Health
| A baby after 40 |
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| Written by Dr Caroline Shreeve, 2008 | |
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Giving birth when you are 40-plus is no longer unusual, says Dr Caroline Shreeve. Looking after yourself is the key to coping with late motherhood. Many of us have at least one friend or relation who has started or added to her family in her 40s - you may even have done so yourself. Well-known later mothers include Halle Berry who is expecting at 41, Desperate Housewives actress Marcia Cross who had twins at 44, and Cherie Blair who had her fourth child, Leo, when she was 45. 'Late' babies are much more common now than they were even a decade ago; reasons include study and career demands, problems finding a suitable partner, wanting a child in a later relationship and the financial difficulties of first-time buyers seeking their own home before starting a family - not to mention our altered perception of age. The new 30The adage "40 is the new 30" may have a basis in scientific fact since women's fertility in their 30s and 40s has increased significantly over the past 20 years. According to the Office of National Statistics, fertility rates for women aged 30-34 rose from 78.2 live births per thousand women in 1986, to 104.6 in 2006, while the average age of giving birth in the UK has risen from 28.6 years in 2001 to 29.2 years in 2006.More than 22,000 women over 40 had babies in Great Britain last year, a quarter of them for the first time. Yet in the 1960s and 1970s, older mothers were a matter of concern to doctors and midwives because they feared for the safety of the mothers and their babies. As recently as the 1980s, a woman over 35 expecting her first child was termed an 'elderly' or 'geriatric' primip (first-time mother). Professor John Mirowsky, an expert on older motherhood at Texas University, believes that a woman's prime child-bearing age for maximising her health and long life prospects, is between 34 and 40. In a recent Daily Mail interview he said, "Older women tend to be more mature and less likely to engage in risky behaviour, and are more settled educationally, financially and emotionally.". The risksFertility peaks during a woman's late teens and 20s when she's physically best suited to pregnancy and child-rearing. No pregnancy, however, is risk-free, and the potential hazards, which increase from the age of 30 as fertility wanes, include giving birth to an infant with Down's syndrome or some other genetic defect, and deteriorating health in the mother herself.Older women are, overall, 70 times more likely to give birth to a baby with chromosomal abnormalities, although many such embryos miscarry in early pregnancy, which partly explains why IVF and other forms of assisted reproduction are less successful after the age of 37. Down's syndrome is the commonest chromosomal (genetic) defect causing worry to prospective older mothers: at the age of 48 there's a one in 10 chance of having a Down's baby, compared with one in 2000 chance during one's 20s. Today's screening tests can indicate the risks of congenital defects to an unborn baby without utilising higher risk diagnostic tests such as amniotic villus (placental tissue) sampling and amniocentesis. Screening tests include blood tests at 15-22 weeks of pregnancy to identify specific substances indicating Down's, and ultrasound scanning. The mother's age is factored in with the test results to calculate her particular risks. The blood tests are classified as "double", "triple" and "quadruple" depending upon the number of suggestive substances sought. The ultrasound scan concentrates on an area at the back of a baby's neck called the nuchal fold, where skin thickening suggests the likelihood of a Down's baby. When screening identifies a higher-risk pregnancy (i.e. a one in 250 chance or greater of a Down's baby), the baby's chromosomes (genetic material) can be analysed from tissue fragments. In chorionic villus sampling, a minute piece of placenta is removed, while in amniocentesis, a sample of the amniotic fluid around the baby is withdrawn at around 16 weeks and studies made of the baby's cells it contains. Amniocentesis is linked to a 1 per cent chance of a miscarriage, and chorionic villus sampling with a slightly higher risk, but the advantage of chromosomal studies is that they provide a definitive answer regarding the existence of Down's. Obstetric healthOlder mothers need to be monitored often and carefully for signs of high blood pressure, diabetes or thyroid problems, the chances of which all rise with maternal age. Most obstetricians would prefer to deliver the infant of an older woman by Caesarean section at around 38 weeks, as opposed to vaginal delivery. The vast majority would strongly advise against a home delivery, particularly in the case of a woman over 40 giving birth for the first time.Caesarean section is a swift, straightforward, safe operation with fewer risks to baby and mother than a prolonged and painful vaginal delivery. Any problems can be dealt with immediately by the obstetrician and their team who have every medical and resuscitative aid at their fingertips. Older and wiser?Pregnancy, childbirth and child-rearing can be comparatively simple for women over 40, particularly if they are experienced mothers. Pregnancies and deliveries tend to become progressively easier and, even when difficulties arise, familiarity with childbirth enables many older women to relax and cope better than they would have done, when younger. Many