Childbirth after 40

I did a planned C Section at Alta Bates (at age 41), and I was very happy with it. I don't have anything to compare it to, but it was all pretty straightforward. The most unpleasant thing during the procedure was that the anesthesia made me pretty nauseous, but I was able to communicate with the anesthesiologist and she made some adjustments that helped. One they stitched me up, everything felt fine.

After I got to the room, they put my legs in cuffs that inflated and deflated to keep the blood circulating. Once the anesthesia wore off, I was super itchy, but the itchiness lasted maybe half a day? Recovery from the surgery wasn't too bad. It was a bit painful at first, but I was taking short walks at about a week. I didn't finish the course of opioids because the constipation ended up being worse than the pain after a while, and the pain wasn't too bad at that point. I was able to manage it with the mega-analgesic alone.

I'm happy to answer any questions! I know it's stressful to be making these choices at this point.

I had my second baby at 41 (first at 37) and a planned c section was never even mentioned. (I was not at Kaiser.) I have never heard of natural childbirth not being recommended at any age. I think starting at 39 weeks I had very frequent checks - 20 min heartbeat monitor and ultrasound - might have even been every day, and they recommended inducing if I made it to 40 weeks, which I didn’t. I had an easy vaginal birth, way better than the first one. 

Hi there,

Unless you have other conditions, I'm not sure why it's not advised to have a natural birth just because of your age. I delivered twins naturally at age 41.8, 3 months before I turned 42. This was at UCSF, and their philosophy is to support natural childbirth unless there is a medical reason to go with a C-section (and of course they have a team ready to go if it's needed).

Naturally everyone's experience and specific situations are different, but I would consider asking your doctor and/or getting another opinion as to why a scheduled C-section is necessary from a medical standpoint. Anyone over the age of 35 is considered "geriatric" for pregnancy purposes, and I'd be surprised if a scheduled C-section is the default for everyone over 35!

My advice would be to trust your body and your own instincts. Be aware of the various risk factors, but I wouldn't assume that you're automatically at a disadvantage because of your age. Your doctor should be building your confidence. Congratulations on this exciting time!

I believe that because you had a natural birth the first time that you can expect a successful vaginal birth as easy or as hard as the first time, my wife said the second time was easier and the kids are 22 years apart. Size of the baby may be of concern and cause for inducing labor or c-section. My late wife had her second child at 45 without complications 10 hours after her water broke but the baby was 35 weeks and 4 days so he was small… My 38 year old wife gave birth via C section after trying to induce failed post water breaking at 37 weeks 5 days… So having seen two “geriatric pregnancies” I would suggest form a, husbands perspective, I would first start by saying the label geriatrics pregnancy just means they’re going to be a little more careful to do a little more test perhaps have a few extra special specialist in the burning room. Either way, I strongly encourage a spinal epidural. There’s no adverse effects to the child. If and you start to go through the process there are ways to naturally induce pregnancy with your partner… if it’s a point where you have to give birth, I would not bother putting yourself through inducing rather just have the C-section. Just my observations as a man yet I was and am very close to my wives and present at every doctors appointment and holding their hand through the birthing process. My 2 cents…

There is no reason to schedule a cesarean in this setting. You are higher risk of needing one if you go into labor but many people are able to have vaginal deliveries if thats your goal. Being more than 10 years from your last delivery makes it less likely your body would have the advantage of a prior delivery, but there is no reason not to try. Many other hospitals would not insist on that. Induction would be recommended by 40 weeks since there are higher rates of many complications the longer you stay pregnant. But its your choice. I am surprised kasier recommends this, wondering if its just this provider…

Have you considered getting a second opinion from another doctor at Kaiser? I delivered my second baby at age 41 last year at Kaiser SF, and my ob gyn had no reservations about me going to 42 weeks (which I ended up going to!), and delivering via vaginal birth. There may be other factors at play in your particular case, of course, but as a simple rule the 39 week cutoff seems arbitrary. Wishing you a happy and healthy delivery, however it happens!

Hello and congratulations on your pregnancy!

I am a 43 years old mother of 2, my daughter is soon to be 11 and my son just turned 2. I obviously cannot give any medical advice but still wanted to share my experience . I hope you still enjoy your pregnancy and will be happy about the birth, whether it will be natural or a C section.

