Waiting to start a family

More women are doing it, but how late is too late?

Former vice presidential candidate Sarah Palin brought national attention to a trend that’s alive and well in the Hudson Valley: New moms aren’t getting any younger. In fact, the National Center for Health Statistics has tracked a steady increase in the average age of first-time mothers in America, from 21.4 in 1970 to just past the 25th birthday in 2005. That’s an average – meaning a significant amount of moms are significantly older. In fact, more than a quarter million women in 2006 had their first child between the ages of 30 and 34.

“Honestly, it’s a nationwide trend,” says Ilan Zedek, MD, an OB/GYN with the Crystal Run Healthcare group in Rock Hill and Liberty. He’s delivered hundreds of babies in Sullivan and Orange counties since 2004, and he’s seeing more pregnant women every year who fit the term “advanced maternal age.”

That’s any mom 35 or older for those of you not familiar with the terminology commonly used by members of the American College of Obstetrics and Gynecology (ACOG). “We’re seeing a lot more women in their late 30s,” Zedek says. “The late 30s is more common than a woman 45 and older, but there are some who are 41, 42.”

I'm an Older Mom

With that advanced maternal age, however, comes a host of increased risks for both mom and baby. The March of Dimes says women have a 1 in 1,250 chance of having a baby with Down Syndrome at age 25. At 30, the numbers increase to 1 in 1,000, and by 35 it’s 1 in 400. At 40, the numbers are 1 in 100, and by 49 they’re a whopping 1 in 10.

Older mothers may also have pregnancies compromised by an underlying chronic illness, such as high blood pressure and diabetes. These are monitored carefully during the pregnancy so that the illness does not become more serious.“Even without fetal abnormalities, the risk to the mother increases with age,” Zedek says. “Risks of blood pressure problems and glucose issues, preterm labor, and bleeding with pregnancy.

Generally, once the pregnancy is completed, most of these problems resolve, with the exception of blood pressure.” Because older women are more likely to have fetuses with chromosomal abnormalities, miscarriage rates go from 10 percent for women in their 20s to 20 percent for women in their 30s. By the time a woman hits 40, ACOG estimates half of all pregnancies will end in miscarriage.

However, these abnormalities can often be detected through prenatal testing early in the pregnancy. A mother over 35 may be offered:

  • amniocentesis – an invasive procedure that detects an abnormal number of chromosomes. Done at 15-20 weeks.
  • Chorionic Villus Sampling (CVS) – an alternative to amniocentesis that tests cells in the placenta for chromosomal abnormalities. Done at 10-12 weeks.
  • Blood screening – tests alpha-fetoprotein (AFP), the hormones estriol and human chorionic gonadotropin (HCG) and inhibin-A for neural tube defects and Down syndrome. Done at 11-13 weeks.

Keep in mind that some of these tests are not 100 percent accurate in indicating a problem, nor are they mandatory. Discuss your options with your doctor early on in your pregnancy. All these possibilities are enough to scare any woman, but the news isn’t all doom and gloom. A 2005 study published in the Journal of Obstetrics and Gynecology (the official journal of ACOG) concluded that while “older maternal age is associated with relatively higher risks of perinatal mortality/morbidity … the absolute rate of such outcomes is low.”

In other words, the risks are present, but they don’t always necessarily play out. In fact, the study – done “to determine if the rates of pregnancy complications, preterm birth, small for gestational age, perinatal mortality, and serious neonatal morbidity are higher among mothers aged 35-39 years or 40 years or older, compared with mothers 20-24 years” – cited advantages Zedek sees every day in his patients here in the Hudson Valley.

“Certainly a 31-year-old woman who has her first pregnancy is in a different mindset than someone who’s 18,” he notes. Kellee Passante was 35 when she gave birth to son Daniel. The Saugerties mom says he was a happy accident – after years of focusing on anything but motherhood.

Not sure what to expect at a birthing center?

“I’m grateful that I didn’t have children when I was younger,” she says. “I’m absolutely more settled in this phase of my life. I’m more ready for the responsibility. I’m more comfortable with who I am.”

Passante was blessed with an uneventful pregnancy her first time out, although later attempts to have a baby were not successful. Now 44, Passante has accepted 8-year-old Daniel will be an only child. She’s happy to report her close network of moms – who ironically all have one son – have provided not just support for her but a core group of friends for Daniel.

The circumstances surrounding her later attempts at motherhood are different – and private – but they’re something Zedek does wish more of his patients would take seriously. “There seems to be a belief that if I don’t get pregnant now that’s OK, I have plenty of time later,” he says. “Yes, there are women after age 40 who are pregnant. Some got pregnant easily, but some traveled a long road.

“Fertility rates actually do start to decline,” he continues. “It starts at age 30, and it really takes a nosedive after age 40.”

Later is better for some moms
For some women, starting a family later in life makes sense. The moms are generally in settled, committed relationships. They’re more likely to consult with their doctor before getting pregnant. Most studies have shown they’re also less likely to engage in any type of risky behavior during their pregnancies.

And when it comes down to it, moms are moms. “My doctor at the time said, ‘Whether you’re 20 or 40, pregnant is pregnant’,” Passante recalls. “Motherhood itself is an adventure no matter the age.”

That’s what Orange County mom Lucy hopes. She asked to have her last name withheld because she’s currently undergoing an adoption process at age 49, already a mom to a 24-year-old daughter and a 20-year-old son. Remarried to a 42-year-old who’s never had the chance to be a father, Lucy dealt with the infertility issues that ACOG and the March of Dimes warn can keep the dreams of motherhood out of a woman’s grasp.

Despite her worries that an article might somehow affect the adoption process, Lucy wanted to go public with her encouragement for moms who are debating starting over at that “advanced maternal age.” Whether you’re giving birth or adopting, for the first time or the second or third, a lot of the fears are the same, she says: How old will I be when my child graduates from high school? From college? Am I too old for this?

“I have friends who are becoming grandparents!” she says with a laugh. “I told my daughter she can’t do that to me just yet. I’m not ready to be a grandmother and a new mother!” Her daughter has told Lucy she’s “not your typical 49-year-old woman,” which has buoyed her spirits. But being 49 is also working for her.

“When I was having [my first daughter at age 25], I don’t think I was ready,” Lucy recalls. “I hadn’t grown up myself. I’m calm now. I’m more complete as a human being. I feel I can give the child more of myself.”

Like Passante, Lucy says a woman who thinks she’s ready to be a mother has the same concerns at any age. She also has the same joys.“Consider the pros and cons,” she says. “If you want it – go for it. Parenting is a wonderful thing. I wouldn’t give up being a parent for anything.”

Jeanne Sager is a freelance writer in Sullivan County.