While the idea that a woman has a “prime” — as CNN anchor Don Lemon ludicrously suggested recently— is patently absurd, ageist and sexist, the biological deck is nevertheless undeniably stacked differently. Women are now considered to be of advanced maternal age once they turn 35. Men have had a long time to decide when and how to have children. The window for conceiving and delivering children has gotten wider in recent years thanks to advances in fertility treatment. Celebrities Hilary Swank and Da Brat, both 48 years old, have shared their first pregnancies with the media in the last few weeks. Montefiore Medical Center published a campaign last year featuring a brain tumour survivor who gave birth to her youngest child at the tender age of 57.
But the reality of pregnancy and birth after the age of 40, 45 and even 50 — especially in the post Dobbs decision era — is complicated.
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The good news is first. The birth rate of women younger than 30 years old has fallen in the US, but it is still rising. According to the Census, there has been a 132% rise in births among women over 40 years old since 1990. It is clear that there are safe and healthy pregnancies at ages previously considered very risky. Evidence suggests that having children older than 40 can decrease cognitive decline and increase the life span of mothers. Children may also be healthier and more educated.
“Some women believe that because they are 47 years old, they can have children with their own eggs. This is not true.
Concerns about fetal abnormalities — often a concern among those who have children at an older age — also need to be thought about in context. This is because many women who get pregnant later in life might not be using the same eggs as they are.
“When we see people in the media, celebrities, they’re not going to announce, ‘I used an egg donor,’ because that’s private,” says Dr. Cynthia M. Murdock, a fertility specialist at Illume Fertility. But it can lead to some women believing that because they are 46 and 47, they are healthy, they can have children with their own eggs. This is not true. You don’t run the risk of Down syndrome and other chromosomal disorders if you use a donor egg. The eggs’ age is more important than the woman who is at risk for Down syndrome.
It is still difficult to get pregnant when you are perimenopausal. As you get older, your estrogen levels decrease and your chances of getting pregnant naturally diminish. Parents notes that “At 45… likelihood of getting pregnant is no more than 3% or 4%.” Donor eggs can dramatically increase the chances of conception and can even reach 60%. But, successful conception may require multiple attempts.
The fees associated with donor eggs, insemination, and other procedures can quickly add up. Many will need to pay some of these costs out of pocket. Resolve, an infertility foundation, reports that only 20 states have passed fertility insurance coverage laws and only 14 of those cover IVF. It is possible to incur staggering out-of-network expenses, along with lost wages and time for travel and appointments.
“Over 40, or actually over 35, most risks go down.”
Even under the best of circumstances the health risks to pregnant people are going to be different over time. This is due to the fact that health generally changes after a certain ages. Pre-eclampsia and gestational hypertension rates are “significantly” higher for pregnant people over 40. “The risks of gestational diabetes go up with age, and really, it doesn’t matter if you are over 40 or 35,” Dr. David N. Hackney, an associate Professor in the Department of Reproductive Biology at Case Western Reserve, says. The risk of stillbirth rises. The chance of having a C section goes up.”
He said, “We tend not to accumulate diseases as we age.” We are more likely to get diabetes, have higher blood pressure, and gain weight. It’s been difficult to distinguish between what is true and what is due to differences in aging and what is due to diseases we have acquired over time. Despite this, it appears that there is a core increase in risk due to age, particularly after 40-45 years. Stillbirth risk is the most worrying and clearest in the data.
The risks of stillbirth — as well as other forms of loss — are concerning on many levels. There are obvious emotional pain and suffering. Then there’s the often confusing and draconian enforcement that restricts abortion, which puts lives at risk for those who are pregnant with complications. Miscarriage occurs in between 10-20% of pregnancies. Even though people who use donor eggs are more likely to carry a pregnancy to term than those who do not, a 2019 study by The BMJ revealed that miscarriage rates among women over 45 can reach 53%.
“Spontaneous miscarriage is very common, especially among older women.”
Supportive, skilled medical management is required to manage a pregnancy loss or decide what to do with a non-viable fetus. Patients often require a D&C [dilation and curettage] Procedure or prescription medication to expel the contents of your uterus. NPR’s Sarah Prager said last year that abortion treatment and miscarriage treatment are identical.
“In roughly half the country now, abortion is essentially banned,” says gynecologic surgeon Dr. Julia Arnold VanRooyen. “Most of these states have language that protects the life of the mother. It is impossible to list all possible outcomes that could occur during pregnancy, which could put the mother’s life at risk. They can’t all be listed in bulletpoints. The doctors at the emergency department and the OB/GYNs who take care of these patients don’t know what might happen if they intervene.
She adds, “Spontaneous abortion happens very, very often in older women.” Half of the country has banned abortion. [the patients] If they are bleeding or are infected, the doctors will scramble to help them. Is it possible? Is it necessary to consult a hospital lawyer? Even if all of these things are in place, this still leads to delays in their care that would never have happened. So these women are getting sicker, they’re bleeding more, they’re getting more infected before they can get a simple D&C that’s going to save their life, even though there’s no chance that the pregnancy can continue.”
Every pregnant woman in America faces the issue of abortion restrictions. However, it is a particularly difficult problem for those over 45 who are facing a pregnancy.
It’s easy to believe that this is a common and simple occurrence, especially when we see celebrities at a certain stage of life proudly showing off baby bumps. Even with the incredible advances that have been made, it is still difficult to get pregnant or expand your family. This doesn’t mean everyone can’t achieve their dreams. Dr. Murdock says, “We have many healthy women.” We encourage and support you in every way you can build your family.
This dream is almost impossible for older women without intervention. If you are fortunate enough to have a baby, you need to take into account health and the punitive, ignorant laws regarding reproductive rights that can make any complications serious or even life-threatening.
Dr. Arnold VanRooyen states, “It’s hard to imagine taking on all that risk and expense in order to have a child. And doing it in a southerly state.” This would be a major flaw in your plan. Women with the financial means to travel anywhere can choose to live in New York, Massachusetts or another state that offers good abortion care. It’s a part healthcare and you may need it.
Every pregnant woman or potential pregnant woman in America faces abortion restrictions. But they are particularly difficult for women over 45. Anyone in that situation, regardless of their best care or doctors, should be aware and prepared to discuss the worst possible outcomes.
Dr. Hackney says, “If you are considering conceiving,” he advises. Talk to your OB/GYN. They are often different from the fertility specialist. I would ask them about the state laws and then ask them what they would do if there was a miscarriage. What would you do if your child was born with a fatal or serious birth defect? What if my bag breaks at 18 weeks of age? What would you do? For lack of a better term, would you trust that person?” Are they going to be brave?
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Concerning abortion rights and pregnancy
