The number of women aged over 35, who are giving birth for the first time, is increasing in many high-income countries.
In the US this figure is around 15%; in Australia and the UK just over 20%.
A century ago, when the average life expectancy for a woman was around 50, a woman would be having her first baby in her late teens and would be considered elderly by 35.
Today’s improved living standards and modern health care mean women are happy to start their families later in life.
A woman giving birth over the age of 35 is automatically classed as high risk, regardless of her actual health status or that of her baby.
Is age a problem when it comes to birth, or is people’s attitude to age the real problem?
What Is Advanced Maternal Age?
The medical profession tends to use the term ‘advanced maternal age’ when referring to women giving birth at 35 years or older.
Women in this age group who are giving birth for the first time are called ‘elderly primipara/primigravida’. Women over 35 having a subsequent baby are referred to as ‘elderly multigravida’.
These terms can be negative connotations for many women. For the purposes of this article we will refer to ‘women over 35’.
The main concerns about birth after 35 relate mainly to preexisting health conditions women might have before becoming pregnant. There is also a greater risk of developing certain health disorders during a first pregnancy.
Can I Get Pregnant After 35?
The biggest issue faced by many women over 35 is getting pregnant. Fertility begins to decline at this life stage, and it can take some time to fall pregnant. For around 80% of women aged 35-39 it can take up to 12 months to conceive.
As women age, they begin to have occasional cycles without ovulation. If no egg is released, pregnancy can’t happen. There are fewer eggs available, and egg quality declines.
There is also an increased chance of ectopic pregnancy, where the fertilised egg implants somewhere other than the uterus, usually in the fallopian tube.
Pregnancy Risks For Women Over 35
Research has shown women over 35 are more prone to complications during pregnancy, but this is likely to be as a result of preexisting health conditions.
The older we are, the more likely we are to have underlying health problems. This, rather than age itself, increases the risks of pregnancy.
Health problems women over 35 might face:
- Gestational diabetes: abnormally raised blood sugar levels
- High blood pressure and preeclampsia: if left untreated, these conditions can cause growth problems for the baby, and serious complications for the mother.
- Placental problems: a greater risk of bleeding during pregnancy, due to lower implantation in the uterus. The placenta might also implant over, or close to, the cervix (placenta previa).
These health complications can increase the risk of premature birth, induction of labour, interventions, and c-section.
Other complications that can arise during pregnancy include:
- Genetic risks: these are more common in pregnancies of women over 35, particularly Down syndrome. The rate of becoming pregnant with a baby with Down syndrome increases with maternal age.
- Miscarriage: women who are aged between 35 and 45 have around 20-35% chance of miscarriage. This is often more related to egg quality than the ability to stay pregnant.
- Stillbirth: the risk of stillbirth (baby dying just before or during labour) is higher in women over 35 than in younger women. The reason for this increased risk of stillbirth is unknown.
Risks Of Giving Birth Over 35
If there are no medical complications during pregnancy, older women shouldn’t face any greater risks during birth than younger women do.
However, many older women tend to have more interventions during labour than their younger counterparts.
A study of almost 170,000 women in Norway found a link between older mothers and an increased risk of c-section. There was a higher incidence of epidural use in older women who had c-sections.
Interventions are any procedures that interfere with the natural process of birth and include:
- Induction (starting labour artificially)
- Augmentation (using medication to make contractions stronger)
- Epidurals (pain anaesthesia)
- Assisted birth (use of forceps or ventouse)
- Continuous fetal monitoring
- C-section
Again, intervention usually occurs as a result of complications that arise during pregnancy. Women over 35 also tend to choose private obstetric care, which has a higher incidence of intervention.
What Are My Options?
If you are a woman aged 35 years or more, and you are thinking about becoming pregnant, it would be wise to discuss this with your care provider as early as possible. A healthy diet, exercise, not smoking, and not gaining excess weight will help prepare you for a healthy pregnancy.
Check out BellyBelly’s preconception checklist.
Being aware of your risk factors, and addressing any health issues before they become problems, can smooth the way to a healthy and trouble free pregnancy. The fewer complications you have during pregnancy, the more likely you will achieve a natural birth.
If you are healthy and have no problems, your pregnancy care should be no different from that of a woman who is under 35. If it is your first baby, there has been a large gap between pregnancies, or if you are older than 40, you might be offered extra prenatal checks and tests.
Find out more about the different tests and procedures you might be offered during pregnancy.
Pregnancy and giving birth can be just as safe for a healthy woman over 35 as they are for a younger woman. How the experience of pregnancy and birth unfolds for women in this age group can depend on a number of factors – particularly maternal health, and care providers’ attitudes.
While it’s not possible to predict whether you will have a completely complication-free pregnancy and birth, you can improve your chances by making sure you engage in good quality prenatal care, and choosing a care provider who supports natural birth.
Recommended Reading: The Cascade Of Intervention – What You Need To Know.
