Older moms, including those who are experiencing low-risk pregnancies, are more likely to feel that their babies are at risk. And, according to a group of researchers from the University of Calgary and the University of Manitoba, this misplaced perception of risk may “drive most of their pregnancy and labour decisions, including those related to cesarean birth.”
It’s a noteworthy finding, particularly at a time when Canadian women are having babies later in life. According to Statistics Canada, the fertility rate of women aged 40 to 44 increased from 3.7 per 1000 women in 1989 to 9.2 in 2009.
“I didn’t meet my husband until just before I turned 30,” recalls Margaret Evans, 36, of Toronto, who is due to give birth to her first child any day. “Then we focused on having a strong and healthy relationship before having a baby.”
when and how to interrupt a career on the rise — can also prolong the path to motherhood.
Add to that biological factors like longer life expectancy — “The 30s are the new 20s,” insists Montreal mother Laura Conforti, who gave birth to her first child at age 37 — more effective contraceptive options, a trend toward smaller family size and the reproductive health wild card and it’s easy to see why pregnancy is increasingly becoming something women do later rather than sooner.
But postponing pregnancy may not be without a cost. That’s a message the Society of Obstetricians and Gynaecologists of Canada has been trying to get out to Canadian women in recent years. “Increased age can make it more difficult for your body. It is important for women and their partners to understand how age can affect fertility, pregnancy and childbirth, and to what extent medical technologies can help.”
Having a pregnancy flagged as potentially high risk on the basis of age is intended to be a kind of alert for the healthcare provider, explains Lisa M. Weston, President of the Association of Ontario Midwives.
“It simply means that you might need additional attention, options, or care.” But that warning doesn’t apply to every older mother. “You can have a 42-year-old who is absolutely healthy — and you can have a 20-year-old with every complication going.”
Unfortunately, many older moms-to-be who are, in fact, experiencing low-risk pregnancies end up feeling just the opposite.
The University of Calgary and University of Manitoba researchers decided to study how age affects the gap between pregnancy risk perception and actual pregnancy risk to try to learn more about the disparity affects pregnancy and birth decision-making.
The researchers, who reported their findings in the September/October issue of the Journal of Midwifery and Women’s Health, compared pregnancy risk perception in two groups of Winnipeg first-time moms-to-be: those between 20 and 29 and those 35 or older. The women completed a series of questionnaires which assessed their fears and worries about their baby’s health, their own health, and labour and birth; evaluated their knowledge of risks associated with becoming pregnant later in life; and provided the researchers with a snapshot of their reproductive health, general physical health, and mental health.
The researchers discovered that women aged 35 years or older reported “significantly higher levels of perception of risk of having cesarean birth, dying during pregnancy, having a child born prematurely, or having a child with a birth defect or one admitted to the neonatal intensive care unit (NICU) than women aged 20 to 29 years.”
Given that psychological factors are known to contribute to higher rates of cesarean birth — fear and a lack of confidence in her ability to give birth may cause a woman to gravitate toward a c-section — an older mother who believes she is destined to have a cesarean c-section because of her age is more likely to see that supposed destiny fulfilled.
“These results suggest that a medically known risk factor, such as age, may influence perception of pregnancy risk,” the researchers noted, adding “incorporating discussions of pregnancy risk into prenatal care visits may assist [pregnant women who are age 35 or older] to make more informed choices, reduce anxiety, and avoid unnecessary interventions.”
It’s an approach Weston uses with pregnant women in her own midwifery practice. “It’s important to individualize risk factors for each woman. We don’t want women to make fear-based choices.”
For Jenn Thomas, a Calgary mother who gave birth to her first child at age 35 three years ago and who planning a vaginal birth after cesarean when she gives birth to her second child later this year, having a caring and supportive caregiver who helps her to put pregnancy information in context makes all the difference. “It’s all about education and informed choice.”
Conforti agrees. After discussing the issue with her doctor, she made the decision to opt for less invasive prenatal screening tests as opposed to amniocentesis (a diagnostic test which carries a small risk of miscarriage).
Ree Ree Phillips, a Toronto woman who will be giving birth to her first child in February at age 39, appreciates her doctor’s “very matter-of-fact” approach to the age issue. “Take care of yourself, eat well, come see me, and you’ll be fine,” he told her at one of her first prenatal visits. The message she took away from that appointment? “I’m pregnant. I’m not sick.”
Ann Douglas is the author of The Mother of All Pregnancy Books, The Mother of All Baby Books, and numerous other books about pregnancy and parenting. Read more of her articles at having-a-baby.com.