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This Q&A reviews the scientific and medical debates about later motherhood, seeking a balance between understanding the biological barriers to having babies in later life, and the lived reality – that many women do have healthy pregnancies in their late thirties. The Office for National Statistics (ONS) reports that in 2012, nearly half (49%) of all live births were to mothers aged 30 and over, and that nearly two-thirds (65%) of fathers were aged 30 and over.
Some of the social and cultural trends that affect the timing of motherhood are worthy of debate (see Question 6, below).
This tends to simplify and distort the science around fertility, and panic many women when their chances of having a baby at the time that is right for them are high.
The idea that delayed motherhood poses a problem, for women, babies and for the health service, has become widely aired in recent years. The Royal College of Midwives has recently suggested older mothers are placing an increased strain on midwives, who are already conducting close to 130,000 deliveries a year for which they do not have sufficient resources. In September 2013, Professor Mary Herbert, a specialist in reproductive biology, told the British Science Festival in Newcastle, ‘What we can say for sure is that reproductive technologies do not do much to buy time. The fertility statistics show that increasing proportions of women are having children in their late 30s.
The widely citied statistic that only 66% of women aged 35 to 39 will be pregnant after a year of trying if based on a 2004 article in the journal Human Reproduction, which in turn is based on an analysis of French birth records from 1670 to 1830. For modern women, the reality is far better expressed in a 2004 study by David Dunson and colleagues, published in Obstetrics and Gynecology. However, this does not mean that all women who want to get pregnant in their late 30s will be able to – and this is really where the problem lies.
This could be related to her age: for example, the RCOG notes that early ovarian ageing happens in around 10% of women in the general population.
If a woman does not find out that she is struggling to get pregnant until she is in her mid to late thirties, by the time she comes to accessing fertility treatment she is likely to be nearly 40. It is widely understood that as women get older, they experience a decline in egg production and quality.
Many women in their mid-thirties fall pregnant without treatment, conceive a fetus without anomalies, and carry the pregnancy successfully to term; and in these cases, attempts to cajole women into having babies earlier than they want to is likely to increase anxiety for no good reason. Given the trends towards later motherhood, it is striking how little positive attention is paid to the possibilities of egg freezing, and also egg donation.
A 1990 study in the New England Journal of Medicine differentiated between pregnancy complications and outcomes for the babies. The general point here is that there are relatively higher risks to older mothers and their babies than to younger mothers.
In other words, while the risks of pregnancy complications increase with age, this does not mean that women having babies at the age of 35 or over are de facto putting themselves or their babies at increased risk. Whatever the age of the mother, the process of pregnancy and birth themselves pose a level of risk to the woman and her baby, through hypertension, bleeding, difficult labours and so on. The difference between statistical significance and clinical significance is very important in working through the relationship between what we might know about the relative risks of later maternal age, and what women, doctors and policymakers might be advised to do with regard to women having babies later in life. The organisation of maternity services is, fundamentally, is where the policy implications of later maternal age should lie. Even if they have not undergone fertility treatment, older women are also naturally more likely to have twins or triplets, which as well as having a higher risk of congenital anomalies (around 5% more common in multiple pregnancies than in singleton pregnancies), are also at risk of growth restriction and preterm birth, which in turn is associated with other complications such as cerebral palsy and learning difficulties. First, the national prenatal screening system that is already embedded in Britain’s maternity service should continue to be supported. Second, the care pathways for women who terminate their pregnancies following a diagnosis of fetal anomaly should be improved. Currently, the risk of fetal anomaly tends to be used rhetorically to scare women into not leaving childbearing too late – and yet women who terminate pregnancies because of fetal anomalies tend to experience a lack of sympathy and sensitivity. 6) What should health professionals and policymakers do about the trend towards older motherhood? With all this going on, doctors and policymakers need to tread very carefully when issuing messages to women about how they time their childbearing.