I had my 1st at Alta Bates with a midwife and it was a wonderful experience, I was 32 years old and in the best shape of my life.

I had my son at 41 year old, the pregnancy was very similar to the first one aka pretty easy and I wanted a natural birth just like the first one since I had such fond memories. I was past due for both kids, my daughter came naturally at 41week + 2 but my son was still not ready at 41 week +6 and so I was “forced” into an induction. Obviously no one can truly force you, but by putting fear in me (as it seems to me your doctor is doing) I agreed to be induce by them breaking my water. I won’t get into details here (but can offline if you are interested in discussing) but I did regret letting them talking me into it. 
My point here is that it is important that you listen to your body and your instinct, if you need more advice maybe you can consult a midwife for another opinion. Regardless of your choice, you may not have the birthing experience that you envision and that is also something important to work on before since that can contribute to postpartum depression.

Happy to talk offline if you want and again congrats on that second baby (I’m soooo happy I went for the second )

I had two urgent C-sections at Kaiser Oakland after "geriatric pregnancies" (at 36 and 38). With my first I was about 4 days past my due date when my water broke, but didn't progress so was given pitocen. Still didn't progress and baby's heart rate was dropping with contractions, so had an urgent C-section. (Note 'urgent' just means not scheduled and chosen after a vaginal birth doesn't work out, but you still just do a spinal tap; while 'emergency' is a true emergency and often?/usually? involves general anesthesia.) Pretty much same course of events with the second, except I had slightly elevated blood pressure so they induced at 39 weeks. I had very positive experiences both times. I felt very taken care of and listened to. I was given ample time to attempt a vaginal, even on the second baby, and a C-section was only suggested when I was good and ready to be done trying. The team of doctors was warm and inspired confidence - attending held my hand while I got the spinal tap, minimal scar, pretty easy recovery. Only advice is going in with an open mind - healthy mom, healthy baby is the only goal, a C-section is not a defeat! 

I would question the reasoning for a C-section. Maternal age is not a valid reason for a C-section if there are no other factors and your baby and you are healthy. I was 45 years old when I had twins which were both born naturally. The only concession my doctor asked me to was to have an epidural and to give birth in the operation room, not in a birthing suite, so that in case something goes wrong they can act immediately. Maybe you can propose that. That was at Alta Bates, not Kaiser. The decision for a C-section or induction should be driven by the health of the baby and the mother, not by the age of the mother.

Hi there – first off, congratulations on your pregnancy, and I just want to acknowledge how hard it is to be navigating all of this, especially when it’s been such a taxing pregnancy. I was in a somewhat similar situation a few years ago, pregnant with my second child at almost 42 years old. My OB was at Sutter Health (Berkeley). My second pregnancy came with complications and a whole lot more stress—so I can really relate to the swirl of emotions you're feeling right now.

This is such a deeply personal decision, so I’ll just share my own experience as a data point, not a recommendation. My OB sat me down around 38 weeks and gave me a very direct talk about the increased risk of "fetal mortality" if I went past my due date at my age. It was very scary. Jumping straight to a c-section was not recommended (as I had expressed that I wanted to avoid a c-section) so we talked through options. She recommended induction at 40 weeks, and I also checked in with a few other providers—both OBs and midwives—who acknowledged there was some increase in risk by going past my due date at my age but ultimately said it was my call. I had wanted to avoid an induction as well, so I took a wait-and-see approach as my due date came and went.

In the end, I went in for an induction at 40 weeks and 4 days, had a smooth vaginal delivery, and brought home a healthy baby girl. 

I haven’t delivered at Kaiser Oakland, but I imagine there are other folks here who have and can speak to that. I am not a doctor, but I would say in my own personal experience, being 42 doesn't automatically mean a C-section is medically necessary. I do think some doctors may suggest it out of caution—especially if induction seems risky or the pregnancy has been difficult.Just know you’re not alone in feeling overwhelmed by this kind of recommendation.

Wishing you a smooth delivery and lots of strength in these final days. Please feel free to reach out to me directly if you want to chat more. I would be happy to help.

