I’m not sure who coined the term “geriatric pregnancy” for any expecting parent over the age of 35, but I think they owe us all an apology. Personally, I won’t consider myself “geriatric” until I am retired, living in a nursing home, and I’ve traded in my everyday mom leggings for some everyday grandma sweatpants.
To give this anonymous person some credit, it is not the birthing parent they are calling geriatric in this situation—it’s their eggs. As tough as it is to admit, the lifespan of an egg is much shorter than that of a human. So while you know that 40 is the new 30 and you may feel like you’re still living your best life, your remaining eggs have pretty much accepted their advanced maternal age status. They’ve essentially already signed up for their AARP memberships and have settled into their favorite chairs to catch up on their TV stories.
In 1960, the median “first birth” age for parents was only 23 years old, according to the Centers for Disease Control and Prevention (CDC). With the majority of birthing parents becoming parents in their early 20s, there wasn’t as much buzz around “geriatric pregnancies” as there is today because in 2019, nearly 60 years later, the median age rose to 30 years old. With more people opting to have children later in life, advanced maternal age is more topical than ever.
What is Advanced Maternal Age?
The American College of Obstetricians and Gynecologists (ACOG) defines advanced maternal age as a birthing parent who is 35 years or older at the time of their estimated delivery. This magic number was determined based on the point at which fertility declines and the risk of fetal genetic abnormalities increases.
Your 20s and early 30s are a comparatively less complicated time to conceive, carry, and deliver a healthy baby; physically, you’re poised and ready. After 35, however, things begin to change, biologically speaking. The closer you come to 40, the more difficult it will be to have a baby (and to recover after the fact, too) or even carry a successful pregnancy to term. Kathy Gunderson of Ashburn, Virginia, delivered her children at ages 35 and 39. She recalls, “I conceived [my first] very easily. In fact, I was a little shocked at how easy it was. Shortly after she was born, I realized I wanted her to have a sibling. However, this time it wasn’t so easy to get pregnant. I began to wonder if I had waited too long and wouldn’t be able to have a second child. That, I think, is the biggest downside to waiting. Time is precious and limited.”
Still, there are more women over 40 joining the first-time mom club than ever before, a shift largely influenced by the success of modern fertility treatments. Celebrity moms can make it look easy to conceive and bear children later in life; however, according to top New York OB-GYN, fertility expert, and high-risk pregnancy specialist Amos Grünebaum, MD, FACOG, “Most famous people you hear about having twins when they’re around 45 or 46 use egg donors. Many people don’t realize it’s close to impossible to conceive naturally at this age.”
While it’s true that fertility markedly decreases every year past 35, if that’s the only thing standing in the way of you becoming a parent, you might be able to work around it. In vitro fertilization (IVF) is pricey but has promising outcomes when both egg and sperm are healthy samples.
However, fertility alone isn’t the only factor to consider; other risks are also associated with advanced maternal age.
Risks of Pregnancy After 35
When someone over 35 conceives, the ensuing pregnancy is a minefield of possible complications. Past 40, chromosomal malformation is much more likely, increasing the odds of Down syndrome. Because of these risks, doctors typically offer genetic counseling to women over 35.
In addition, gestational diabetes, preeclampsia, placental abruption, placenta previa, and premature delivery are more likely with older birthing parents. Throughout their pregnancy, a parent over 35 years old will usually have more testing, ultrasounds, and office visits than someone in their 20s. Dr. Grünebaum counsels over 40 patients to seek an OB with high-risk experience even before attempting to conceive. A knowledgeable doctor will be able to diagnose preexisting health problems that could complicate the pregnancy and then monitor closely throughout the gestational period for changes that could predict premature delivery.
Advanced maternal age patients may also experience extra challenges in the delivery room. Dilation may be slower or inadequate, and multiple births are more common; therefore, C-sections are often necessary for older first-time moms.
And what happens once you’ve recovered from the C-section? Life with a newborn (or two) can be profoundly exhausting. Christine Jarrow mothered twins at age 39. She admits, “I do think my body had a harder time physically bouncing back from the pregnancy,” and advises other later-life parents to “get in the best physical shape you’ve ever been in so you can keep up with the little ones and enjoy every moment.”
And while not a health risk for parents over 35, there is the social aspect to consider, too, particularly for new parents who are 40+ years old. Because a 40-something new parent is outside the statistical norm, having a peer group to rely on is especially important. Certain struggles are unique to older parents, such as being the most senior parent at preschool, having to correct strangers when they assume you’re the grandma, and most painfully, potentially facing the grief of incurable secondary infertility. Having friends to commiserate with can be a powerful lifeline. If you can’t find an existing support group in your area, consider launching one or joining an online community.
The Perks of Motherhood After 35
The risks of advanced maternal age shouldn’t be ignored, but that’s not to say there isn’t any benefit to waiting to enter parenthood until you’re a bit older. Think back to life in your 20s (or even your early 30s); most of us weren’t financially secure, we were still figuring out our careers, and since the prefrontal cortex of the brain doesn’t fully develop until we’re 25 years old, we probably weren’t making the best life decisions, either.
Tricia Goyer, author of Life Interrupted: The Scoop on Being a Young Mom, says that the most challenging part about being a young mother for her (three kids by age 22!) was making time for her marriage. “There were times when we had no money, and we had to get creative about spending time together,” Goyer recalls. “We would get ice cream and a movie and have a date on the living room floor after we put our kids to bed.”
Some may say that having a child very early shapes who you will become. In contrast, by age 40, you have had more time to get to know yourself; you can now apply yourself to parenthood with a mature perspective, perhaps with more self-awareness.
In other cases, maybe you feel like you’re racing against your biological clock. Back in your 20s, you may not have been ready for children; maybe you weren’t in a committed relationship, or you were with a partner who didn’t want to have children, or life just happened, and the next thing you knew—bam! You’re 40 years old, and you realize that you don’t want to miss the opportunity to become a parent. You may decide to have a child with a partner or on your own through natural conception, in vitro fertilization (IVF), or intrauterine insemination (IUI). However conceived, in such cases, parents-to-be have made a decision and a commitment to having a baby. Most likely, they want nothing more than to become parents and have made the conscious decision and physical (and often financial) effort to conceive after age 35.
And let’s not overlook the fact that older parents have the advantage of life experience. Nancy London, MSW, author of Hot Flashes Warm Bottles: First-Time Mothers Over Forty, says, “I don’t agree that older mothers are more peaceful, but simply having weathered a lot, we have a lot of wisdom.” She points out that younger parents are more apt to fall into the trap of imitating their own parents’ patterns, whereas older first-time parents may have a deeper understanding of who they are and what type of parents they want to be. “That is a big, shining plus: If you have done a lot of work on yourself, you have a lot to give as a person.”
As the median maternal age continues to rise, “geriatric pregnancies” (seriously, yuck!) will become more and more topical and common. Thankfully, science has brought incredible fertility treatments to help us work around our poor, tired, dried-up old eggs, and with the right prenatal care, other risk factors can be addressed and managed in a way that makes you feel safe and comfortable. Don’t worry, you’re still in your prime—no matter what your biological clock is trying to tell you.