In Your 40s
In Your 40s: Older, Yes, but Also Much Wiser
There's no getting around it: From a medical standpoint, this is the toughest decade for pregnancy. By now, you've run through your highest-quality eggs, making conception slower than ever. "You're left with those eggs that have not only taken the longest to respond to the body's cues for release, but they also don't function well during fertilization," says Dr. Berry. This further raises the risk of chromosomal abnormalities and miscarriage. Meanwhile, your menstrual cycle may grow increasingly irregular well before menopause, which also compromises fertility. (And otherwise health-conscious women in this age group may be slow to seek out prenatal care -- they often assume the skipped period that signals pregnancy is the first sign of menopause. "When my doctor gave me the news, he said, 'You're going through a change, but not the change you think,'" recalls Bennett.)
Interestingly, while it's now hardest to get pregnant, this is also when you're most likely to carry multiples -- itself a high-risk pregnancy -- even without medical intervention. "It may be that shifting hormone levels during menopause stimulate the release of more than one egg at ovulation -- like a natural fertility drug," says Dr. Berry.
Standard blood work (the alpha-fetoprotein or AFP, also known as triple or quad screening) that estimates the risk of chromosomal defects such as Down syndrome is usually considered a waste of time and money, says Dr. Swamy. Screening will invariably reveal risk, which now accelerates more rapidly, from about 1 in 86 at age 40 to 1 in 21 at age 45. Women at 40-plus who opt for testing usually go straight to the definitive tests -- amnio or chorionic villus sampling (CVS), which involves removing a bit of tissue from the placenta and carries about a 1 percent risk of miscarriage. (CVS is also available for younger women, but many decide against it because, for them, the procedure's miscarriage risk still outweighs the Down's risk.)
Pregnancy may exacerbate chronic conditions as well as early signs of aging, such as stiff, sore joints; varicose veins may also get worse. "It's all magnified with pregnancy," says Dr. Sang. A slower metabolism may have profound effects, too: "I ate the same but gained twice as much weight with my son as I had with my earlier pregnancies, and the greater load sapped a lot more of my energy," says Bennett. Despite this, she headed up a major arts festival until the day she went into labor.
Doctors may be quick to tick off the physical downsides of later pregnancy, but a list of other pluses balances the scales. You have greater financial stability, for starters, which may enable you to focus more on motherhood. Life experience may have made you more patient and flexible. "First-time motherhood can seriously rattle long-established routines, but a woman in her 40s knows more about life's ups and downs and can better take shake-ups in stride," says Sanford.
And you've likely proved yourself professionally -- you may now be more content to stay home, or more confident about melding motherhood and a career. "You're more savvy, and not as afraid to step up to the plate and negotiate your terms for employment," says Ford-Martin. "Older mothers will ask for family-friendly workplace arrangements like telecommuting, flextime, and job sharing."
That self-confidence may also carry itself into the doctor's office, where you're more inclined to speak up about your preferences regarding labor and delivery. "Women who are a bit older tend to be more active in their pregnancy and overall healthcare," says Dr. Swamy. "They may ask their ob-gyn more questions about things we consider to be standard practice, such as prenatal labs, diabetes testing, and ultrasounds."
Finally, says Bennett, she's learned coping strategies over the years that have served her well in her second round as a mom of a newborn -- including an afternoon teatime and taking one day a week when she leaves the baby with other family members. "One day I saw three movies in a row," she says. "Now I know that it's important to indulge myself, and I think it makes me a better mother."
Rachelle Vander Schaaf is a writer in Macungie, Pennsylvania, and a mother of two.
Originally published in American Baby magazine, February 2004.
All content here, including advice from doctors and other health professionals, should be considered opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.