Hi! I was recently in a similar boat - I'm 41 and recently had a repeat c-section at Kaiser Oakland. Induction at 39 weeks is standard for "geriatric pregnancies" due to the risk of stillborn birth. I also had a tough pregnancy and opted for a planned c-section. It was great. Recovery from a planned c-section is 100x easier than an unplanned c-section. The L&D surgeons and nurses at Kaiser Oakland are amazing and everything went smoothly. I'm happy to share tips on recovering from a c-section, if that helps. The c-section was the easiest part of the entire pregnancy experience. It also made childcare and planning for my other child extremely easy. Good luck with everything!

Hi mama, so sorry you’re dealing with this anxiety on top of everything else! Pregnancy is no picnic and while some medical interventions are important and helpful, many are simply unnecessary and stress provoking such as the common practice (and Kaiser bottom line) of early elective inductions in the US. If you’re on other medications, it sounds like you may be dealing with some additional challenges this pregnancy so please take my words with a grain of salt, but I wanted to share my experience of successfully opting out of an induction/ C section with Kaiser with a healthy pregnancy and having a natural and easy birth at the age of 41 in 2023. 

My Kaiser Berkeley OB also wanted me to schedule an induction at 39 weeks which made no sense to me in a healthy pregnancy. (In Europe for example, you are not considered post term until after 42 weeks.) Luckily, I was also working with a midwife so was able to create a plan with her help. In the state of CA, midwives can only care for you if you go into labor before 42 weeks, so I scheduled a just in case induction (at Kaiser San Leandro which was considered more midwife friendly, birth tubs etc) for the last possible moment (41 weeks and 6 days) when I could no longer be under my midwife’s care anyway. 

After 40 weeks I had twice weekly Nonstress Tests at Kaiser to monitor baby who was super healthy and I spontaneously went into labor and had healthy baby boy at home at 41 weeks and 2 days. 

Ultimately you should pick what feels safe and right for you given the particular array of challenges you are dealing with, but just a reminder that Kaiser can’t MAKE you do anything as long as you and baby are healthy— though their strongly worded recommendations can make you feel otherwise. 

Please feel free to reach back to me if you would like to talk more specifically and my situation feels useful. Whatever you choose, I’m sending you all my best! 

As someone who had a healthy and pretty straightforward pregnancy and delivery at Kaiser a couple years ago at age 45, I am sort of appalled at this advice. I suggest switching OBs if you can to Dr. Botha. I was very surprised (to put it mildly) to find myself pregnant at 45 and she really kept me grounded in the idea that age my statistically correlate with high-risk conditions, but itself is not a problem. I did to the induction -- in my case at 37 weeks because I had a condition that I had in each of my three pregnancies. I chose to go to Walnut Crreek Kaiser because I wanted to work with the midwives rather than OBs, given the orientation of their training. They were awesome.  I know you said you are on medications and of course I can't give advice on your medical situation, but if they are telling you that because of your age you can't have a vaginal delivery that is blatantly false. I know you said your pregancy has been hard so far but I don't think anyone can guarentee you that your birth or post-partum will be: for me, pregancy, birth, and postpartum recovery were notably easier at 45 with olders teens/tweens and a newborn than in my mid-thirties while also caring for a toddler. 

I turned 43 in January, 7 weeks after my second child was born. We did IVF, so because of that and my age my doctor also recommended not going to full term. We induced at 39 weeks for a natural birth and everything was fine. I had a Stanford OBGYN and delivered at Sutter Eden, there was no conversation of a C section. My first child I was two weeks shy of 41, not induced and had the baby full term with no issues.

I’m wondering if there is another medical reason your doctor wants to do a C section. The induction for me was fine, definitely not as stressful as going to the hospital 3x. 
I’ve heard Kaiser has different practices and standards than other hospitals, so maybe that’s it.  Feel free to contact me if you need an ear.

