Playing the waiting game.

Byline: Scott Maben The Register-Guard

In the movies, anything is possible. And more celebrities are taking a page from that script, having babies well into their 40s.

But the trend isn't as surprising as the star power might make it seem: The demographic bubble of older women having kids is as true in Oregon as it is in Hollywood - reflecting a pattern in the general population that began building steadily in the mid-1980s.

And that bubble is still growing by all kinds of measures: The birth rate for women 35 and older rose 16 percent between 1997 and 2002. The birth rate for women 34 and younger declined by 13 percent in the same period.

"People are waiting later and later and later to reproduce," said Dr. Douglas Austin, a Eugene infertility specialist.

Just look at Oscar winners Geena Davis, 47, and Marcia Gay Harden, 44, who each had twin boys this spring. Other famous new moms include Helen Hunt and Courteney Cox Arquette, both 40, and Debra Messing, 35. Actress Julia Roberts, 36, is pregnant with twins.

"Many women are now working, establishing their careers, getting their own professional identities going," Austin said. "Once they do that, they turn inward and ask, `What else do I want to do with myself?' '

Waiting is easier than ever now, thanks to advances in contraception and medical care for older mothers and their babies. And if eventually couples have trouble conceiving, they can turn to an array of fertility measures, from ovulation induction to intrauterine insemination to reproductive surgery.

Fertility treatments may be the biggest single factor in the surge of advanced-age pregnancies, said Dr. Richard Depp, professor of obstetrics and gynecology at Drexel University in Philadelphia and executive vice president of the Society for Maternal Fetal Medicine in Washington, D.C.

"Fertility treatment used to be primarily for those who could afford to pay," but more insurers are covering the costs, said Depp, who became a father himself at 53.

But news of celebrity births also may give false hope to some.

"Unfortunately, I see people who are 49 years old who say, 'I've just met somebody, I want to have a baby now,' ' Austin said. "Sometimes I'm dumbstruck. One of the problems is stars are having children later in life, and they often are doing it because they have donor eggs."

Women in their 20s, the principal childbearing ages, historically account for the largest share of births. But the proportion of births by these women has dropped dramatically: from two-thirds of all births in 1980 to about half in 2002, according to a just-updated report from the National Center for Health Statistics.

Women in their 30s and 40s, meanwhile, are spawning their own little baby boom. The birth rate for women in their 30s grew by 62 percent from 1980 to 2002. The rate for women in their 40s more than doubled in that time.

Birth to Three, the Eugene organization that offers new parents a range of help, generally saw younger mothers in its programs when it began 25 years ago this summer. It still sees parents in their teens and 20s, said Juvata Rusch, who manages the First Three Years program.

"But in our general groups, they range from the early 20s into early 40s, and occasionally older than that," Rusch said.

More effective birth control is a key reason for delayed childbearing, she said.

"People are choosing to have babies at a certain point rather than coming together as a couple and babies follow," she said.

Risk factor

Planning and basic care can reduce the higher health risks associated with pregnancies after 35, Depp said.

Women thinking of having children then should first consult a doctor about potential risks and focus on a good diet, he said. They can work with their doctor to reduce the likelihood of developing diabetes, hypertension or other problems during their pregnancy.

"Once we rule those things out, we're dealing with a group of women who, even though they're older, can expect to do reasonably well," Depp said.

The exception may be for twins and other multiple-gestation cases, which usually result in shorter pregnancies and Caesarean section deliveries. "You can end up with a cascade of potential problems," Depp said.

And just as fertility-enhancing therapies have contributed to increasing birth rates for women 35 and older, those strategies also result in a higher incidence of twins, triplets and so on.

In 2002, one of 18 births to women 40 to 44 and two of every nine births to women 45 to 54 was a multiple delivery, an outcome associated with infertility treatment, federal statistics show.

Depp said older moms generally have done their homework on the health risks and what they need to do.

"My experience is these women come in and are quite prepared," he said. `Many have been trying to get pregnant for many years."

Sue Subbot's background as a special education teacher in Eugene gave her insights into the increased risk of having babies with congenital conditions such as Down syndrome and spina bifida.

"So I went into this knowing a lot of the risks," said Subbot, who had daughters when she was 36 and 40. "And we did genetic counseling and we did all the tests for high-risk infants. We knew what the possibilities were."

She had an amniocentesis, the extraction of amniotic fluid in the uterus when she was pregnant, to test for the presence of genetic defects. The procedure is common among pregnant women in their late 30s or 40s.

Although the results present some couples with difficult choices, Subbot and her husband, Bob Bury, whose children were born healthy, regarded the test as a way to prepare.

"We said we were going to greet this baby whoever she is and whatever she presents," Subbot said. "She's going to be a part of our family. It wasn't a dread."

How much time?

Although menopause in American women occurs on average at age 51 1/2 , women generally begin to rapidly lose fertility about 10 years before they hit menopause, Austin said. Similarly, the success of in vitro fertilization, or having a "test tube" baby, starts to fall after age 35.

"At 41, the success rates are down in the teens," Austin said.

For women wondering how much longer they can get pregnant, blood tests for certain hormone levels can give them a rough estimate of their egg reserve - the quality and quantity of eggs left in their ovaries.

He said many professional women contemplating having children down the road but worrying about declining fertility ask if they can have some of their eggs removed and preserved. While a man's sperm easily can be frozen, a woman's eggs are damaged severely in the process, he said.

"I think there is an impression that if we use technology, there are no limits to fertility," Austin said. "We have a strong belief that science and medicine can solve all problems."

BABIES BY THE NUMBERS

On average, women are waiting four years longer to have their first child than they did in 1970. Among the factors are changes in contraception use, economic cycles, social support and marriage patterns. For instance, from 1970 to 2000, the number of women completing college has nearly doubled and the number in the labor force has gone up by almost 40 percent.

The U.S. birth rate for women 35 to 39 rose by 31 percent between 1990 and 2002. Also for this age group, the total number of births increased 43 percent even though the number of women in this category grew by just 9 percent.

The birth rate for women 40 to 44 rose 51 percent between 1990 and 2002, and the number of births nearly doubled to 95,800.

The number of births to women 45 to 49 has more than quadrupled since 1984. The current number - 5,224 - is the highest reported since 1945, the end of World War II.

At Sacred Heart Medical Center in Eugene, 865 women ages 30 to 39 gave birth in 2003, up from 718 in 2002. They accounted for a third of all babies born at the hospital last year. There were 61 babies born to women 40 and older at Sacred Heart in 2003, up from 58 in 2002.

- National Center for Health Statistics, Sacred Heart Medical Center