You just mentioned at the end there that being a primip that her chance of achieving a normal
birth was about 25%, but I think they mentioned that she’d had a previous birth, albeit
quite a while ago. Are the numbers still the same in that case?
Well I might say the figure of 25% is rubbery, but putting everything together, I was showing
you the data for someone who is aged 40+ there. She’s 47. So in my mind, I’m thinking
if it was her first labour, it’d be worse than that, but given that she’s had a child
before, maybe not quite as bad as someone who’s having their first labour. That’s
where that figure came up. But I wouldn’t be ashamed of using a figure of around that
to counsel someone in those circumstances.
I’ve got a quick question – I know the numbers aren’t very large, but do you have
the data dividing that older age group into their BMI as well?
Well I think it might be available. Wendy might be able to find that for you. But your
groups are going to be just so tiny there that I just don’t think you can come up
with anything meaningful out of that with those numbers. You know, you’re going to
have one.
Just assuming less rates of vaginal births in the heavier older population.
But I think it’s reasonable to assume that if Tamara were obese as well, then her chances
of achieving a normal vaginal birth would be miniscule.
Just wondering if there are any statistics on these people that are going for IVF and
for the older population that they’re automatically electing caesarean sections instead of even
trying for normal delivery?
Well I guess that’s why I showed the data on elective sections in that age group, if
I’ve got your question right. To show that, yes, there may be some influence for that,
but it’s not gigantic. I mean, to me, I thought 16% at that age didn’t seem too
big, to me, a rate for elective sections. So I was trying to imply by that that I doubt
very much that there’s a tsunami of women demanding a caesarean for their first birth
because they’re concerned that they are getting on in age and they have a limited
reproductive life left. I think that figure suggests that there’s probably not a massive…
it may be a contributor, but it’s probably not a massive contribution.
Sorry, I just wanted to ask, are a lot of these women, because of their age and medical
problems, also induced and would that have anything to do with the increased rates?
I don’t know the answer to that, I’m sorry. Inductions are frequent, and because they’ve
got a higher proportion of medical complications, I imagine there would be more inductions.
But I don’t know whether you’re suggesting the argument that inductions lead to caesarean
sections because there’s a greater risk of having a caesarean in women who are induced,
but I don’t think anyone’s ever been able to show that’s because they were induced
compared with not being induced. You know, it doesn’t naturally follow just because
caesareans are associated with induction, that it’s the induction that’s causing
the caesarean.
So although Tamara was induced, she progressed very well in labour, but as we discussed,
she required a forceps delivery secondary to foetal distress in second stage. She delivered
a 2.4 kilogram female which required level 2 nursery care. Now, I am delighted to invite Dr Chris
Munt, who is well-known by many of you guys, he is a neonatal paediatrician who has worked
within South Australia for 21 years and been a major contributor to neonatal services in
the private sector. Dr Munt.
It’s a very big privilege to be here. A touch of anxiety, but that’s okay. And certainly
I’m not a neonatologist, I’m a general paediatrician, but I’ve always had an active
interest in neonatal medicine and it’s been the most significant part of my working life
there too. I think I started with Bob at Stirling Hospital in 1994. But, we’ve talked about
much of the information and much of the potential challenges for our older parents in that as
well too. And we all understand that there’s clearly an increased incidence or increased
risk of neonatal morbidity and mortality and, unfortunately, for our older couples and that
too. Much of the discussion from me is not going to be with the same expertise as my
colleagues here, but just based more on experience. So I mean, I think we all pretty much understand,
don’t we, the subsequent care that will be required for Tamara and John’s baby there
as well. Hopefully, the baby comes out in good condition, of course, and obviously we’d
be looking for any signs of respiratory distress. And, as we know, in about 15-30% of 32-36
weekers are significantly mortified with Celestone and that as well. And forceps delivery was
a good thing, I think, wasn’t it, in the end. And I think, having a little bit of labour
obviously may support and minimise slightly the risk of respiratory distress syndrome,
of course. Maybe an improved surfactant release. So, yeah, hopefully the baby is in good condition.