Heather

I’m so sorry you are going through this! My experience was somewhat similar: I was 46 and pregnant with my second child (my first was 12 years old at the time, and he was born marginally). I started out with the OB practice at Sutter Health and the OB told me their c-section rate in women over 40 was some astronomical number like 75%. A friend convinced me to see a midwife (Lindy Johnson, now retired) and she said that the OBs were clearly NOT taking into account that my body had done this already — that they were treating me as if I were >40 and this were my first pregnancy. 
She went on to give us a 30% reduction in her fee because she predicted she would only have to be in the hospital with me for a few hours — and she was right! My second child was born at Alta Bates and I was only on the Labor and Delivery floor for an hour :)

Get a second opinion!

Hello,

I am 42 and pregnant with my first child. John Muir is my medical provider, and I plan to deliver at their hospital in Walnut Creek.  I am currently 37 weeks pregnant and thankfully have had a fairly easy pregnancy without any complications.  A couple of weeks ago my team of OBs recommended that I be induced at 39 weeks because my age presents a slightly higher risk of still birth.  I've scheduled an induction two days before my actual due date, but my team has been very flexible and has even offered to allow me to hit my due date and be induced shortly thereafter if I prefer.  At no point has anyone brought up the need for a c-section.  I've polled other mom friends who birthed in their 40s, and all were provided the same medical advice. While some did get induced at 39 weeks, those who did not went on to have healthy vaginal births.      

That’s overkill. I had my first child at 44 - yep. My OB at the time was the keynote speaker at the American academy of OB/gyns and an expert on AMA pregnancies (advanced maternal age). It was a normal unplanned pregnancy with no complications. No planned C-sec, but - eventually I did have a C-sec bc the baby didn’t rotate fully. Was that age or chance? No clue, but it wasn’t a raging emergency when it happened and I was fine, baby was fine. He’s now a college student and thriving. So I think this OB is going overboard and stressing needlessly. Are they inexperienced? Young? Our bodies are awesome. I’d get a doula or midwife on board and resist the surgery. 

Hi there,

I had my second at 47(!) and I was induced at exactly 39 weeks. There is a robust ARRIVE study that shows that the 39th week is a sweet spot in terms of minimizing risk for mom and baby (and avoiding c section). This is guidance and you have the power to advocate for you and your baby. However, the study is quite compelling and has been extensively peer reviewed. I did not want a c section for me personally, if there were alternatives. I have mad respect for mamas that went that route but was worried about the recovery with two kids. 

So I did a membrane sweep the day before, woke up, started laboring, put my older kid in camp, got a prenatal massage, went to the hospital, got some pitocin, delivered my new baby and my partner went to pick up the kid from camp. Everyone is different and every labor is different. With my first,  labored for 48 hours and 4 hours of pushing. The second was so much faster with laboring for a few hours, pushing for 2 minutes. I wish you the best of luck and hope this info was helpful!  

Hello, I’m sorry to hear you aren’t feeling well and I’m sending prayers and good thoughts for a speedy and uneventful delivery.  I had my first at 39 and my second at 42 both were planned c sections at 38 weeks.  My situation was different in that I had several fibroid surgeries that weakened the tone of my uterus and I had placenta accreta during my 2nd birth so natural birth wasn’t even considered. It was a lot to deal with.  I had successfully csections but the 2nd ended in a hysterectomy which I was told could happen so I was prepared for that outcome.  What was helpful for me was that I had lots of help after the surgeries.  I was in so much pain and between that and lack of sleep and nursing I was not able to take care of my 2 year old or myself.  If you can hire a night doula that you trust that may help to alleviate some of the care burden for you so you can actually rest. Proper rest and nutrition will go a long way to helping you recover. Be prepared also with a good team of medical professionals you can call in a pinch if there are issues.  A lactation consultant, nurses, your OBGYNs office.  I reported every concern I had post-surgery you don’t want anything to go untreated while you heal.  Lastly if you can try to get outside for walks as you can tolerate I really pushed myself even to just sit on the patio and get some natural light.  Because of the pain and heavy meds I was on I was starting to feel depressed. I felt like natural light exposure helped a lot.  Hang in there! I hope everything goes smoothly! 

