The Mature Mum - Motherhood later in life
Women in Ireland are increasingly having babies well into their 30s and beyond, Karina Corbett looks at factors such as fertility, conception and possible risks, as well as the positives of having a baby later in life
Irish mothers are officially the oldest in the EU.
The latest Eurostat Demographic Report found that most Irish women are, on average, just over the age of 31 when they give birth. The European average age for women giving birth is 29.7. And while 31 is considered to be somewhat mature in terms of reproduction, it would appear that an increasing number of women in Ireland are waiting until even later than that to have babies.
“I would certainly agree that I am seeing a lot more mothers over 35, both having their first child and also further pregnancies,” says Dr Rachel Mackey from the Women’s Health Clinic in Dún Laoghaire, Co Dublin. “I think the reasons they are waiting are good contraception, careers, waiting for financial security, enjoying their relationships and not wanting to introduce children until later in life.”
This age of 35 is generally considered to be something of a watershed for a woman planning to conceive. “The consensus is that between 20 and 35 years of age is the optimum age to have your family,” explains Dr Mackey. “This is based on research that looks at all outcomes, including difficulty conceiving, pregnancy-related complications and healthy babies, etc. It is due to the onset of reproductive ageing, a term used to describe the decline in quality and quantity of eggs after the age of 35. The numbers of women conceiving reduces, and the number of miscarriages starts to increase after 35.”
About 10pc of women will experience early ovarian ageing, she continues. “We have no screening test as such, but anti-mullerian hormone testing (AMH) is sometimes done – we do it at our clinic. It is ideally suited for women in their 30s who want to know whether they can defer pregnancy. The test gives an accurate picture of the degree of ovarian ageing, and if it is normal you can advise the patient that they could defer pregnancy for up to 18 months.”
So what about the medical risks and complications that are associated with pregnancy in older women?
“It is well recognised that the risks to the mother and baby are significantly increased if the mother is over 40,” says Dr Mackey. “Risk to the mother includes high blood pressure and diabetes in pregnancy, and the baby is more at risk of Down syndrome and poor growth.”
Much is made of the risk of a random (ie not inherited) chromosomal disorder such as Down syndrome increasing with advancing maternal age; however, it is in fact lower than most people expect, and there is a gradual, rather than sudden, increase in the chance of such an occurrence. Even at the age of 40, a woman has just a 1pc chance of having a baby with Down syndrome.
As ageing undoubtedly reduces a female’s ability to reproduce, the medical advice given to a woman aged 35 or over who is trying to conceive is different to that given to her younger counterpart. For instance the majority of healthy women under the age of 30 would be told not to worry about infertility unless they have been trying to get pregnant for at least a year.
But women over 35 who have been trying to get pregnant for six months would be told to speak to their doctor as soon as possible. With her chances of having a baby decreasing each year beyond this age, a complete and timely fertility evaluation is deemed to be important.
“The general advice for any woman over 35 who has been trying to conceive for six months or more would be that she should have investigations done to see if there is an infertility problem,” concurs Dr Mackey. “Women under 35 should try for 12 months before seeing a doctor.”
Dr Mackey says that the lifestyle tips she gives to women over 35 who are trying to get pregnant or who are pregnant are also different and much stricter than for younger women. “They need to stay very fit and healthy, eat really well and reduce alcohol intake dramatically, etc, in order to stay well. The older you get the less forgiving the body is, so they have to try harder to maintain their health.”
While women who leave having a child until their later years are sometimes criticised for taking a gamble on their fertility and risking their own and their baby’s health, it has been suggested that such women are making the right choice because they are more financially secure and happier to put their careers on hold to look after the baby. Older women usually tend to be more self-confident and comfortable in themselves too, and with more life experience behind them they feel readier to take on pregnancy and motherhood.
Professor Elizabeth Gregory, author of Ready: Why Women Are Embracing the New Later Motherhood, made the point that the best argument for later motherhood is an emotional one, with the experience having overwhelmingly positive effects. These women, she noted, feel they’ve come to motherhood prepared and that their children, relationships, careers and sanity are all the better for it.
Even so, apart from the more obvious health and fertility concerns, there are downsides to becoming a mature mum. For example, it’s likely the children involved will lose their parents at a younger age, while their children may not enjoy having grandparents.
“You can argue that being older gives you maturity, financial security, etc, and those factors are all important,” says Dr Mackey. “But, from a strictly medical point of view, it is preferable to have your family between 20 and 35 years – at this moment in time we have no technology that can stop the reproductive ageing process.”
Of course there exists technology such as IVF as an infertility treatment, which is being increasingly used in Ireland, adds Dr Mackey. “This is due to lots of reasons, but the increasing age at which women try to conceive plays a large role in that.
“Women closer to 40 will be more likely to be offered IVF sooner rather than later, because time is so precious and IVF is their best chance. Women over 42 won’t be offered IVF in general in Ireland, because the success rates are so low. IVF overseas using eggs donated by younger women is becoming more popular in older women, for whom IVF with their own eggs has failed.”