One for the Decades
When Stacey Fellner became ready to start a family at age 33, she was as worried as she was excited. Initially, she and her husband, Jon, weren't even sure they wanted kids. "But when the time finally felt right, I couldn't seem to conceive," says the Chevy Chase, Maryland, mother of two, now 41. "I was so stressed! I couldn't help but wonder whether motherhood in my 30s was a bad idea."
Though her ob-gyn tested her for abnormalities, everything was fine. "My doctor reassured me that not getting pregnant right away was typical at my age. Hearing those words made me relax instantly." She got pregnant two weeks later -- before all the test results even came back.
Fellner's story is easy to relate to -- what woman hasn't sweated over the right time to have a baby? We've all heard stories about the health risks of delaying pregnancy or wondered if we'd even feel energized enough at 40 to handle pregnancy -- or, on the flip side, settled and mature enough in our 20s. Add in old-fashioned societal pressure, and it's no surprise that we're anxious.
But how much does age matter for your health and your baby's? "It does have an impact, but the differences aren't anything to prevent you from trying to get pregnant whenever it feels right for you," says Richard Schwarz, MD, obstetrical consultant for the March of Dimes and vice chairman for clinical services in the department of obstetrics and gynecology at Maimonides Medical Center, in Brooklyn, New York. "And the problems that could arise can be managed with good prenatal care and counseling."
So what can you realistically expect? We asked experts and moms of all ages to take us on a decade-by-decade tour of pregnancy -- and put your mind at ease!
Starting Early: Your 20s
These peak childbearing years are still the most popular time to have a baby, though the average age is inching up. In 1970, American women typically had their first child at 21 -- today, most of us are just shy of 25 on the big day. And as you've likely heard, the younger you are, the smoother your pregnancy will be. "Because your eggs are young and more likely to be healthy, it's generally easy to conceive now," says Jennifer R. Niebyl, MD, professor and head of the department of obstetrics and gynecology at the University of Iowa Hospitals and Clinic, in Iowa City.
High-quality eggs also translate into a lower risk of birth defects; at 25, the likelihood of having a baby with Down syndrome is about 1 in 1,250. The chances that you'll miscarry are also minimal, since carrying a fetus with Down syndrome or another chromosomal disorder is often the reason women lose a pregnancy, notes Dr. Niebyl.
Like many women who conceive for the first time in their 20s, Cassie Lyons, 24, of Chattanooga, Tennessee, knows she has it pretty easy. Currently in her seventh month of pregnancy, Lyons admits she's felt more tired recently but hasn't had to adjust her life beyond going to bed earlier. "I started a family now because I'd like to have two or three kids by my mid-30s, but I didn't want to cram them in," she says.
Steven Goldstein, MD, a professor of obstetrics and gynecology at New York University Medical Center, adds that women Lyons's age are also more likely to have a smoother time recovering from birth. "The older you are, the harder it is to bounce back," he says.
Age may also affect your delivery experience. According to a recent March of Dimes study, 80 percent of women in their 20s give birth vaginally, compared with 40 percent of women in their 30s and 43 percent in their 40s. "Vaginal deliveries are more common in younger women because their bodies have more muscle tone in the uterus and abs. This makes pushing easier," says Dr. Schwarz.
In fact, the only con Dr. Goldstein cites for twentysomething moms is that "societal norms have outpaced evolutionary ones. Younger bodies are better able to handle the physical demands of pregnancy, but you may not feel financially or psychologically prepared to be a parent at that stage," he says.
The Middle Years: Your 30s
If you opted to put off pregnancy until your 30s, you're in good company: According to the National Center for Health Statistics, the birth rates for women ages 35 to 39 doubled between 1978 and 2000.
Ella Moore, 32, of Austin, Texas, planned her first pregnancy in her 30s because she wanted to establish her career first. Though her husband was ready to start a family earlier, Moore had a job that she enjoyed, which required long hours and frequent travel. "Holding off to have a baby enabled me to move ahead professionally."
In fact, there's not much to fret about when you're expecting in your early 30s. "It's much like being pregnant in your 20s -- your health, energy, and fertility are still all at optimal levels," says Dr. Schwarz. Plus, the quality of your eggs is still very good, making the risks of genetic defects low.
