Advanced Maternal Age

Labelling mums above the age of 35

If you are finding yourself reading this, chances are you just found out you are pregnant and your care provider has thrown the “geriatric pregnancy” or “advanced maternal age” label at you. I just wanted to say: Congratulations on your pregnancy. Maybe this hasn’t been an easy road for you. But you are here now and navigating being pregnant in the later years in life. 

This can be the most exciting and transformative season in your life and there are many benefits to becoming a mum later in life and is associated with improved health in their children, including cognitive ability. Children of older parents have described benefits such as emotional and financial stability and devotion, patience and attention of their parents.

In this blog my aim is to provide you with evidence-based information about how AMA can impact your pregnancy and birth, so you can make informed decisions in relation to your care, how you look after yourself and how you would like to give birth.

Advanced maternal age (AMA)  by definition is a term that is used to describe pregnant women over a certain age bracket. Unfortunately the term is not clearly defined internationally and varies across healthcare providers and literature. It might be when you are over 35, 38 , 40 years or even 45 years of age. 

It is important to note that pregnancy and birth carry risks across all age groups, nothing is completely safe and that all age related concerns raise gradually and not all at once.5

I also believe that it is important to remember that literally everything in life carries risk and that every decision you make has a consequence (good and bad). 

Often care providers talk about risks and they might say super scary things like: You have a 50% increased chance of a still birth compared to a younger mum. 

Let’s dissect this statement and remember that there is absolute and relative risk (which is the above example). 

While, yes there is an increase in stillbirths for women over the age of 40 the data9 shows that women aged 18 – 34 also have a risk of stillbirth. The absolute risk is 0.17%.
For mums over 40 the absolute risk is 0.30%. So yes, while we could say that there’s almost a 50% increase we also need to acknowledge that 0.30% is a small number and that 99.7% of women over the age of 40 don’t have a stillbirth!

Other risks your care providers might mention is chromosomal abnormalities, gestational diabetes, and miscarriage. Unfortunately there doesn’t seem to be a lot of evidence surrounding the reason why older mums have an increased risk of stillbirth, GD, chromosomal abnormalities etc. One theory is that it has to do with the age of the egg, another is that older mums may or may not be generally more unwell than younger mums.
Just remember that your care provider will likely offer you further testing in regards to those risk factors but that you have a choice to decline any diagnostic tests. 

Having those risk factors may also affect your birthing experiences and your care providers might recommend the following: 

Induction

The number one reason for generally recommending an induction around 39-40 weeks to most women aged over 35 is to decrease the risk of having a still born baby as discussed above.

Induction of labour involves a series of procedures and interventions with the aim to artificially bring labour on.

However, induction carries its own risks and can sometimes lead to other interventions, or resulting in a caesarean section, which can result in the mother feeling dissatisfied about her birth.

There is not enough evidence showing that induction of labour for women in AMA reduces the risk of stillbirth as there have not been any randomised controlled trials undertaken.

Induction is a huge topic, if this is something you are offered or faced with I would encourage you to research the topic and read what Dr Rachel Reed and Dr Sara Wickham have to say. Both have excellent resources on their website and have written books about inductions.

 

Caesarean Section 

C-section rates across Australia are at an all-time high with 1 in 3 women giving birth via c-section.

The table below shows the effect age has on women having a c-section compared to younger mums.

 

Maternal Age

2011

2021

25-29

28.4%

32.7%

30-34

34.2%

38.9%

35-39

41.4%

45.9%

Over 40

48.8%

55.7%

Data source: AIHW

The data doesn’t tell us why c-sections were performed, whether elective or medically indicated, but it does show how much higher the percentage is of women having a c-section based on their maternal age.

C-section is a major abdominal surgery and is not without risks either. A study published in the Canadian medical association journal states that “Caesarean delivery is associated with a higher risk of severe acute maternal morbidity than vaginal delivery, particularly in women aged 35 years and older. Clinical decisions regarding delivery mode should account for this excess risk accordingly”.

Despite all the potential risks in pregnancy and birth discussed, many women in their late 30s and 40s have healthy pregnancies and give birth to healthy babies.

It is important that you are educated and well informed so you can take responsibility and make the best decisions possible for your individual circumstances, knowing that all choices carry consequences – good or bad. And remember – you can always change your mind and give or withdraw consent.

Having a care provider that respects your decisions, gives and explains to you evidence based information and treats you with dignity is crucial to maintain a sense of autonomy and empowerment.

A doula can be a beneficial addition to your support team and is a great way of receiving continuity of care, providing you with information and education, supporting you emotionally and helping you to release any fears.  Evidence shows that women who received continuous support were more likely to have spontaneous birth, less interventions and less negative feelings around childbirth.

Where to from here ?

  • Enjoy your pregnancy and look after yourself
  • Map out your wants and needs and what tests, interventions etc you are agreeing to. Remember you can change your mind, give and withdraw consent at any time.
  • Choose a care provider that supports your decisions and consider finding a new one, if your current provider is not supportive
  • Use BRAIN (Benefits, risks, alternatives, intuition, doing nothing) for decision making

My inbox is always open. Email me at hello@nurturedbyjosi.com.au if you would like to book in a one off birth mapping session or discuss how I can support you in your pregnancy, birth and postpartum journey. 

 

RESOURCES & REFERENCES

https://evidencebasedbirth.com/advanced-maternal-age/

https://www.sarawickham.com/research-updates/induction-for-advanced-maternal-age/

https://www.sarawickham.com/articles-2/questioning-induction-of-labour-in-older-women/

https://www.sarawickham.com/research-updates/no-evidence-that-early-induction-of-labour-makes-a-difference-in-older-women-3539-trial/

https://www.matermothers.org.au/mothers-news/mothers-blog/november-2018/are-you-an-advanced-maternal-age-mater-mamma

https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/advancedageoutcomesOct21.pdf

https://ranzcog.edu.au/wp-content/uploads/2022/05/RANZCOG-position-assisted-reproductive-treatment-for-women-of-advanced-maternal-age.pdf

https://www.uptodate.com/contents/effects-of-advanced-maternal-age-on-pregnancy

https://pubmed.ncbi.nlm.nih.gov/33185505/

https://evidencebasedbirth.com/advanced-maternal-age/

https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/method-of-birth

https://www.cmaj.ca/content/191/13/E352

https://evidencebasedbirth.com/the-evidence-for-doulas/