Birth over 40

For a woman who has more or less worked through the struggles of career, relationship, and autonomy, having a child may be the perfect way to bridge one half of her life to the other.

Birth over 40 pushes the edge of the envelope for many women and their care providers, triggering concern and apprehension. Yet, how much of this anxiety is founded on fact, and how much on diction? And what is the difference between birth over 35--a topic of longtime discussion--and birth over 40?

Age Factors versus Stage Factors

The only absolute concern for women over 40 is an increased risk of birthing a baby with a genetic abnormality. Findings of risk-by-age for Down Syndrome and other trisomies are remarkably consistent. The risk of birthing a baby with Down Syndrome at age 40 is approximately 1 in 106. At 44, the probability is 1 in 38. The risk of birthing a baby with a known aneuploidy of any sort (including such anomalies as XXX or XXY) is 1 in 64 at age 40; by 44, the probability increases to 1 in 24.(1) Environmetal and occupational factors may well figure into the aging process of the eggs and sperm.

Genetic sampling is fairly accurate in screening for these abnormalities. Chorionic villus sampling has the distinct advantage of early detection (at 10 to 12 weeks) and provides results within a day or two of testing, whereas amniocentesis cannot be performed until later (around 16 weeks), and results may take a week or more.

In all other respects, age as an indicator of maternal health has generally fallen by the wayside. Increased cardiovascular fitness, nutritional awareness, proficiency in stress management, and attention to lifestyle have forever changed the notion that women over 40 are old. Mothers of this age may be slightly more at risk for hypertension and gestational diabetes; however, much depends on medical and family history as well as socioeconomic factors, which most studies on advanced maternal age and pregnancy outcomes fail to take into account.(2)

In terms of lifestyle, women over 40 have a unique liability, and that is to stress. Global socioeconomic shifts have induced struggle between the genders, between the haves and have-nots, between a passing political configuration and one yet to emerge. And women bear the brunt of much of this turmoil because women are the mouthpiece for change. We find ourselves working overtime at home, at the office, in the community, and in our intimate relationships.

Researcher Arlie Hochschild notes that women in the United States work about 15 hours more per week than men. On the average, women do 75 percent of the housework, whereas 61 percent of men do little or none. When a woman marries, her unpaid labor output increases about 60 percent; when she births a child, her unpaid workload shoots up 91 percent.(3) Most of us need only look at our desks, files, and closets piled high with nonremunerable projects, or our calendars inked in with PTA meetings, Little League events, women's group discussions, and company parties, to appreciate the extent of our responsibility.

Stress is insidious, especially on the emotions. Coping physically does not spell emotional release. Nor are we able to use our "time of the month," that PMS window, for venting our feelings and speaking the truth without feeling guilty or apologetic, no matter how much we may long to meet our deep needs for realignment.

Pregnancy offers a respite from the stress, a holiday of sorts, as hormones sweep aside everyday tensions and induce physiologic rest. Moreover, pregnancy, as well as birth, is an ideal time for creating new priorities to prevent these stressors (and our habitual reactions to them) from rushing back into our lives.

Women who wait until their 40s to birth a child may have special difficulty in this regard. Accustomed to being in charge and in control of themselves, their work, and their relationships, they may find themselves at odds with the rapid changes characteristic of pregnancy. Letting go to weight gain and a softening of the body, genuine appetites, and sexual fluctuations can be more than a little frightening. Labor can arouse further resistance. Indeed, physical pain in labor is usually preceded by emotional pain--the pain of discovering limits, of surrendering to the unknown, and other tribulations that increase a woman's vulnerability, empathy, and emotional capacity to encourage her young. The older we get and the more set in our ways we become, the harder it can be to unpeel the layers of ourselves and reach to the core.

That is, unless we are verging on a midlife transition. Women in their 40s are more likely than those in their 30s to "have it all," and thus may see parenthood as a treat, a reward, an opportunity to relish in the transformation it inspires. So it is that birthing is influenced less by maternal age factors than by maternal stage factors.

