The association between maternal age and stillbirth increases beyond age 40. So how do we best care for these women? Otago Polytechnic graduate midwife, Morgan Weathington, and lecturers Jean Patterson and Rae Hickey sought to investigate.
“I observed a trend in my midwifery practice that women were delaying childbirth until later in life,” says Morgan. “I often work with women over the age of 40, most of whom are in good health and physical fitness. These women ask me about the risks of childbearing at their age and I realised I needed more knowledge to facilitate these discussions.”
Currently there is no New Zealand-based research on the risk of advanced maternal age and stillbirth. As it is a rare occurrence, affecting a small group of women, New Zealand does not have a population large enough to easily draw conclusions from. Therefore, District Health Board guidelines on how to care for advanced maternal age women are based on research from countries with different models of care, which do not include mitigating factors such as parity and good health.
“What I found out was that the current District Health Board guidelines recommend induction of labour after 39 weeks to address this increased risk of stillbirth, regardless of complications. However, many New Zealand midwives address this risk differently by using expectant management,” says Morgan.
Despite this disparity, stillbirth rates are not vastly different between midwifery-led care and GP or obstetric care. This prompted Morgan to consider the possibilities of a collaborative approach with obstetric colleagues, to hopefully uncover an effective model of care that addresses the increased risk but that also allows individualised care. This paper is currently under review by the New Zealand Midwifery Journal.
Weathington, M., Patterson, J. & Hickey, R. (2015) What are the risks of advanced maternal age in the New Zealand maternity setting? A literature review of the evidence to inform midwifery practice. 7th Biennial Joan Donley Midwifery Research Forum, Napier, 24–25 September 2015.