Risk Assessment

Risk

At the end of one of my weekend classes, a healthy and fit-looking Momma came up to ask a question.

“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 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 up with me having a Cesarean.”

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

So here’s what I said instead: “If your provider ever had a Momma over the age of 35 who had a “negative outcome” during a birth that went past 39 weeks, it might change how they practice from that point forward. But many providers are only looking at the risk of increased complications that can happen to all women over the age of 35. Is your provider looking at you as an individual, considering any other risk factors that might increase your risk? And what’s the risk, anyway? What numbers are being considered? This information might help you understand ”increased risk” really means for you.”

For example, a provider might read a study that states a woman’s risk of stillbirth increases after the age of 35. The provider might then choose to focus solely on the age of the woman in their care, and encourage an induction at 39 weeks to prevent stillbirth.

Now, stillbirth is a terrible experience which most people would like to avoid at all costs. But women need full information to be able to assess if their risk of stillbirth in waiting for labor to occur on its own is high enough to agree that an induction at 39 weeks is the right decision for themselves.

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

I might be a little bit touchy on this subject, if I’m being honest! 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 (woman who’s had a baby before) with Baby #4 was probably lower than that of a primipara (woman who’s not had a baby before) at a much younger age.

Part of that lowered risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part of that lowered risk can also be attributed to the fact that I was much healthier at 41 than I’d been when I started this whole baby-making enterprise a decade before!

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’s high-risk, strictly because she’s over the age of 35, 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 so much out there that’s opinion only and not evidence-based – and that’s really scary!

So there are only a few online resources I recommend and trust for this kind of research. One of those resources is Evidence Based Birth. Rebecca Dekker, a PhD-prepared nurse researcher and founder of EBB, is on a mission of “Putting current, evidence-based information into the hands of communities so they can make empowered choices.”

Her references list used to research any one issue can sometimes be pages long, and her articles are always reviewed by a panel of experts before she publishes them online. Plus, they’re written for the lay person, not a medical researcher, so they’re easy to understand. Here’s the article from the EBB website that speaks directly to this issue of Advanced Maternal Age.

After doing this important work of researching, I encouraged this Momma to have some more dialogue with her provider about her particular situation. In the end, she might come to the same conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what’s most important, is that she’ll be engaged with her provider in a shared-decision making model and her decision will be made using full information.

In this day and age, I think we should be encouraging women to know what their 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 years old 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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