Childbirth Past 35.

This article is gratefully excerpted from Every Woman's Body by Diana Korte, Ballantine Books, New York, New York, copyright 1994.

Many women who give birth after age 35 are healthy, well-educated, working professionals, which is the profile of women at any age who are most likely to have a safe pregnancy and healthy baby.

Having a baby at 35 or 40 isn't new; what's new is the trend for so many women to have first-borns at an older age. Until the 1970s, women having babies in their thirties or forties were usually pregnant with child #5 or #6.

Their general health cannot be compared to that of many of today's past-35 women who are having baby #1 or #2. Now, nine percent of all U.S. babies are born to past-35 moms. This group of pregnant women, whether married or single, has doubled in size in a decade and is the fastest-growing group of new mothers in the United States.

This is not just a U.S. phenomenon -- it's happening in other Western nations, too.

Healthy, non-smoking 35-or 40-year-old pregnant women who do not have chronic diseases like diabetes or hypertension can give birth with as much ease as younger women. This is a controversial finding which is contrary to popular belief.

If you do have a chronic health problem, that doesn't guarantee difficulties with your pregnancy and birth, either. It does mean that you and your birth attendant will need to pay more attention to certain aspects of your prenatal care.

Despite this rosy picture of past-35 pregnancy, there are a half-dozen confusing issues these women face -- the higher risk of a cesarean, low-birth-weight babies, birth defects, miscarriages, infertility, and the rare maternal death.

Cesareans

Older mothers have a higher cesarean rate -- one-in-three (actually nearly one in two for first-time moms past age 40) versus nearly one-in-four for younger women. This may be in part due to some health professionals' outdated ideas. Although doctors can't be blamed for all the problems that some older pregnant women experience, researchers in 1990 could not find a specific physical reason for the higher cesarean rate and speculated that it was due to "conservative treatment" of over age-35 women.

When these same past-age-35 women have midwives as birth attendants, the cesarean rate is in the single digits.

Low-birth-weight babies

Although statistics show that older mothers are more likely to have a low-birthweight baby, the size of a newborn baby is related more to the mother's education and economic status than to her age. Women who are poor and who have had little or no prenatal care are the most likely to have low-birthweight babies, and that happens more commonly to these women as they grow older, especially past age 40.

Birth Defects

The only birth defect which occurs more commonly in older mothers is Down Syndrome [which is covered in greater depth later in this article]. It's important to remember, though, that 80 percent of all babies with Down Syndrome are born to women who are younger than 35. However, the risk for this birth defect increases each year. At age 35 the risk is one in 378 births, at age 40 it's one in 106 births, at age 45 it's one in 30 births, and at age 49 -- when births are truly rare -- the rate for Down Syndrome is one in 11 births.

Infertility

If you are older, your first challenge is to get pregnant. The ability for women to conceive decreases after their 20s. Some research shows as many as half of all women past 35 are unable to get pregnant. Similarly, over-40 men are not as likely to impregnate women as are younger men. Despite all this, every year 360,000 U.S. women over 35 give birth.

Miscarriage

Many studies show that older women miscarry at twice the rate of younger women. But some studies do not distinguish between healthy women with their first or second pregnancy and those women who have a history of chronic health problems, repeated pregnancy loss, and/ or infertility.

Maternal death

Older mothers also have a higher mortality rate. Although the rate of women 35 or older who die after childbirth has dropped nearly 50 percent in recent years, women in this age group are three times more likely to die in childbirth than younger women. This is in part due to the higher rate of cesareans -- major abdominal surgery with heightened risks primarily due to anesthesia, hemorrhage, and infection.

White women past age 35 have the same mortality rate as women in their twenties. However, four times as many pregnant black women who are past 35 die, especially as a result of ectopic or tubal pregnancies, than do white women. This is not because of their race, but again because of the mother's education and the size of her wallet. Lack of education and lack of income are both associated with too-little or too-late prenatal care.

As an older mom, your biggest challenge is to have a worry-free pregnancy. That's because if you're planning on a normal and uneventful pregnancy and birth, which is the ideal attitude at any age, you can't ordinarily expect a lot of positive support. Instead, you are likely to hear concern and horror stories from a variety of kibitzers, including family, friends, co-workers, and many doctors and nurses.

Your enemy is unfounded fear, not your body. New research shows that anxiety -- both your own and that exhibited by your partner, family, friends, or especially health providers -- can actually cause slowed labors. In this way, fears become self-fulfilling.

To avoid the side effects, both physical and psychological, of inappropriate worry -- and its companion, stress -- on your pregnancy and impending birth:

* Surround yourself with supporters, not naysayers.

* Educate your partner, family, and friends if you need to.

* Find a birth attendant, whether midwife or physician, who mirrors your philosophy about pregnancy.

Diana Korte lives in Boulder, Colorado. She is the author of Every Woman's Body (Ballantine 1994) and co-author with Roberta Scaer of A Good Birth, A Safe Birth (Harvard Common Press 1992). She is currently writing a book about VBACs.

[Editor's Note: References for this article are available upon request. Please send a SASE to Laine Gerritsen, 1062 Love Court, Boulder, CO 80303.]