Mollie McQuarrie, of Brooklyn, New York, waited until she was 34 to conceive so she could complete graduate school first. "It did take a while to get pregnant -- a little over a year -- and I had a miscarriage," she says. Unfortunately, the risk of losing a pregnancy is higher now: By ages 35 to 39, the odds hover at about 20 percent due to declining egg quality. However, McQuarrie was successful the second time and is now in her seventh month. "I'm happy having a child now," she says. "I'm more confident in who I am, so I have more to offer as a parent."
The progression of your 30s can also bring other changes. "Once you turn 35, your pregnancy will be monitored more closely," says Dr. Schwarz. One reason for that: The risk of birth defects rises at 35 -- the odds your baby will have Down syndrome is now 1 in 400 -- so expect your doctor to offer you an amniocentesis and/or other screening tests to check for it and other chromosomal abnormalities. One option is chorionic villus sampling (CVS), in which a catheter is inserted into the placenta to suction out a tissue sample; if everything is clear, you can skip having an amnio.
"Some women may also be offered a nuchal fold translucency, but the procedure is still being studied," notes Dr. Goldstein. This less-invasive test measures the back of the fetus's neck during an ultrasound scan; a thick nuchal fold can indicate an increased risk of chromosomal problems. It's less accurate than CVS, so a positive result will need to be confirmed by an amnio. Still, none of this is a cue to go into panic mode: About 95 percent of women who undergo prenatal testing receive good news. Even the cutoff number of 35 is arbitrary. "Your genetic risks are naturally increasing as you age," says Dr. Schwarz. "Thirty-five is simply the age experts agree that these tests should be offered."
The Mature Mom: Your 40s
The experts won't lie: Having a baby now can be exhausting. "I make the analogy to my patients that there's a reason why football players don't compete after age 40 -- you don't have a physical advantage and energy reserve anymore!" jokes Dr. Niebyl. Jessica Kasten, who had her first child at 41, can relate: "I was so tired that I regretted choosing an ob-gyn who was 25 minutes away from me."
Chris Roll, who had twin girls when she was in her late 40s, recalls wanting to shut her eyes at precisely 3:00 every afternoon at work when she was pregnant. "I needed three extra hours of sleep at night, and if I could have taken that nap, I would have!" she admits. Still, Roll was so happy that she didn't care very much -- she had been trying to get pregnant for several years, a fairly common occurrence for a woman in her 40s, when conception is most difficult.
But even if being pregnant feels more taxing as we age, "we're a lot healthier at 40 than we were even a generation ago, so it may not be as difficult as you expect," notes Dr. Goldstein. On the plus side, you're less likely to experience morning sickness when you're older. "The placenta is smaller and producing fewer hormones, including HCG (human chorionic gonadotropin), the one that causes nausea," explains Dr. Niebyl.
What does become a bigger concern, however, is the risk of birth defects. "The older your eggs are, the more likely it is that an embryo's chromosomes will be improperly sorted," explains Dr. Schwarz. For example, individuals with Down syndrome generally have an extra chromosome, 47 instead of the normal 46. At 40, the chances a fetus will have Down syndrome is 1 in 100. This risk of chromosomal imbalance also partly explains why the risk of miscarriage stands at more than 50 percent by age 42. Due to these higher risks, you may be urged to get extra testing at this stage.
You can also expect your doctor to be highly vigilant about checking for chronic health problems. First-time moms over 40 are 60 percent more likely to develop high blood pressure and four times more likely to develop diabetes during pregnancy than mothers in their 20s, according to a study from the University of California at Davis.
The same study also revealed that fortysomething first-time moms are up to eight times as likely as women in their 20s to suffer placenta previa, a condition in which the placenta is implanted low in the uterus -- sometimes over the cervix -- impeding delivery.
"This condition can cause complications but can often be prevented with a cesarean," says Dr. Schwarz. C-sections are also more common in older moms, since they may suffer from other health problems such as fibroids, which can complicate delivery, adds Dr. Goldstein.
Kasten knew about all these concerns and though she worried, she also appreciates the advantages of raising daughter Lianna now. "I have more financial resources, so I can take a six-month maternity leave," she says. "And because many of my friends also waited to have kids, I have a better support network now than I would've had in my 20s!"
Jessica Brown is a writer who lives in Brooklyn, New York.
Originally published in the January 2005 issue of American Baby magazine.