In developed countries, many women over the age of 35 are having babies – often for the first time. Delaying first pregnancies has almost become the norm – in the past 4 decades, 46 states in the US have experienced a rise in the first-birth rate for women over 35, according to a CDC report. In the UK, between 2007 and 2012, the number of babies born to mothers over 50 doubled.
And in many developed countries, such as Italy and Japan, there has also at the same time been an overall decline in the birth rate.
In South Africa, the main focus of problem pregnancies is on teenage pregnancies and HIV-positive mothers, as SA has the highest burden of childhood HIV infection globally, according to a report in the SAMJ in 2014.
Delay in starting families
Many more women in developed countries are now delaying starting families and settling down, first getting tertiary education and then establishing themselves in careers. The ticking of the biological clock seems to have quietened down for many women.
Some critics question whether it is fair to a baby when the parents are so much older. Also, raising a child is a hard physical job – a 50-something mother might struggle.
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“But in my experience when women choose to have a baby at 50, money is usually not a problem, and they can afford to call in help with childcare,” says Ciska van Straten, nursing sister and registered midwife from Cape Town.
Fertility peaks in most women in their 20s and after the age of 35, fertility starts to decline rapidly, says the SA Medfem Fertility Clinic. They go on to say that in any given month after the age of 40, your chances of getting pregnant are 5 percent – down from 25 percent between the ages of 20 and 25.
Women over the age of 45 have less than a 1 percent chance of falling pregnant with their own eggs, and many women in this age bracket seek to use donor eggs instead. A woman’s eggs diminish in both quality and quantity with age, and many older women make use of donor eggs.
The risks of a late pregnancy
Pregnancies later in life are not without their risks, warns the UK Royal College of Obstetricians and Gynaecologists, and mothers over the age of 40 are three times more likely to lose their babies, experience complications during pregnancy or risk abnormalities such as Down Syndrome in their babies.
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But, older women also often have the means to get access to excellent medical care, and while their risks might be two or three times higher for certain pregnancy complications, that might mean that a two percent chance of experiencing complications becomes a four percent chance.
But when it gets to miscarriage and high blood pressure, the statistics are alarming: Only eight percent of pregnant women under the age of 30 are likely to have a miscarriage, whereas in the 44–46 age bracket that jumps to 60 percent according to statistics released by the Centres for Disease Control, published in 2012. Three percent of younger women experience high blood pressure during pregnancy, whereas it is a complication for 35 percent of women over 50.
It also depends on the individual woman’s state of health (whether she is a smoker, obese, chronic sufferer or drinks heavily) one person at 50 might be in a better state of health than someone else at 30.
“Each case is different,” says Van Straten. “If a woman knows the risks, has good access to healthcare, and is in good health, there are no real reasons why she can’t have a baby at this age.”
The National Institutes of Health list the following birthing complications as risks for women having a first baby after the age of 35:
• The necessity of having a Caesarean section
• Delivery complications, including excessive bleeding during labour
• Labour lasting more than 20 hours
• Labour that does not advance
• An infant with a genetic disorder
Other risks associated with a pregnancy late in life are:
• Gestational diabetes
• High blood pressure
• A baby of low birthweight/ a premature birth
• Multiple births (due in part to the use of fertility treatments)
As long as a woman is aware of the risks and has access to good medical care, there is no reason why someone over the age of 50 should not get pregnant, says Dr Richard J Paulson, from the University of Southern California Keck School of Medicine.
“But," says Van Straten, “If anything does go wrong, such as the sudden development of high blood pressure, a woman at age 50 is simply at greater risk than someone of 25.”
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