks are closest to the cervix, instead of the head. Breech births are more difficult because the legs or feet can bend and get stuck. They occur in 3 to 4 percent of all deliveries. Age increases your risk of breech birth 1.3 times for every five-year age increment. The risk at age 40 is 11 percent. The highest risk group is older mothers who are having their first baby. The exact reason for the increase in risk for older moms is not known. Some have theorized that uterine fibroids, which are more common in older women, may distort the uterine cavity.
The number of women ages 40 to 45 who are giving birth is swiftly increasing. The rate for this age group doubled between 1990 and 2002. The birth rate for women age 45 to 49 has remained the same since 2000, but births in this group more than quadrupled between 1984 and 2000.
If your baby is in breech presentation, your health-care provider may try what is called an external version, in which she tries to turn the baby by applying pressure to your abdomen. This should only be attempted by an experienced health-care provider. The overall chance of success for an external version is about 70 percent, and it is usually done around 37 weeks.
In the United States and Canada, breech deliveries are generally not performed vaginally any longer. Many health-care providers have no experience with breech deliveries, and there is some evidence that a C-section is a safer option. Breech deliveries with twins are somewhat different. Some health-care providers will perform a vaginal delivery of a twin breech if the breech is the second twin (first twin head down, second twin breech) and the gestational age is not extremely premature.
Large-for-Gestational-Age Baby
A large-for-gestational-age (LGA) baby is one who measures over the ninetieth percentile for the gestational age of the baby, which at term is nine pounds. Large babies are common in mothers who have gestational diabetes (an increased risk for older moms), are obese, or moms who gain too much weight during pregnancy.
An LGA baby can be difficult to deliver vaginally and is at a higher risk for shoulder dystocia (having shoulders that become stuck during delivery). These babies can also have low blood sugar, especially if the mother has gestational or pregestational diabetes. If a baby is still large for its age when it is six months old, it is at a higher risk for obesity. Listen to your health-care provider's recommendations for weight gain during pregnancy to try to avoid these problems.
Placenta Previa
This condition occurs when the placenta covers the cervix. A vaginal delivery is not possible in this situation. This is a condition that is usually diagnosed well before you go into labor and is usually not a surprise.
Preeclampsia and Gestational Diabetes
When these conditions are uncontrolled or at dangerous levels, your health-care provider may recommend against vaginal delivery.
Multiples
If you're carrying multiples, it is likely your health-care provider will recommend against a vaginal delivery.
Your Attitude
A 1999 study in the journal Birth found that older mothers seemed less likely to believe their babies' lives were in danger during labor and were happier with the way staff handled labor problems. Based on this study, it seems that older mothers tend to come away from the birth experience feeling more comfortable and secure than younger moms.