We should also be honest in saying that the context in which women make their fertility choices is not necessarily ideal, and it would be better if young mothers stood a decent chance of being career women too. Fertility treatment is expensive and uncertain, but most women know that already: and they also know that it can work in some cases. If policymakers are worried by the consequences of later maternal age, they should be focusing on supporting prenatal screening services, preparing maternity services to be better able to cope with obstetric complications, and funding decent miscarriage care and fertility treatment.
It situates this discussion in its wider social context, and indicates the policy implications that might flow from a trend towards later maternal age.
For this group, the chances of being able to conceive a healthy pregnancy and give birth without serious complications are good.
A more precise account of the figures reveals that about 29% of births are to women aged 30-34, 16% are to women aged 35-39, 4% are to women aged 40-44, and less than 1% are to women over 45. It reflects the fact that in the twenty-first century, women have access to effective contraception, and this gives them the scope to construct their lives around choices about partners, careers, and friendships.
There is no right to have a child, and it is not always possible to control whether one becomes pregnant or not. That women are having babies later in life is neither an obviously good thing, or an obviously bad thing. Perhaps the most important message to give is that the best cure of all is to have your babies before this clock strikes 12.
If a woman wants just 2 children, the chances of her being able to achieve this in her mid- to late thirties remain high. The abortion statistics show, further, that a sizeable proportion of women have unintended pregnancies at this age.
The attraction of using data from a pre-modern population is the fact that the data is not distorted by the use of birth control. This found that, if they were having sex twice a week, 82% of women aged between 35 and 39 fell pregnant within a year. The social trend towards later motherhood, which is evidenced by the growing number of mothers in their 30s, indicate that getting pregnant is not a problem for the majority of women aged 35-39. That is to say, women become progressively less fertile, and embryos are more likely to have anomalies, which in turn can contribute to the risk of miscarriage.
In this way, warning women about the problems of delayed motherhood can be seen as a form of expectations management; an attempt by parts of the medical profession to prevent women from assuming that fertility treatment will be successful in their case. The studies cited below indicate the kind of problems that are associated with pregnancy and neontatal outcomes in older mothers. The issue at stake here is only how much additional risk is posed by advanced maternal age. This study delineated between women aged 35 or younger, women aged 35-39, and women aged 40 or older. The implication of the 2005 Obstetrics and Gynecology study is that, for women aged 35-39, and even for women aged 40 and older at delivery, most of the risk factors that are known about and statistically significant will not present a clinical problem. The National Down Syndrome Cytogenetic Register indicates that there were 1,115 cases diagnosed in 2010 to women aged 35 and over, of which 60% ended in abortion (around 90% of cases diagnosed prenatally), and just over 400 cases of Edwards and Patau syndrome.
At a time when there is greater awareness of fetal anomaly, better technology to detect anomalies at earlier gestations, and a demand for screening from women whose age puts them at greater risk, it is crucial that the resources are provided for women to obtain accurate diagnoses as quickly and sensitively as possible.
Currently, it tends to be the case that women diagnosed with an anomaly at gestations of under 24 weeks are signposted towards termination services that may not offer them the choice to terminate their pregnancy using surgical methods. However much prenatal screening services develop, there will always be some women who choose not to have screening, or who have a positive result but choose not to terminate the pregnancy. Culturally, increased attempts to portray disability in a positive light often gloss over the daily, practical problems faced by parents of disabled children and young adults. On one hand, it is important to be honest, and recognise that a woman who is biologically infertile cannot get pregnant just because she wants to.
The continual conflation of the problems facing women at aged 35 with those aged over 40 seems deliberately designed to present women with a worst-case scenario, as though there is a need to scare women in their early thirties into rushing into pregnancy.


But in twenty-first-century Britain, it is not generally biology that pushes women to have babies, but personal decision-making, which takes place within a wider social context. But many of these social and cultural debates tend to be played out through a discussion of the clinical problems about older women’s ability to carry a pregnancy in their thirties and give birth to a healthy child.
As a 2014 commentary by the US obstetrician WR Cohen in the British Journal of Obstetrics and Gynaecology (BJOG) concludes, after reviewing the extent to which maternal age affects pregnancy outcome, ‘it is important to remember that the great majority of pregnancies in older women are relatively uncomplicated and end quite satisfactorily.
In 2012, almost 27,000 women aged 35 and over had an abortion; and this number and rate has remained stable since 2002. We know that in general, women aged 35-39 have a reasonable chance of getting pregnant; but when an individual woman aged 36, or 38, tries to become pregnant she might not always succeed.
At a purely biological level, if this woman had tried to conceive earlier, she would have had a better chance of becoming pregnant. But issuing a wider public health message about the problem of delayed motherhood is not the best, or only, response. But women who froze their eggs at 30 had a 72 per cent chance of becoming pregnant by thawing these eggs at 41. The high rate can be explained only in part by obstetric and medical comorbidities and the propensity of older women to have dysfunctional labour.
No – they simply mean that maternity services should be aware that older mothers might present these additional complications, and organise around them accordingly. Women carrying more than one baby have an increased risk of anaemia, hypertensive disorders, haemorrhage and postnatal illness. For these women, who are often terminating a much wanted pregnancy, having to go through the induction of labour causes additional distress. Potentially, this might become one consequence of later motherhood, where women feel that their pregnancy is their last chance to have a child. It is assumed that there is a contradiction between enabling women to avoid having a baby with a congenital anomaly, and supporting parents of children with disabilities. It is impossible to argue convincingly against either of these statements in their own terms. At a general level, the evidence strongly suggests that women are likely to find the process of conceiving, being pregnant, and giving birth more straightforward if they are under 40, and there is little to be gained from denying that this is the case.
The likely reality is that more women will have children in their mid to late thirties, and the likely outcome of that is that most pregnancies, births, and babies will be healthy.
Women respond, not to journal articles and pronouncements from Royal Colleges, but to their personal circumstances and the experiences of those around them. This is despite the fact that the percentage of conceptions leading to abortion has generally decreased for women aged 35 and over in the past 20 years, reflecting the trend towards later motherhood.
In other words: women in their thirties might have to try harder to get pregnant, particularly if their partner is also in his late thirties. In general, maternal mortality associated with multiple births is 2.5 times that for singleton births. More attention should be given to ensuring that women have access to choice of termination method, by making use of all NHS-funded abortion providers.
These women’s choices should be supported in a practical way, through providing care, education and opportunities for disabled babies, children and adults. These circumstances and experiences suggest to them that having babies in one’s thirties is quite normal. Policymakers need to be realistic about disability, offering less rhetoric and more practical support.



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