older mums are better at breast-feeding, having more time and patience and possibly less inclination to fret over neglected housework.Most mothers over 40 feel exhausted after their delivery, during their child's infancy and toddler stages, and later when bringing them up. Young children are extremely demanding, requiring patience and concentration, which older mothers may believe they have lost - yet often rediscover. Some more mature mothers suffer from post-natal depression, but it is often less severe than any they experienced when younger. The secret is to compartmentalise your day, devoting the greater part to your child's needs, but always setting aside half an hour or so for your own personal time. At first, to do so may seem impossibly hard, but failure to do so can bring on irritation, anger, despair and possibly post-natal depression. A healthy pregnancyWhatever your age (but especially if you're over 40), a healthy lifestyle is essential if you wish to conceive, have a trouble-free pregnancy and have the energy to look after your baby well. Here are the basics:
Dr Caroline Shreeve MB BS (Lond) LRCP (Lond) MRCS (Eng) is a member of Llanboidy WI. Advice from women who have been through it all"For four years I was collecting child allowance in addition to my state pension!"Pamela Stanley, Warborough & Shillingford WI After 20 years of happy marriage and two sons, then aged 17 and 15, I found that I was pregnant for the fourth time in 1987. I would be nearing 46 by the time the baby was due. That autumn I felt well, I had the wholehearted support of my husband and very attentive care of my GP and the John Radcliffe Hospital. I carried on my part-time job as a medical secretary through the winter until I was five months. Both boys were studying hard for their A levels and GCSE exams. My husband was heavily involved in his work, but from winter into spring we attended antenatal classes. I was also attending yoga lessons with my excellent local teacher, who gave me special pregnancy exercises, which I know helped me in labour and in subsequent months right up to the present time. During the summer half-term and more or less on time, we prepared to leave for the hospital. I had a three-and-a-half hour labour with my husband present before another wonderful little boy of 8.5lb was born. It was painful at the end and I needed stitches and, a few days later, a blood transfusion. I was given a room on my own and the nursing care was good, especially the sister who helped me with breast-feeding. Our baby is now 19 and studying engineering at university. Our two older boys benefited from having a baby around day and night and they have become good fathers themselves. Likewise our youngest has learned a lot from his older brothers. Financially, it has meant the cost of nurturing three sons has been spread over a longer period, which has been beneficial. For four years I was collecting child allowance in addition to my state pension! Another child later in life has kept us young in outlook. We were able to participate in and enjoy family adventure courses well into our late 50s, when some of our contemporaries were taking early retirement. "She's a beautiful, healthy child but because I took so long to recover (one year) we decided to thank God that we'd got her and not to risk my health or the chance of a disabled baby" Sue Case, Caythorpe & District WI, Lincs. I got married the first time at 18 and had my first baby (a son) at 19. At 21, I had a baby girl. At the age of 28 I had another girl after having been fitted with the coil (which obviously didn't work!). Even at that age I was referred to by the doctors and midwives as being "a geriatric mother". I had planned to have another baby as the births had become progressively shorter and easier. But it was not to be - my husband went to pastures new and I was now a single-parent family with three children under 10. Eight years later I had an abnormal smear test result and shortly after had a cone biopsy and had most of my cervix removed. In 1993 I met the man who was to become my second husband. We planned to have two children very close together who would be 'ours', if I was still fertile enough. Sure enough, the following year Maria arrived, 7.5lb. She was delivered early by caesarean section because she was extended breach and I had so little cervix that it would not be able to dilate when the time came. She's a beautiful, healthy child but because I took a year to recover we decided to call it a day, thank God we'd got her and not to risk my health or take the chance of having a disabled baby. "We had quite a fight to have my husband stay with me... finally he told them that if they didn't allow him to stay he would take his wife away!" Linda Hartley, Kilsby WI, Northaptonshire My fifth child was born at home when I was 41 and it was a wonderful experience, with my husband there - as he was at all five births - and the midwife. My other children all raced home when they heard the news and saw Maddy within 40 minutes of her being born. I had my first baby in hospital in Cheltenham, and the second in 1972 in a maternity home, which was even further away from us than the hospital. We had quite a fight to have my husband stay with me there. In the end he told them that if they didn't allow him to stay he would take his wife away! They let him stay then. Our third baby was born at home in Yorkshire and what a difference in the experience! By the time our fourth baby came along I was 35 - he was born in 40 minutes, again at home. When I