I have been bombarded at my office recently with information about the risks of pregnancies in women of “advanced maternal age”, also known in obstetric lingo as “elderly parturients”, a term I consider particulary offensive. I do not consider a woman who is pregnant after the age of 35 as elderly.
I have cared for a significant number of women over the age of 35 during the years I’ve been a midwife, and have become increasingly frustrated with the modern obstetrical approach to this age group.
There is nothing magic about the age of 35 that predicts a higher risk pregnancy. Women don’t turn 35 and experience some dramatic biological change in their bodies, placing them at higher risk. The medical community settled upon the age of 35 as the indication to step up dscreening for genetic disorders because it was the age at which the risk of a miscarriage caused by an amniocentesis done for diagnosis of chromosomal disorders was equal to the risk of having a baby with Down syndrome. Nothing mysterious happens in your body when you turn 35. This age was chosen pragmatically, based on statistics.
Another pet peeve of mine is the assummption that all pregnant women over the age of 35 are in need of incresed “surveillance” during pregnancy. This generally includes the recommendation for multiple genetic screening tests, such as the quad screen and PAPP-A, followed by an amniocentesis. In addition, many providers recommend that the woman of advanced maternal age take a baby aspirin daily (to prevent pre-eclampsia, though aspirin not been proven to have any protective benefit), have twice weekly non-stress tests after 32 weeks of pregnancy, and monthly ultrasounds. Many providers are also recommending induction of labor at 39 weeks, “just in case” anything might go wrong after that point.
Recent studies have indicated that women over the age of 35 or 40 (depending on the particular study) are at higher risk for complications of pregnancy, not just increased risk of a baby with Down syndrome. However, some studies have concluded that this risk is more likely a result of prior health problems in women who become pregnant.¹
As we age, we cannot be as careless with our bodies as we can in our teens and twenties, without noticing adverse effects. Ideally, all pregnant women would be in good healthand physically fit before conceiving, and would take optimal care of themselves during pregnancy. The reality is that many women will not start pregnancy in excellent health, and complications they experience during pregnancy may very well be a result of their health condition prior to pregnancy.
Sophie was a 42-year old client of mine, pregnant with her fourth child. Though this was an unplanned pregnancy, Sophie was in good shape. She exercised regularly, maintained optimal weight, and ate a balanced diet of whole foods. Due to the protocols of the office where I work, I was required to review with Sophie the standard medical recommendations for a pregnant woman of her age. Sophie balked at the suggestion of multiple tests, pills, and ultrasounds. ”I am very healthy, and would prefer to be treated that way unless there is an indication of a problem during my pregnancy,” she stated. “I don’t want any routine tests. If I have a problem, I will consider tests at that time.” She paused. “Do you think that is an irresponsible approach?”
I told Sophie I thought she had a lot of common sense, and I would support her in declining increased testing based on her age alone.
I have cared for numerous pregnant women over the age of 35, and those who made the effort to begin pregnancy in optimal health, and continued to make choices to maintain excellent health throughout their pregnancy, had uncomplicated pregnancies and births. Modern obstetrics could better serve women of advanced maternal age by stressing preventive health measures before and during pregnancy, than the “bandaid” solution of aspirin and frequent testing currently offered. The increased level of stress and fear that accompanies being subjected to frequent testing and pills may cause more problems than it prevents.
Common sense tip for today: Whether you will experience complications during pregnancy has less to do with your age, and more to do with how you take care of yourself before and during your pregnancy.
1. Schutte JM, de Jonge L., Schuitemaker NW, Santema JG, Steegers EA, van Roosmalen J. Indirect maternal mortality increases in the Netherlands. Acta Obstet Gynecol Scand. 2010 Jun;89(6):762-8.
I love all of your posts- they just make so much sense! I can’t imagine the stress associated with all of that testing! It’s nice that the your clients aren’t fear-mongered into ultra-high management of their pregnancies. I personally chose to have almost no testing done during my pregnancy, because if they had found anything wrong it wouldn’t have changed my decision to have the baby
And when I was younger 35 seemed old, but now…it’s only 8 years away! Shame on doctors for treating pregnant mothers over the age of 35 as walking time-bombs!
