If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them.
With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’. I counsel women on their risks nearly every day. I already knew that at my age, it may take longer for me to get pregnant.
I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation. I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age. I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material.
I knew my chances of conceiving a chromosomally abnormal pregnancy (more specifically, Down’s Syndrome) were higher. I knew that at age 35, my risk of a chromosomal abnormality in the pregnancy would be about 1/250 pregnancies, at 38 yo that risk increased to about 1/100 pregnancies, and that at 40 yo it was as high as 1/60 pregnancies. I knew the available blood tests (Quad screen, FIRST screen) and diagnostic tests (CVS, amniocentesis) to find out my specific, individual risks within the pregnancy. I knew my risks for medical complications within the pregnancy would be higher, and that I was at a higher risk for developing hypertension (high blood pressure) and diabetes within the pregnancy. What I didn’t know…was about a parent’s abounding love for their children.
I didn’t know how grateful I would be for this overwhelmingly, awesome experience, of undefinable love and connection for my child. That’s something that all of my years of medical training, didn’t teach! Like many older moms, I intentionally delayed childbearing because of desires to achieve education and career goals, as well as marital and financial stability, before planning pregnancy.
In deciding to try for a baby, all of a sudden, all of the information on ‘advanced maternal age’ risks (that I knew so well) became just that…just numbers and statistics. As an Ob-Gyn physician I do have an obligation to share and inform patients on their risks.
For older age women contemplating pregnancy, the information is not only real, but potentially life-changing (emotional stress from miscarriage, the medical risks due to hypertension and diabetes, the decision-making involved with carrying a chromosomally abnormal fetus.) Though the information on medical risks in pregnancy for women of advancing age is valuable…It is still, nevertheless, difficult to balance the ‘decision to have a baby’… against a game of statistical odds. …Such as it is, in this game called Life.
Suzanne Hall, MD
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