Pregnancy & Birth


Question: I just got pregnant with our first baby at age 36. Everyone tells me I’m considered “high risk” and they all talk about extra tests, inducing labor early, C-sections and all these other horrors. I’m perfectly healthy – I just started having babies later than most, I guess. Am I really at such high risk of complications?

Becky Burpo responds: In today’s illness-focused health culture, many newly pregnant women are asking me if they are too “high risk” for midwifery care, birth center birth, home birth and so on. They want to know if their chronological age at the time of conception requires that they be treated with special care. Let’s look at this from the perspective of medical research.

Medical research does show a significant increase in the occurrence of Down’s syndrome in children born to women after the age of 35. The figure rises even more among women bearing children in their 40s and 50s. Based on this data, you do have a higher chance of having a baby with Down’s syndrome – so you could say that you are “high risk” for that.

Being at high risk does not mean that you already have such a baby, though. Prenatal diagnostic testing, ranging from alpha-fetoprotein screening to sonograms to amniocentesis, could all be used to determine this to the best of current medical knowledge. The first two diagnostic tests may be performed or arranged by certified nurse-midwives (and in some states by certified professional midwives). Amniocentesis (which carries its own risks) usually is done by a maternal-fetal medicine specialist (as opposed to a regular ob/gyn).

Medical research also shows that the incidence of pregnancy-induced hypertension, gestational diabetes and macrosomia (very large babies) increases in women after the age of 35. Again, these facts do not mean that you will automatically develop any of these conditions.

There are more incidences of prolonged labors among older women; however, this is not a complication unless your care provider or facility has set an arbitrary time line for labor. Providing that you are well-nourished and your baby is doing fine, you need support during a long labor, not pressure to have your baby within someone else’s desired time frame. Time is not automatically a high-risk medical situation.

So what is the cause of all of this concern for older mothers? Many thoughts abound. “Aging eggs” is the traditional medical response to this question. Based on more research in other fields, we’re now considering lifestyles, total number of children, spacing of children and aging sperm as well. In previous generations, women who bore children in the second half of their reproductive years tended to have had several children previously and to have lived in lower socioeconomic conditions that prevented them from getting adequate health care and nutrition. Things may develop differently now; it will be many years before we know.

In the meantime, the current generation of childbearing women is the first to reap the benefits of all of the research of the previous generations. We now know that chronic illnesses (many of which first show up during pregnancy) are usually the result of particular lifestyles — i.e. prolonged stress, insufficient exercise or faulty nutrition. And these illnesses tend to start showing up in people in their late 30s and early 40s. Just as not all 70-year-olds are demented and invalid, not all women in their 30s and 40s are hypertensive, overweight consumers of high-fat and high-sugar diets. Women who have taken care of themselves do not suddenly become defective when the calendar page turns.

Because we know that lifestyle is a major contributor to pregnancy complications, seek a care provider who has time to examine and evaluate your lifestyle at periodic visits during your pregnancy. This type of preventive care is the hallmark of midwifery. Allowing women to labor at their own pace and keeping them nourished during labor are the mainstays of both birth center and home births. A mature woman needs more time and attention; thus, these environments and their personal focus are the ideal situation for an older mother.

“High risk” is a highly subjective term. Looking at statistics, it’s evident that the “highest risk” of injury that any of us will ever meet is from getting into automobiles. Supposedly, Volvos are the safest cars (at least, that is their marketing strategy). So should we all be driving Volvos? … The term “high risk” is a convenient scare tactic that empowers some care providers to control their patients and force many costly procedures on them. It is up to the woman to determine if they need or desire the procedures.

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