Category Archives: Pregnancy and Birth

Older Mums And Pregnancy Risks

In the following clip Professor Philip Steer, Consultant Obstetrician, at the Chelsea and Westminster hospital talks realistically and positively about pregnancy over 35, 40 and 50. He has monitored the pregnancies of women in their late 40’s and 50’s. He stresses that its not the physical age that’s the problem but aging eggs. Women in their 50’s are a lot healthier and fitter and will usually experience a straightforward pregnancy after successful conception with the donor egg of a younger woman.

Overall older women can expect to experience straightforward pregnancies. Professor Steer says that older mothers tend to be highly motivated, have lots of life experience and are educated which compensates for the exhaustion experienced when the baby arrives.

Professor Steer advises the main risks during pregnancy are;

1. Downs Syndrome

The average statistics for the population are 1 in 700 babies will have this chromosomal disorder. At 35 this increases to 1 in 350. At 40 the probability increases to 1 in 100 and over the age of 45 its 1 in 10.

2. High blood pressure
3. Diabetes – Insulin production declines and sugar levels increase as we age.

Women who have been known to have high blood pressure and diabetes before pregnancy are at greater risk but will be constantly monitored throughout preagnancy.

4.Pre term birth
5.Multiple birth – Older mothers have a higher rate of twins.

As a woman ages it becomes more difficult to give birth naturally due to the pelvic floor muscles stiffening up. The rate of c-sections for older mothers is 40 – 50% although this might also be a result of augmenting the process of labour due to a woman’s age. Older mums also tend to birth larger babies especially if they have had diabetes during the pregnancy.

Professor Steer advises if that if you are 35 years old and over to consider the following;

1. There is no perfect time to have a baby so you need to think about getting on with it if you want to increase your chances of conceiving naturally. This is all well and good if you have a partner!
2. Have a health check before you start the journey of conceiving a baby. Have your blood pressure checked and if you have had or have diabetes, have your blood sugar levels monitored.
3. Find an obstetrician who is experienced in pregnancy in older women.
4. Consider the optional screening tests for chromosomal disorders and diagnostic tests like amniocentesis although the latter does come with risk of miscarriage. If you are aged 43 or 44 and over you might want to consider going straight to a diagnostic test.

Older Mums And The Risk Of Post Natal Depression

Recently there have been a number of press articles which have reported studies that show a link between being an older mother and increased vulnerability to post natal depression.

As with any research contradictory evidence abounds.  Australian studies show that older women are more psychologically prepared for pregnancy and able to deal with the stress of parenthood compared to younger mothers. A study by Catherine McMahon at Macquarie University confirmed that rates of serious post partum depression were below average in mothers aged 37 or older in the four months after they had given birth. As older mothers are more likely to breast feed, this too protects from the risk of depression.

Recent studies are now reporting the reverse.

A preliminary study led by Giulia Muraca-Muir at the University of British Columbia in Vancouver, Canada, found after analysing the records of 7,936 women, that there was a five fold increase of risk in depression amongst women aged 40-44 than those in the 35-39 age group.

Muraca-Muir said that if the results are accurate it might reflect greater anxiety amongst older mothers who may be worried about the health risks to themselves and their child or the impact of having a baby later in life might have on their careers.

Additionally she also observed that the study had identified a potentially high risk group to PND and one which is growing rapidly given the increasing numbers of women bearing children later in life. In The Guardian Muraca-Muir said of the potential emotional risk of becoming an older mum, “we need to be able to counsel women on what the psychological consequences of late pregnancy might be.”

Another recent study led by Silje Marie Haga, from the University of Oslo, Norway, suggests there are some indications that older first time mothers might be vulnerable to postpartum depression not because of their physical age but because they are used to being in control of their lives.

In an article by the Daily Mail, Silje Marie Haga says “older mothers may have higher expectations of themselves and are more likely to ‘over-prepare’ for their first-born and struggle when things don’t go as planned” and that “‘It’s not the need for control in itself, but rather the failure to achieve specific expectations that can trigger a depression”.

The study found that those mothers with the greatest need for control desired a natural childbirth and when that didn’t work out as planned caused the mother distress. Additionally older mothers often have a greater expectation to breastfeed and when difficulties arise this might trigger depression.

Ms Haga is now developing a web-based program with a mental health centre in Norway that will monitor pregnant women from 22 weeks gestation and new mothers up to six months after the birth. She emphasises that new mothers need both practical and emotional support as well as being made aware that life can be exhausting for them.

If a baby is long awaited for and especially if there have been previous miscarriages, it would be understandable, even expected, for a mother to experience anxiety around the well being of her unborn child. Bearing this in mind it would be interesting to know the percentage of women aged 40-44 in the Canadian study that underwent fertility treatment and had also experienced previous miscarriage. Its well known that IVF treatment is emotionally stressful regardless of age and any distress could trigger the onset of depression in pregnancy and after birth.

The results of Silje Marie Haga’s study demonstrates a link between depression and not having the desired outsome from a specific set of rigid expectations. This is an issue of personality and not one of physical age. Who’s to say that the mothers in Ms Haga’s study wouldn’t have suffered depression anyway if they’d had children in their twenties or thirties.

Counselling women on the psychological consequences of late pregnancy seems false economy. A woman will have a baby when she feels ready and when the fabric of her life provides the best opportunity for doing so. This might not be until she’s passed 40. There is a risk of post natal depression at any age. Maybe it would be more prudent for an older woman to identify whether she is going to be more vulnerable to depression based on her life history and personality and then take measures to lessen the emotional impact a new baby inevitably brings. It goes without saying that a more relaxed approach to motherhood with undefined expectations will enable a new mother to cope more resiliently with the daily unexpected challenges.

Source
The Guardian
The Daily Mail