The age at which women have their first child continues to increase. In fact, according to the CDC, the first birth rate for women ages 40 to 44 has doubled since 1990, and the rate for women ages 35 to 39 has increased sixfold since the 1970s!
Having a first child at an older age is a different experience medically, as well as emotionally and psychologically. As a doctor in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center, I've worked with many moms who are considered older (or of advanced maternal age). I've noticed five key themes that continually pop up:
1. “I am not only my age.”
Moms over 35 have told me that when they see their doctors for appointments, the majority of the time the focus is on risk factors and potential hazards of pregnancy at an older age. One patient wistfully said, “I just wish my doctor was excited about the pregnancy for me and focused on all the good things, too, instead of just the bad.”
It is important to advocate for yourself in this situation (as well as for clinicians taking care of these moms to be aware of this!). Say, “I understand those risks. Right now, things are going well and I feel grateful and excited and would like you to support me.” Being open and honest with your doctor about how you are feeling is crucial for a healthy doctor-patient relationship.
2. “I planned to have a baby later in life because I wanted my life to be organized. So the uncertainty of pregnancy and childbirth is anxiety-provoking!”
Women who have children at an older age have postponed childbirth for various reasons. One common reason is wanting to feel settled in the workplace and having advanced to a position where taking time off for child-rearing feels appropriate. Another is feeling settled in a partnership, having taken the time to get to know one’s partner and grow closer. Many of my patients describe themselves as women who are planners and worriers. As a result, their baby was planned, as were all the circumstances around the pregnancy, labor, and beyond.
If you are a planner and organizer and have many expectations, any deviation from those plans can cause anxiety and distress. A medically complicated pregnancy, like an early delivery or having a miscarriage, can feel devastating not just because of the circumstances themselves but because of a loss of hopes and plans. Reaching out to a counselor or support group can help provide a comfortable environment in which to voice those uncertainties and losses in order to move forward.
3. “I planned this baby, but I didn’t plan on feeling anxious or depressed.”
Pregnancy-related anxiety and depression are common, affecting as many as 10 to 15 percent of women. Risk factors include a family or personal history of depression or anxiety, unstable circumstances at home, and lack of social support. While having a baby later can be very well-planned and desired, this does not completely eliminate risk. As a result, all women should be familiar with symptoms of perinatal depression and anxiety.
Untreated illness can have consequences not only for the outcome of the pregnancy but also for the postpartum period and attachment and bonding with the baby—not to mention the loss of the ability to enjoy pregnancy and motherhood. Treatment varies and might include medications safe for pregnancy, psychotherapy, and various forms of self-care such as massage, acupuncture, and exercise.
4. “I didn’t even think I could get pregnant! I’m in shock.”
Women over age 35 repeatedly hear the message that their fertility is declining. Those over 40 often hear that the chance of conceiving is highly unlikely. So women in this age group are less likely to use contraception and consequently, unplanned pregnancies can occur.
An unplanned pregnancy—different from an unwanted pregnancy—can still be challenging. A woman whose pregnancy is a surprise likely did not have the opportunity to take vitamins early on or have an early OB appointment. It can mean a sudden rush to make lifestyle changes, employment adjustments, or adjustments to finances. This sudden stress can take a toll.
If you are in this situation, I encourage you to take some time to focus on your emotional health (like a relaxation or mindfulness app or class) and reach out to your support systems to ask for help. I know this isn’t easy to do, but it's often very necessary.
5. “I feel like I don’t fit in with the other moms.”
Many older moms have described to me the feeling of not belonging—whether it's in the pregnancy yoga class, the postpartum lactation group, or on the preschool playground. They note that it's difficult to relate to the new mom who might be in her late 20s or to the older mom who already has several children. It can be hard to hear comments like, “Aren’t you concerned that you’re changing diapers when everyone else’s kids are leaving for college?”
When in this position, it’s important to reframe the situation. It's valuable to think about your reasons for making the choice to have the baby at this time in your life. It may be as simple as this was the right time for you! Your decision was based on many factors that naysayers do not understand and you should not feel obligated to explain to them. Instead, take comfort in knowing this was the right decision for you and your family. As there is a rise in the number of women choosing to have babies later, finding the right support group becomes easier, and sometimes online is the best place.
My hope is that all moms over age 35 understand that focusing on emotional well-being can help make your pregnancy, regardless of your age, more enjoyable and rewarding.