Hello, I just had a planned c-section at Kaiser Oakland and my situation was similar to yours.  I was also a geriatric pregnancy (38 turning 39 next month) and had multiple health issues throughout my pregnancy.  My first child (who is almost 7) was born by c-section, and while my OBGYN thought I was a good candidate for a VBAC, I felt nervous about it due to my health and age.  At 37 weeks pregnant, my hands and feet started intensely itching, I contacted my doctor and did some testing and found out I had cholestasis, a rare condition during pregnancy that slows bile flow and increases the risk of stillbirth.  When a mother has cholestasis, the best course of action is to deliver between 37 and 38 weeks.  If I wanted a vaginal birth, this would mean an induction, and I knew VBACs have less chance of success with inductions, so I opted for a planned c-section.  The entire experience at Kaiser Oakland was phenomenal.  I was originally scheduled for a Friday, but they were extremely busy that day so after some fetal monitoring they sent me home and scheduled me for the next day, Saturday.  I arrived 2 hours prior to the planned c-section, was taken to the prep area, and everything went extremely well.  The labor and delivery nurses were so kind, calming and professional, and I had both the anesthesiologist and the doctor who would be performing the surgery come in and speak with me.  I was impressed with all of them and knew I was in good hands.  At the scheduled time, they wheeled me into the operating room for prep, while my husband waited until he was brought in.  The operating room was large and well lit, there were more nurses there and 2 or 3 more doctors on duty (one of them was a resident, I believe).  The anesthesiologist let me pick music I wanted (I had no clue this was an option) and gave me my epidural (basically painless except for the small pinch of the numbing shot).  They laid me back, put up a curtain so I couldn't see the operation itself, and brought my husband in.  Other than some nausea from the epidural (which I communicated to the anesthesiologist and she immediately adjusted my IV with anti-nausea meds) everything was smooth sailing.  They operated, I felt nothing, baby came out healthy, they let me meet him and then took his measurements and gave him his shots.  They sewed me up and I also opted to have my tubes removed. The tube removal (salpingectomy) both prevents future pregnancies and also decreases your chance of ovarian cancer (which often starts in the fallopian tubes) by something like 65%, so if you don't want more kids I would highly recommend this procedure along with your c-section.  After operation I was taken into recovery for an hour for observation, then taken to the maternity ward.  You get your own private room, with a bathroom and a couch for your support person to sleep on.  The maternity ward nurses were some of the kindest women I have met in my life, every one of them was phenomenal.  They do come in the room constantly to check your vitals and baby's vitals, and you have many other visitors (pediatricians, doctors, social worker, hearing test for baby, lactation consultants) that come in frequently as well.  So it is not the most restful place, but I felt extremely well monitored and taken care of.  Overall, fabulous experience at Kaiser Oakland with the planned c-section, giving birth is always scary but they made me feel beyond safe and well cared for.  Highly recommend.

Hi There,

Another "geriatric" mom here. What a groan-inducing label! I've given birth to two kids at Kaiser Oakland. One in 2022 which was a month before I turned 40 (that was a scheduled c-section at 39 weeks) and one in 2024 a few weeks after I turned 42 (early labor, vaginal delivery at 36 weeks). Both were positive experiences so I felt compelled to respond to your question in hopes my experience could be helpful!

I feel like there is this weird false hierarchy that a lot of us are fed about some births being better than others. As we know though, there is so much variation and complication and unpredictability involved in fertility and pregnancy and birth. One of the things I've thought about a lot after my two very different experiences is that ALL births (medicated, unmedicated, vaginal, c-section) have the potential to feel empowered and peaceful and beautiful and connected. I say that just to maybe help you free yourself of any ideas you might be holding about vaginal birth being "better" than a c-section. Do what works for you. It's all "real" birth. Suffering does not make us more or less deserving of the title of mother.

I had a very complicated pregnancy with my first and I was getting the same advice as you about inducing at 39 weeks. I got a lot of opinions from different doctors and was ontrack to induce at 39 weeks. Ultimately it turned out that my baby was breech and they won't attempt a vaginal delivery with a breech baby. I was considering the ECV procedure to turn her around but opted instead to schedule a C-section. I had lots of nervousness at the time but ultimately it felt like a gift to myself (and my partner) to have one tiny part of this crazy challenging pregnancy experience be a tiny bit predictable. I scheduled the c-section for the first thing in the morning and it was incredible to have a full night of sleep (and no labor!) before bringing home an infant. The c-section recovery was more intense than the recovery I had from my vaginal delivery a couple years later but I had lots of help and after a few weeks was a lot better. (Happy to share c-section recovery tips if you'd like!)