was told that our 'surprise' baby was on the way we were no longer living in Yorkshire and I was told I would have to have the baby in hospital. What if the fifth birth was even faster than the fourth? How would we get to the hospital in time? The doctor didn't approve of a home birth, but our marvellous community midwife suggested that we at least have an emergency pack in the house in case. This pack contained things like oxygen in case the baby was in distress, waterproof sheets etc. When labour started we called her and Maddy was born, at home, an hour and 20 minutes later. "I was much more relaxed during Sarah's childhood... I did not get uptight if housework was left and spent far more time with her" June Freeman, Ravenshead WI, Nottinghamshire I had a daughter when I was 41 after remarrying. I have two sons from a previous marriage and there is an 18- and 16-year gap between them and Sarah. I found I was much more relaxed during Sarah's childhood - I didn't get uptight if housework was left and spent far more time with her. I was very healthy all the way through the pregnancy with Sarah and worked up to three weeks of her birth. We had consulted our GP before I got pregnant and he assured us that as I was fit and well and had never smoked there should not be any problems other than my age. All the test results were clear. I was in labour about 18 hours and Sarah was the largest of my babies at 8lb (the boys were only 6.5lb). I experienced little of the post-natal depression I'd had with the boys and I was much more relaxed. I returned to work part-time when Sarah was about a year old. I have asked Sarah if she ever felt embarrassed that I was an older mum but she said she never really noticed it. None of the other mums realised how old I was until I told them and I never felt unable to keep up with them. Sadly my husband died from cancer when Sarah was only 11, so we were left on our own to get through those difficult teenage years. We came through it OK though. Sarah is now 22, with a good job and engaged to a very nice fellow. "My second pregnancy, with a three-year-old to look after, was very tiring and made stressful because of the additional worry of test results." Mary Morgan, Morton WI, West Yorkshire My first baby Jonathan was born in hospital, by planned caesarean in 2002 when I was 37 and my second, Christopher, was born, again by caesarean, in 2006. My second pregnancy, with a three-year-old to look after, was very tiring and made stressful because of the additional worry of test results. My risk factors for Down's syndrome - one in 25 - seemed so high, but they didn't tell me that at my age they would never have been low. They can measure the fat at the back of the baby's neck and after that test they told me it was a one in eight chance. I than had amniocentesis, which was also worrying because of the miscarriage risk. They found something on one of the chromosomes, which thankfully turned out to be "non-active", but this was an additional worry for my husband and I. My first baby had been born prematurely and so it was stressful having him in intensive care, but Christopher was on time and all was well. After a Caesar you should wait six weeks before driving etc., so I was careful to follow that advice. "I was told by medical staff on several occasions that children born to older mothers tended to be slow at school." Carole Lancaster, Norbury WI Staffordshire My daughter Claire Louise was born when I was 42. Our son Dean had been born when I was 36 and I desperately wanted a girl. I was told by medical staff on several occasions that children born to older mothers tended to be slow at school. But even at the age of two, Claire seemed bright to me - and she got an A in maths at A-level last year so she can't be slow! They told me to "concentrate on having a healthy baby", as though that was the best I could expect. Even though I wanted a baby girl so much, I didn't want to know the sex of the baby before she was born. I had the blood test for abnormalities but it showed a very low risk so I didn't have amniocentisis. She was born by C-section because Dean had been a breech baby and there was scar tissue that the doctors thought might tear were I to give birth normally again. I ate sensibly and recovered pretty quickly. "Despite the fact that I had worked for 24 years, I was treated as though I was stupid, especially by the male doctors..." Pam Durnan, member of Heath End Reach WI, Bedfordshire My mother was 38 before she had me and was surprised to discover she was pregnant again at the age of 44 with my brother. I was 41 when I got married and 42 when I had my daughter in 1987. I worked until the 29th week of my pregnancy. I was a computer programmer and my company offered me a lead apron to wear, but because I didn't know until fairly well on, by then any harm would already have been done, so I didn't use it in the end. Luckily all was well with my daughter. I took NCT classes but there's no way the doctors would let me have a home birth. Scans were quite new then and so were epidurals. Despite the fact that I had worked for 24 years, I was treated as though I was stupid, especially by the male doctors. I felt I knew what I needed to do to make labour progress (I thought if I ate something and they topped up my glucose drip things would start again) but they refused all my suggestions and said they might have to do a caesarean. In the end she was born with forceps. I wanted to have more children, and was even prescribed Clomid but unfortunately it never happened. |
