40 and pregnant

I peeked at my chart—scrawled across the top was the ominous phrase “advanced maternal age.” The OB handed me a referral to a high-risk clinic. “Is there something wrong?” I asked. Without looking up he said, “We refer all our older patients. It’s policy.”

I left feeling too ancient to carry a baby. I was 38.

Four years later I found myself sitting in another OB’s office, anticipating disapproval for bringing life into this world when I should be retiring to a rocker. After my exam, the doctor said, “Well, you’re—”

“I know,” I interrupted. “Old and high-risk.”

“Completely healthy,” he continued, looking me in the eyes, “which puts you at lower risk than a younger woman who is overweight, smokes and doesn’t take care of herself. Your age increases your risk of becoming high-risk; it doesn’t automatically make you high-risk.”

What’s with the scary numbers?
Every woman considering pregnancy after her big 4-0 is inundated with intimidating statistics. While data claims that mothers in their 40s collectively experience slightly more complications in pregnancy and childbirth, tacking on a “high-risk” label based on age alone is archaic. A woman’s health history and a physical exam form a more accurate risk assessment.

“Today, many health care professionals say health status, not age, is the most important factor in determining pregnancy risk,” reassures Cynthia Wilson James, founder of the maternal support network InSeason Mom and author of Trying to Conceive in Your 40s Coping Tips. “Most healthy women who get pregnant in their 40s tend to have healthy babies.”

A woman in her 40s who is neither overweight nor diabetic and is healthy enough to conceive naturally is often an excellent candidate for a complication- free pregnancy and a healthy baby. “If you were to take 100 healthy younger women and 100 healthy older women, the outcome is about the same, with maybe a slightly increased risk of C-section in older patients,” says Bill Chun, MD, FACOG, OB/GYN at Women’s Healthcare of Woburn near Boston.

Medical advancement during the years a woman postpones pregnancy further diminishes the age issue. “When we study childbearing from the perspective of an individual woman, the positive changes in public health conditions, medical knowledge and educational opportunities in the intervening years seem to outweigh the negative aspects of childbearing at older ages,” explains Kieron Barclay, PhD, of the Department of Social Policy at the London School of Economics and co-author of the study Advanced Maternal Age and Offspring Outcomes. Today’s medical community can better handle complications that were a challenge two decades ago.

“I would tell any women in her mid-30s and up: If you’re in that place where you want to be a mother and if you have the right support system, you should proceed,” encourages Chun.

Where is the support?
A support system for a pregnant or new mama is gold. Unfortunately, many midlife moms have a tougher time connecting with other newly minted parents. Some report younger parents avoiding them. A few receive open criticism about their age, often from strangers.

“In Hollywood if you become a later-in-life parent it makes headlines, and generally not in a bad way,” says Robin Gorman Newman, founder and blogger of MotherhoodLater.com and author of How to Marry a Mensch. “When you’re in the trenches in your local park doing the mom thing, however, it can feel very alone and not so easy to connect with peers.”

Not only is it difficult to chum up with moms decades younger, a woman’s current social network might need adjusting. If your gal pals are visiting colleges with their kids while you’re researching cloth diapers versus disposable, it can be tough to juxtapose those topics over wine (or grape juice) on girls night. Find common ground where you can, but don’t be afraid to reach out and build new friendships as well.

Another consideration is the potential lack of parental support. “You might have lost a parent, which was the case for me,” shares Newman. “Plus, my dad was older, so I was doing the caretaking—the sandwich generation thing—which is very challenging.”

That’s not to say support is unavailable, but you might have to search. “I knew it takes a village, and I didn’t have a village —so I needed to create a village for myself,” explains Newman, who started Motherhood Later … Than Sooner when she had her son at 42. The support network has since grown to more than 900 chapters.

Similarly, InSeason Mom provides the support that James lacked when she was pregnant at 42 and 44. Organizations such as these help diffuse the criticism and fears of pregnancy and parenting beyond 35.

What about the future?
There are pros and cons to having a baby at any age, but older parents are more inclined to worry about what lies ahead. That awareness, however, can be a helpful motivator that keeps moms and dads more focused on their health.

“I find that firsttime moms over 40 are more aware of their mortality than younger moms,” says James. “Because they want to be there for their kids, older moms tend to pay a lot of attention to eating healthy and exercising.” This also improves energy levels, preparing moms for midnight feedings and toddler-chasing, which are challenging at any age.

Of course, the most significant aspects of parenting have nothing to do with how old you are or how fit you are. What matters is what you teach your children—about themselves, about others, about the world. “I probably won’t be around for their 50th or 40th birthdays,” says Chun, whose twin girls were born when he was 48, “but I’m going to make the most of what I have and give them a good foundation in life.”

There is maturity and wisdom and patience that comes with age, all of which make you a different parent than you would have been earlier on.

What about bringing up baby?
The ultimate question comes after the nine-month pregnancy is over. Can an older mom juggle babydom with other midlife issues, such as parental caretaking, career success and the hormonal roller coaster of perimenopause?

Chun believes mature parents are more prepared for the challenge of parenthood. “They’re better at dealing with the good, bad and ugly than a younger patient.” Many have already traveled, established a career and furthered their education.
In general, later-in-life parents tend to pour more of themselves into their children. “You bring a lot of life with you,” says Newman. “You’ve been through stuff. You’re ready to share your life … putting your child first without having regrets, without having missed out on things.” The result is more emotionally stable children with higher language and social skills and fewer illnesses or accidents, according to a study out of University College of London.

As if that’s not enough, an intriguing study called “Happiness Before and After Kids” by the Max Planck Institute for Demographic Research reports childbirth increases happiness levels for most parent groups, but the joy boost for the over-40 crowd is the most dramatic and enduring. Perhaps that’s because of the hurdles many have cleared to become parents, or maybe life taught them what really matters.

“Age really should not be an obstacle,” assures Chun, “because mature women in their 30s and 40s have so much to offer.”

Good to know … A mother’s chances of giving birth to a baby with Down syndrome increase with age—at 40, the risk is 1 in 100, compared to 1 in 1,000 at 30. Interestingly, however, about 80 percent of babies with Down syndrome are born to women younger than 35 because significantly more women in that age bracket are having babies.

Making a comeback
Despite decreasing numbers from the late 60s through the early 21st century, pregnancy and childbirth for women in their 40s is on the rise again. Why?

• Women are waiting for a stable relationship.
• Couples want to finish their education, establish their careers and be financially secure.
• Medical advancements in fertility treatment allow for later-in-life pregnancies.
• The economic downturn in recent years past slowed the birthrate.