COMMENT:GIVING BIRTH OVER 30

The number of women giving birth over the age of 35 is steadily increasing. According to one estimate, by the year 2000, 40 per cent of births in the UK will be to women of 30 or over ( J Langford, New Generation, vol II, no 4, 1992). Another estimat

Women over 35 (or even younger) expecting a first baby are automatically assigned to a “high risk” category. Having a first baby over the age of 40 is often seen as positively reckless. Women over 35 are typically expected to have a greater number of problems during pregnancy, labour and birth: hypertension, pre eclampsia, diabetes, fibrosis, premature labour, placenta praevia (where the placenta is in the lower rather than upper part of the uterus), placenta abruptio (where the placenta prematurely separates from the uterus wall), dystocia (difficult labour), and caesarian section.

A close look at available research, however, suggests that age itself is not a factor. Those studies which take into account the health of the mother show quite clearly that older mothers are not necessarily at any greater risk than younger women.

A study of 1328 births (K L Ales et al, Surgery, Gynecology and Obstetrics, vol 171, as above) concluded that: “Important peripartum maternal complications were no more frequent in women aged 35 or more than in women 20-34 years old, although operative delivery was significantly more common. Similarly adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital abnormalities to be born among older women.”

Researchers who looked at the “obstetric performance” of women over 35 at the West London Hospital from 1980 to 1982 (G M Cario et al, Journal of Obstetrics and Gynaecology, vol 5, no 4, 1985) reported that the older mothers usually had uncomplicated pregnancies. “The perinatal mortality rate for the babies of older mothers (corrected to exclude those weighing under 1000 grams) was no higher than that of younger mothers 7.7 per cent per 1000 compared to 9 per cent per 1000 and 6.4 per cent per 1000 in 1980 and 1982 for all primigravidae in the hospital. There were no congenital abnormalities other than one case of talipes [club foot].

It seems that a woman’s health is far more important than her age per se. It is certainly the case that the older you are, the more health problems you may have built up, the effects of an unhealthy lifestyle over a longer period may have caused damage to health, imbalances in essential minerals and vitamins may have developed and more older women are overweight.

Similarly, although older women may not ovulate as frequently, there is no reason why age alone should be a reason for infertility.

Indeed, the organization Foresight, which offers pre pregnancy counselling for the achievement of optimum parental health, states that it has excellent results with women over the age of 35 and into their early to mid 40s (Foresight, The Old Vicarage, Church Lane, Whitley, Godalming, Surrey, GU8 5FN).

As has already been mentioned, older women are more likely to have “operative deliveries”. In one study women over 35 were six times more likely to have a caesarean section (SM Tuck, Maternal and Child Health, April 1989).

There is, however, strong evidence to suggest that this reflects “obstetricians’ distress”, rather than any inherent problem. Researchers in the study at West London Hospital concluded that the supposed high level of infant distress which led to the intervention was not reflected in the Apgar scores (a method of evaluating a baby’s well being immediately after birth), the rate of emergency caesarean or neonatal morbidity.

The authors suggest that the greater intervention is down to the extra electronic monitoring that these mothers receive. They suggest that “emotional factors” on the part of the obstetrician play a part in aggressive management of labour. “A relative indication for induction or caesarean section becomes an absolute indication when combined with advanced maternal age and a degree of obstetrician’s distress.”

Having led birth groups over the last eight years, it is my observation that mothers over 35 are no more likely to have complications than younger women, and that they cope well with labour. They are, however, often required to be assertive, well informed, and resourceful in order to avoid unnecessary interventions.

Midwives running home birth services and childbirth educators all report positive anecdotal evidence of older women giving birth at home.

There seems to be no reason to be excluded from homebirth due to age alone. The mother’s overall health, emotional state and attitude are equally important factors.

The most critical factor governing the outcome of birth, regardless of age, appears to be good health provided by a good diet, exercise and appropriate antenatal care.

Gail Sforza Brewer writes in The Pregnancy After 30 Workbook (Rodale 1987): “If your health is good, there is no age at which pregnancy should be abandoned due to age alone.”