A woman who is still struggling to make her mark in her career, to resolve major issues in relationship with her partner (or her parents), and to establish self-sufficiency and autonomy is apt to find childbearing a source of disruption and upheaval. For a woman who has more or less worked through these struggles and reached a midlife plateau, having a child may be the perfect way to bridge one half of her life to the other. And while facing her own mortality and beginning to reckon her possibilities in the time ahead, what could be better than attempting to revision youth through motherhood?

Although I have not experienced birth over 40, I am a 43-year-old mother of a 7 year old, intrigued by the way his crises dovetail with my own midlife shakedown. I am surprised, too, at how much of my youth I have forgotten. When I had my first child at age 21, I could vividly recall a great deal of emotional content from my own childhood, which helped me empathize with my little one's experience. Now, with my third, I feel a certain detachment. Able to astutely observe distinctions between my process of mothering and my son's growth, I am less victimized by emotional ups and downs, pushes and pulls.

Certainly, as the mother of two college-age children, I have had ample opportunity to see that love works, that a child's basic nature is present from day one and need only be supported and encouraged. The true cause for my new approach to mothering, however, seems related to midlife realities. As a result of two additional decades of life experience, the weathering of my idealism, and the crystallization of my purpose, I have become more individuated and less likely to project my identity onto my offspring.

Challenges and Triumphs

At any age, the act of giving birth is beset with energetic stumbling blocks. The first critical turning point arrives at around 4 centimeters dilation. This is known as the time of "reckoning with the forces," the transition to active labor.

Women who are not adequately supported may exhaust themselves just getting this far. Lack of rest or nourishment may lead to numerous interventions: morphine for sleep, pitocin for "progress," an epidural for pain, more pitocin, more pain relief, forceps, or perhaps a cesarean. Those of us who are well rested and well nourished may experience more pain than we expect. After applying an entire repertoire of techniques, we find that the contractions still hurt! Then, slowly, the realization dawns that birth is bigger than we are, that it cannot be controlled, that the only way out is through, and that nothing short of a leap of faith will carry us onward.

Physiologically, this shift brings stronger contractions. It also brings a release of endorphins, which alters our perception of pain and greatly increases our capacity to cope. Thus, we may be crying and desperate at 4 centimeters dilation, yet on our feet and smiling between contractions at 9.

For a woman comfortable with herself, confident in her body, and seasoned by working on her shortcomings, the vagaries of labor can feel more like revelations than obstacles. Indeed, life experience can prove immensely advantageous to a birthing woman.

Postpartum challenges abound as well. Immediately after birth, particularly a hospital birth, attendants appeal to a mother's rational mind (the underbelly of fear), citing reasons to take her baby off to be checked or tested. A mature woman who is in touch with her urges is equipped to attach deeply to her baby, steering clear of whatever protocol may get in the way of bonding.

Truly, there is no more tempestuous time in a woman's life than the first six weeks postpartum--a period of sheer hard work. For a breastfeeding mother, demands for rest and food exceed any she has thus far experienced. Rest, however, is hard to come by with baby waking every few hours; and food is unappealing in a state of total exhaustion. Whereas most cultures extend social provisions to new mothers and their families, including help with food preparation, housework, personal grooming, and the rudiments of newborn care, ours does not--creating a predicament that intensifies anxiety levels as well as guilt for harboring feelings of frustration, anger, sadness, and loss.

Women over 40 tend to underestimate their need for help in the early postpartum weeks, perhaps unaware that the hormonally induced vulnerability and dependency of this period have nothing to do with immaturity or incompetence. At the same time, women who have compared birth over 40 with birth in their younger years report that the older they get, the longer is their recovery time, and the lower their stamina and capacity to tolerate sleep deprivation. Advance preparation is a must; and older mothers are fortunate to have at their disposal years of well-developed connections and carefully honed discernment to help them orchestrate an effective support team.

Women over 40 also note that their bodies do not spring back into shape after childbirth. Metabolism typically slows during this decade, and weight becomes harder to take off (and keep off). Even so, most pounds can be shed when the fat-burning metabolic activity of breastfeeding is combined with regular exercise, such as long hikes with baby in a front-pack and later a backpack. In addition, although health-giving foods should not be restricted while nursing, empty calories can certainly be avoided.