All that said, it sounds like you're not quite sure about the advice you are getting from your doctor and I wonder if you might want a second opinion from a different doctor? Even if the other doc has similar advice, maybe they would explain it in a way that feels more comfortable to you or addresses your concerns more directly. One of the benefits of how impersonal Kaiser can (sometimes) be is that it's fairly easy to talk to a different OB in the office.

Anecdotally, the two medical doctor friends I have who have given birth recently both induced at 39 weeks, got epidurals, and had fairly uncomplicated vaginal deliveries. Neither of them was as old as me, both in mid-30s I think. Could totally be coincidental but I took comfort in knowing that a smart doctor friend had made that choice for her own delivery!

Best of luck to you!

I obviously don’t have the full picture of your health (co-morbidities etc), but I gave birth at age 40 (1st), 42 (2nd), and 46 (3rd) both here (Alta Bates, John Muir), and on the East Coast and never—not once—was the notion of a scheduled C-section even floated in the room. That just sounds crazy to me in a healthy pregnancy unless there is a specific reason. Those are dangerous, harder to recover from, and are all-around a worse outcome. Now, about induction, none of my fellows vacated voluntarily, so I’m intimately familiar with those… in the last one my OB listed a number of good reasons to induce week 38 and I listened. Turns out she was exceptionally right; I ended up with post partum preeclampsia that would have, presumably, been prepartum had I not complied and maybe I’d needed up with an emergency c section. Inducing is pretty standard with AMA but if I were you I’d seek a second opinion about the push for an elective c-section.

I just barely fell in the geriatric pregnancy bucket at 35, but I had a wonderful experience with my planned C-Section at Kaiser Oakland (baby was breech). Well, it was supposed to be planned but I went into labor 3 days early so the oncall nurse said “See you soon girl!” and they had the baby out as soon as it was safe. The staff was thorough, professional, and I felt very well cared for. Dr. Chanchani performed the surgery and was very supportive during and after the procedure. There have been a few other recent posts about C-Sections at Kaiser Oakland that you might want to check out to get other perspectives as well. Good luck and congratulations!

Hi - I had my first child at 43 and I can relate to what you're saying. I started experiencing contractions on a Friday night and when I went to Alta Bates the next AM, sure I was ready to deliver, they suggested I not come back until the next day (sunday) because I was not dilated enough (don't remember how much, but ugh that was dispiriting!). Anyway, to make a long story short, it was exhausting. After 35 hours of this, They took me into the ER to have a C-Section but my midwife thought we/I could push through. I had an epidural and my will kicked in there somehow but it was hard and I think really taxing on the baby. She's fine now - this was 17 years ago! But I would listen to your body. C-sections take time to recover from too. Is there any way you can negotiate for some amount of time to try natural birth and if too much time (or stress on the baby) happens then do the c-section? I am hearing they want to plan it, but maybe there is some wiggle room? Good luck!! <3 

I had mine at 44, planned C-section at Kaiser Oakland and felt very well taken care of. My first and was very nervous. The staff was so caring, kind, and competent. Totally normal to be nervous. The doctors were so capable and everything was very smooth. 

I had a vaginal birth at 46 in NYC and there was never any mention of a c-section. My water broke a week or so early and then i had to be induced. i opted for the drugs early because i was throwing up with the contractions. If you do take them take them early, not late. I was able to sleep for 8 hours and then push for 1.5 hours and everything worked out fine. Its so normal to be nervous! But the hardest part of this all is caring for the baby after they are born and you are exhausted. The most rewarding thing though!

I had a vaginal delivery at Kaiser Oakland of twins at age 44. While it may be true that a c-section is best for you (and that’s a fine choice), it is not true that it is inadvisable for someone “your age” to have a vaginal delivery (based solely on your age — I would add happens all the time in many other countries. So I hope that you do whatever is best for you and your baby based on an affirming and medically appropriate doctor’s recommendation that is free of bias. And I’m with you on how much harder it is on the body later in life. My experience is that the parenting part though is much easier based on your added wisdom and perspective.