The older the mother is the greater the chance of her having to undergo emergency delivery when she gives birth, researchers warn today.
The researchers have identified several factors that raise the chance of "emergency operative delivery", that is, emergency caesarean or vaginal delivery with forceps or ventouse.
Increasing age, foetal distress in labour and greater birth weight all indicate a higher risk, say Dr Lina Herstad and her team at the Norwegian Resource Centre for Women’s Health, Norway.
The team used figures on 169,583 low risk, first-time mothers to examine the risk factors for emergency operative delivery. Those aged over 40 had a 22% rate of emergency caesarean, versus 7% for those aged 20 to 24. The rate of operative vaginal delivery was 24% versus 13% for those aged 20 to 24.
Full details are published today (6 August) in BJOG: An International Journal of Obstetrics and Gynaecology. Other risk factors included shoulder dystocia during labour, pregnancy over 42 weeks, induced labour and use of epidural. Shoulder dystocia and foetal distress were the strongest risk factors.
Careful attention is needed when managing older mothers who may need interventions during labour, say the authors.
"Previous research around advanced maternal age has mainly focused on high risk pregnancies," said Dr Herstad. "However, most women of advanced maternal age are healthy, of higher socioeconomically status and are low-risk. Our results are particularly helpful for both healthcare professionals and women of advanced maternal age in decisions regarding the optimal mode of delivery."
But she called for further research to look at interventions and operative deliveries across all age groups, taking into account other factors which may have an impact, such as rising obesity rates.
The UK Royal College of Midwives said the findings highlighted the need for more work on the care of pregnant women over the age of 40.
Chief executive Cathy Warwick said: "The number of babies born to women in England and Wales, aged 40 or over, was higher in each of the last three years than at any time since the late 1940s.
"We already know that women over 40 have an increased risk of complications during pregnancy and it is important that more research is done into the needs of this group of women.
"Further research will help to ensure that women over 40 are given high-quality information and that appropriate resources and staffing are committed to their care."
Herstad, L. et al. Maternal age and emergency operative deliveries at term: a population-based registry study among low-risk primiparous women. BJOG 6 August 2014; doi: 10.1111/1471-0528.12962 [abstract]
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