As baby grows, mother advances from survival considerations to more ordinary--and in some ways, more pressing--concerns. A first-time mother may begin to struggle with the notion of responsibility versus vulnerability. Her desire for a quick rebound to her "normal" life may conflict with an urge for radical departure into the new world of motherhood and a less outwardly focused lifestyle. For a first-time mother in her 40s, these postpartum upheavals may link up with midlife desires for fundamental change, creating a double-whammy effect. A woman in this situation will be at loose ends, unsure of what she is feeling and what to do about it.

I recently spent an afternoon with a 41-year-old friend and her 3-month-old baby. It was summer's end, and my son, about to start first grade, was wading in the lake nearby as Pat and I talked. We both expressed feelings of malaise, fatigue from juggling career and family, and disillusionment with career as an end in itself, as well as a desire for something more. Then Pat suddenly said, "You know, I think we're having a midlife crisis." Such a thought had never occurred to me, perhaps because discussions of midlife crises have focused primarily on men, in hardly a positive way. Yet, her words hit the mark.

The most formidable obstacles encountered by many mothers of infants and young children emerge in the attempt to reenter the work force. Some women respond by changing occupations or starting a business of their own, which can bring welcome relief from the tedium of having to work by the clock and according to another's wishes. Women who birth later in life, however, are already overloaded with responsibilities: the older children demand increasing diligence, college is looming, parents require more and more attention, or become ill and die. And the thought of taking on additional worries about job security pales before the notion of mothering one's own baby--with its promise of freshness, immersion in the renewal of life, the chance to play again.

Then, too, women in their 40s are rapidly approaching menopause--a major life transition. The menopausal passage, with its hormonal shifts and heightened emotional sensitivity, is deemed magical, a communing of soul with the Great Mother. In most world cultures, women who have experienced "the change" are accorded great honors. Native American postmenopausal women, for example, are given a seat in the Council of the Elders and asked to advise their tribe on all major decisions regarding war and peace, growth and change. The transition itself calls women to reevaluate their priorities, release outmoded roles and emotions, and align their essential nature with their purpose so that the years ahead may be healthy and productive.

In many respects, women giving birth as this time draws near have a distinct advantage, a head start in an otherwise challenging process. Their perspective is mature; their wisdom, unique; and their children, decidedly lucky!

WATCHING FOR WHALES

There is no salty breeze here; Binoculars look in the wrong direction. There is no sonorous sound of the sea; No horizon line, That meeting place of which infants First become aware, Artists find essential to their vitality, Political leaders meet their match. That place where one ends, Another begins. Boundaries, membranes, borders, demarcations. Whale watching depends on putting yourself In position. It does not matter what you see. Here there is fresh air, insight, The substantial sound of my own heart, And meeting places; Demarcations between myself and my unborn child The peaceful separateness today Will be alive with struggle tomorrow. I sit, breathing quietly, landlocked. My hands resting as on braille on my bulging belly Waiting for movement, Focusing on meeting places Between me and the child, Like watching for whales.

Notes

(1.) Ernest B. Hook, MD, et al., "Chromosomal Abnormality Rates at Amniocentesis and in Live-Born Infants," JAMA 249, no. 15 (15 April 1983): 2037 [Table 4]. This 1983 study is regarded by the March of Dimes as the most authoritative study to date. Although the research has not been repeated in more recent years, rates of cytogenetic abnormality are thought to be similar today. (2.) Phyllis Mansfield, "Maternal Age: What Is Really High Risk?" Mothering (Fall 1986): 64-70. (3.) Arlie Hochschild, The Second Shift (London, England: Viking, 1989); cited in Sheila Kitzinger, Ourselves As Mothers (Ontario, Canada: Doubleday, 1992), pp. 224-225.

For more information on maternal age factors in pregnancy, see the following articles in past issues of Mothering: "Maternal Age: What Is Real High Risk?" no. 41.

Elizabeth Davis (43), a midwife and midwifery educator for the past 16 years, is the author of Heart and Hands: A Midwife's Guide to Pregnancy and Birth (1987), Energetic Pregnancy (1988), and Women's Intitution (1989), all published by Celestial Arts. She currently chairs the Midwifery Education Accreditation Council and cochairs Midwives' Alliance of North America's Education Committee. Elizabeth lives in Windsor, California, and is the mother of Orion (21), Celeste (19), and John (7).

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