I wish more care providers shared your sensibility about this, and I wish more recognized that the high-risk way they MANAGE “elderly” moms often has an impact on their outcomes…..i.e. the prophylactic induction at 39 weeks undoubtedly plays a role in the extremely high cesarean rate in “elderly” moms.
I had 3 of my 4 pregnancies at age 35 and above and all was just fine. However, I had to aggressively pursue low-tech care in order not to be automatically herded into high-tech, high-intervention pregnancies and births.
I really appreciated this post too! I am over 35, not yet pregnant and looking for a care provider who will see me as a person, not a collection of risks. Right now I am healthy, eating a good diet, taking care of myself, etc, so why should I expect to have any more problems than someone a few years younger than me?
I think the important question to ask ourselves is “Is it possible for a person to remain in good health as they age?” We know that this is possible. Older people who exercise and eat healthfully can remain vigourous and healthy into old age. It’s the same for pregnant women. If you take care of yourself, and begin pregnancy in optimal health, there is no reason to expect any higher risk of pregnancy complications than in a younger woman. However, our bodies do have lower tolerance for abuse as we age. A young woman may be able to eat a lot of junk food without experiencing blood sugar control issues, whereas an older woman may not be able to do the same. So again, it comes back to taking care of ourselves properly and expecting the best!
I am 37 and was 36 when I became pregnant with and delivered my second baby. I remember vividly the conversation with the midwife around 29 weeks regarding the recommendations for all of the ultrasounds, non-stress tests, etc for the last 8 weeks of the pregnancy. She even admitted that the recommendations were based on primarily “trends” and what “other OB offices are doing”. Yet another part of obstetrical practice that is not based on sound research. Irritating. I was looking forward to declining all of it, except maybe a few non-stress tests, right near the end during my routine visits. However I went into pre-term labor at 31 weeks and had a healthy preemie who just needed to grow and learn to eat in the NICU. Remember women, you have a right to say no to certain tests and procedures….. It is just that pregnancy leaves us in a vulnerable state, as our body no longer belongs to us, but to our baby, and thus our OB….. OB’s are good to have around, but they do not know everything.
I appreciate this article / post very much, thank you!
As you know I cant help myself answering articles written around “advance maternal age”….
as an inspiration for all women I got pregnant naturally at 45 (my third child, 8 and 11 year gap) and gave birth at 46 years of age AT HOME IN THE WATER ALL NATURAL FROM A-Z..and still bestfeeding my beautiful, strong and healthy 20 mth old daughter..and on an added note at 32 years of age the DR told me
“you will NEVER get pregnant naturally!!”
16 years plus later ..hello three naturally conceived and born gorgeous kids!!!
HOORAY FOR OLDER MUMS!!!!
I completely agree with you! I have often told people, “It’s like when you hit 35, suddenly your uterus is going to blow up. I don’t remember feeling that happen when I hit my 35th birthday!” I conceived my third child when I was 33, and actually had a midwife (err, a medwife, really) harping on me “being 35″ and nearly *insisting* that I get tests done. I had no plan to do so, and she just could NOT accept that. After I told her “I am 33, not 35!” and refused the tests for the nth time, I left the practice.
Great perspective – as a 41-year old (still hopeful) mom-to-be, I’m 5 weeks+ post-IVF and about at that point where the fertility doc is ready to start scheduling a barrage of ultrasounds for “routine monitoring”. I probably wouldn’t even have questioned it until the nurse told me that I’d probably have 2-3 before they turned me over to an OB – which seemed utterly excessive considering the window between now and then is about 4 weeks! I understand there is allegedly a higher risk of ectopic pregnancy following IVF and I know that it’s important to screen early so I’m frantically trying to find a less invasive alternative to check for this. I’ve found some info on a urinary ELISA test as a follow up to the normal hCG and progesterone blood tests that could virtually rule it out completely but since docs are so used to doing routine US for this I’m having a hard time finding someone who has ever heard of this as an alternative. I don’t yet have a midwife as most seem to take their first appointments after 8 weeks so other than the internet, I’m out of resources. Any suggestions?