Starting a Family: The Issues for Older Mothers
Individual circumstances vary enormously. That is not in question. You cannot therefore be prescriptive about rights and wrongs of having or considering having a child at a certain age. However, that does not absolve prospective parents of the responsibility to consider the implications of what they are setting out to do. It is also food for thought to those young women who are wrestling with balancing career, family and social life. If you are already in your late 30s or beyond, it is just good to know and be prepared.
It is accepted that, in an ideal world, women will have children from their early 20s to their early 30s. It is, of course, not possible for the entire female population to have their circumstances falling into this ideal. This is the age range where evidence shows the least risk of pregnancy complications. It is also the case that the mother is not too young (or too old) to be overwhelmed by the demands of motherhood and, as every mother will know, these can be onerous.
· Erratic ovulation: To maximise chances of successful conception, ovulation (the release of an egg) has to be regular, happening in every cycle or at least in most cycles. Sexual intercourse has to take place regularly but particularly so in mid-cycle when the egg has been released. The female egg (ovum) has a short life-span of a matter of hours (around 24) and so timing is crucial. From the mid-30s, for most women, ovulation becomes increasingly erratic. The timing is unpredictable and, in many cycles, no egg is released at all. If in the entire year, only six cycles are accompanied by ovulation, it means there are only around six days in the entire year that there is a live egg that can be fertilised. The challenge is made harder by the fact that because the pattern becomes irregular, pinpointing those ‘fertile’ days becomes increasingly tricky.
· Quality of eggs: In addition to erratic ovulation discussed above; the quality of eggs produced becomes progressively poor. This increases the chance of failed fertilization and, crucially increase the chances of
· Chromosomal abnormalities: Most, if not all prospective mothers will know the condition Down’s syndrome. One of the strongest risk factor for Down’s syndrome is advanced maternal age. For instance, at 25, a woman has a 1 in 1350 chance of having a baby with Down’s syndrome. By the time she is 40, the risk is 1 in 85. That is an increase of almost 16-fold. Down’s syndrome may be the most common and familiar chromosomal abnormality mainly because it is compatible with life. However, it is not the only one. Far from it. Edward’s syndrome is another. This condition is 10 times less common but it is a far more serious abnormality. Affected children don’t usually survive more than a few days or weeks. The risk of having a baby with Edward’s syndrome increases with age also.
· Stillbirth: There are few things worse than losing a baby. Is it possible to compare degree of grief for parents? Probably not. However, it is probably safe to assume this sort of life event hits older mothers particularly hard. It is, however, a fact that a woman in her 40s has a significantly increased risk of suffering from a stillbirth compared to her younger counterpart. The risk may be up to three times compared to women in their 20s.
· Miscarriage: Stillbirth is not the only form of pregnancy loss associated with age. Miscarriage is also more common. It is important to always be aware that a positive pregnancy test does not equate to a baby. A woman conceiving at age 40 or above has at least a 35% chance of ending up with a miscarriage, a lot higher than a woman in her mid-20’s (around 10%)
· Pregnancy complications: Older mothers are at higher risk of almost all the significant pregnancy complications. Apart from miscarriage discussed above, there is placenta previa (a low lying placenta with a potential for serious haemorrhage), gestational diabetes, hypertensive disorders including severe pre-eclampsia, intra-uterine growth restriction (IUGR) which, in turn can lead to preterm delivery and low birth weight baby. These babies are at increased risk of perinatal morbidity and even mortality. All these can happen to mothers of any age but they are a great deal commoner among older mothers.
· Birth complications: An older mother has an increased risk of having a caesarean section, both as planned (as a result of pregnancy complications discussed above) or as an emergency. A caesarean section being a major surgery carries more risk than a normal (vaginal) birth. Other birth complications that are more common among older mothers include a potentially serious postpartum haemorrhage (PPH). Apart from being life-threatening, PPH can and is frequently a cause of prolonged ill-health for the newly-delivered mother.
· The baby’s perspective: I would prefer to steer clear of this particular subject as it falls outside my comfort zone. However, it behoves every prospective mother to have the welfare of the child at the heart of her decisions above all else. Babies have a tendency to become toddlers, teenagers and ultimately young adults. A parent has a central role to play at each of these stages and should ensure she has the ability to do so.
The other end of the spectrum
You can’t help what age you are. What you can decide is whether you should have that child or not. Once you have made that commitment you should be in a position to know what pregnancy and childbirth might throw at you. That is what is covered above. To help you navigate those waters, a lot of professional input might be required. That will be a subject of another hub.