But it does require nursery care, of course, because of its low birth weight. It’s slightly
small for gestational age, as we know, but not hugely small – 2,400 grams, 26 weeks
– so nursery care would, of course, be regarding respiratory observation, assessment of hypoglycaemia,
managing thermal stability, of course, as well too and then subsequently managing the
feeding issues as well. So we all understand that and there’s not a whole lot to say
about that as well.
My experience, interestingly, with nursery care over the years – and I’m sure it’s
the same with everybody – is that some of our nursery parents, as they go through the
anxiety of their baby in the nursery, actually have a little bit of extra time to learn about
what normal babies do and subsequently when they leave, they just have a little bit more
confidence and, of course, we try to readmit them for a couple of days before they leave
to build on that experience that they’ve had coming and going from the nursery and
that as well. And I think, in general, I may have seen a little bit more confidence from
our parents in terms of just general care and management of their babies there too,
but obviously it differs for every couple there as well. The things we find – obviously,
there’s anxiety. I presume that with the expert counselling now of our older parents
who have their babies, they understand the risk factors more, they understand the potential
for that and may manage things - it’s obviously anxiety-producing to have a sick baby - they
may manage it slightly better than the unexpected baby there as well. Although there may be
initial anxiety after the birth of the baby, that anxiety may be a little bit more in our
younger parents because of their psychosocial setting at the time, because of their access
to Google and the website which talks about lots of things, but doesn’t necessarily
put things into perspective. Whereas older people perhaps they have a little bit more
life experience and my experience perhaps to manage things a little bit better after
delivery of their babies and subsequent care of the babies. Obviously, the risk factors
need to be managed. Hopefully, we’d aim to get the baby home as soon as possible if
the baby is feeding independently and not requiring any other special care. And after
that, there’s obviously some follow-up, obviously the baby that’s had neonatal risk
factors has an increased potential for issues with growth, with time and for issues with
neurodevelopment. Interestingly, in older couples, obviously we know there’s a higher
incidence of genetic syndrome and chromosomal anomalies, but also there is said to be a
slightly higher incidence of autistic spectrum disorder in some of the kids and there may
be some increased incidence of potential mental health issues and behavioural and learning
issues too with time. I’m not quite sure about the incidences of those, but I just
know that there’s said to be a slightly increased incidence of those sorts of things.
So again, they’re challenges that older parents may have to manage with their children
as well.
Tamara and John, it would be interesting to know how they actually get on, won’t it
– having a 19 year old, they’ve already got their babysitter, haven’t they? I’m
sure all of us have a different feeling about the differences between younger couples and
older couples. As I say, I think having worked with older couples much more in the private
sector than our experts in the public sector, I’m not sure that I see a lot of huge differences
in this first few months of management and ongoing management with time of the kids.
But obviously the kids are more at risk and there’s the potential stressors throughout
life which may exist for some of those families because of the risk factors for the kids and
obviously that’s a significant thing for them. We’ve had a couple of different cases
over the years, or many different cases over the years. I’m not sure if it’s okay just
to talk openly about a couple of cases that we’ve seen, but we won’t go into detail
about them, of course. It’s all confidential stuff there too. But we’ve had at Ashford
Hospital, a few older parents in their late 40s/early 50s in the last few years as well
and, in general, they’ve all coped well. Some of them have had stressors in their relationship;
some of them have had stressors because of little problems – Down Syndrome and things
like that as well too. But in general they’ve been coping okay overall. But we understand,
as Erin pointed out, with the challenges of older age group and their own health and managing
kids with potential problems. It’s obviously going to be a difficult thing for them potentially
as well. Although we see differences in personality, of course, between the older and younger couples,
in terms of their management of the babies, you know, in general, once we want to have
a baby, we’re beautifully committed to them and we just want to love and care for them
and that instinct exists for most couples who have children. So I’m not sure I’ve
personally seen a lot of differences over time there as well.
So again, not a lot of useful information, just a little bit of old experience there
and point of view or opinion. But I don’t know whether there’s anything else. Are
there any other questions?