34 = A Spring Chicken, But 35 = An Old Bird?! I Cry Fowl!

Chickens

I was busy all weekend doing what I love: teaching expectant families all about how to get a baby out (Saturday – Express Class) and where to go when the baby is actually coming out (Sunday – Maternity Tour). It was a gorgeous, sunny, not-too-hot weekend and I was stuck inside both days catching glimpses of the sun when and where I could. AND I WASN’T EVEN MAD.

I mean, I saw how nice the weather was the night before, and I may have even mumbled, “Ohhhhhh, I don’t want to go to work tomorrow!” before going to bed, but some sort of alchemic transformation happens when a class or tour begins. And then I know I’m exactly where I need to be, doing exactly what I’m supposed to be doing. I’m not sure if anyone else can truly understand this, unless they too, are lucky enough to have a job that they love.

At the end of class on Saturday, a healthy and fit-looking young couple came up to me to ask a question about their particular situation. “I’m 35 years old,” she began and I already knew where this was going… “And yours is considered a “Geriatric Pregnancy,” am I right?” She kind of laughed and then said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end with a Cesarean.”

Now, I don’t know the particulars of this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action. But I could tell that she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I’m not going there with her.

Here’s what I told her instead: “If your provider had a Momma over the age of 35 who had a “negative outcome” during their birth, it might change how they practice from that point forward. But many providers are only looking at the relative risk of increased complications that can happen to women over the age of 35. Is your provider looking at your absolute risk?”

This is not something that many providers consider. They read a study that says a woman’s risk of stillbirth increases after the age of 35, but their focus remains solely on the age of the woman in their care, and this can translate into only discussing her relative risk. If they were looking at the woman’s age as just one of several other risk factors that might contribute to or lessen their overall risk, this would mean that they were considering the absolute risk. Too many women don’t even know to ask about relative vs absolute risk, and too many providers are not forthcoming with this information.

Pregnant women and their partners should be able to determine their individual, personal absolute risk of complications and what those complications are if they wait to deliver spontaneously at term, as opposed to being encouraged to deliver early via induction at 39 weeks, because their is a relative risk of increased stillbirth for women over the age of 35.

The risk is real, it’s true – but there are many, many other factors to consider in assessing an individual woman’s absolute risk of any complications, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being completely honest. I mean, I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara with Baby #4 was probably lower than that of a primipara at a much younger age. Part of that lowered absolute risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part can be attributed to the fact that I was in much better health at 41 than I’d been when I began this whole baby-making enterprise ten years earlier!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me! The power of words cannot be understated. And when a woman is told that she is high-risk, strictly because she is over the age of 35, with no other known risk factors, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth! 

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s just so much out there not evidence-based and that’s really scary!

That’s why I was so excited when I “met” Rebecca Dekker a few years back as she was just starting up her website, Evidence Based Birth. Rebecca wanted to create a resource for expectant families (and professionals!) that would review the latest research on a particular topic in obstetrics and translate the findings into something that someone who wasn’t a clinician or a researcher could actually understand.

She takes her time with each article and reviews everything, making sure to use “good” studies – meaning studies that are unbiased, that used the proper technique, assessment and validation tools, and that have statistically significant results. After she’s written her article, she submits it to her advisory Board to insure that the information that goes “live” on the website is exactly what she claims it to be: evidence-based. I know that if I send any of my families to her website, I can feel comfortable that the information they’ll find there is something I can trust.

How crazy is it that I took a look at the EBB website this afternoon and did a search for “Advanced Maternal Age” and found out that Rebecca was doing a free webinar on that exact topic in exactly three minutes! I know, right? Cue up the woo-woo music!

I quickly registered for the webinar and was happy to hear that the discussion I had with the Momma from my class about relative risk vs absolute risk was exactly what Rebecca would be covering in both the webinar and the written materials that accompany it on the website. I really hope that the Momma from class took me up on my suggestion and checked it out.

After doing this important work of researching, I encouraged her to have some more dialogue with her provider about her particular situation. In the end, she might come to the conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what is most important, is that she will be making a decision with her provider based on full information.

In this day and age, I think we should be encouraging women to know what their absolute risk vs their relative risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

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2 thoughts on “34 = A Spring Chicken, But 35 = An Old Bird?! I Cry Fowl!

  1. Excellent article and valuable information, I would have appreciated as I went through this. A conversation I had with a midwife as I carried late in to my pregnancy and induction was being discussed. She reminded me “I always have a choice” because I thought the same thing … I didn’t have a choice when it came to induction. Keep that in mind as well!

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    • Sara: If I’m reading this correctly, there are times when some interventions do become medically necessary (an example around induction might be that Momma is presenting with preeclampsia or is actually post-dates) and then the choices might become much more restrictive as there is real consideration for either Momma, baby or both. But with all suggested interventions, it’s so important that families know: 1) It’s okay to ask is it medically necessary? 2) It’s okay to do some research about your own absolute vs relative risk. 3) It’s okay to engage in respectful dialogue with your provider and come to a shared decision. 4) And, it’s perfectly okay to choose another provider if you don’t feel like #s 1, 2, & 3 will be honored. I’m not saying that #4 is an easy option, it’s not and can end up being quite challenging – but it’s still an option. Thank you so much for reading and for leaving a comment! I love to hear from you!

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