Pregnancy and motherhood at 20, 30 & 40.
Pregnancy often is planned around certain benchmarks. Establish a career. Find the inner you. Marry Mr. Right. Lose those extra 5 pounds. Floss more. Put ovaries on alert. (Read: Sperm incoming . . . go, girl!) Of course, the ducks line up at different ages for different women, making the ideal time for motherhood as individual as DNA. Yet mostly, motherhood is motherhood, as any bleary-eyed mom worth her weight in spit-up and dirty diapers will attest. Still, pregnancy in the 20s, 30s and 40s comes with specific advantages and disadvantages.
The 20s: Reproductive Prime
For 26-year-old Sherilyn Walker, pregnancy and motherhood are part of a carefully constructed plan. "Life fell together for me," says Walker, a pharmacist in Agawam, Mass., who met her future husband, completed a five-year program in pharmacology and passed her state board exam all by the age of 23. "We definitely wanted children before our 30s. Our parents were young when they had children." Walker and her husband view their youth as an advantage, allowing for more energy, a more childlike outlook and more years with their offspring. "Other reasons were that risks go up with age, and you never know how long it's going to take to get pregnant," she says. A previous pregnancy resulted in a miscarriage at nine weeks, but at 39 weeks, Walker's current pregnancy has been problem-free.
Youthful advantage Physiologically, the 20s are an ideal time to become pregnant, because miscarriage, infertility and medical risks are at their lowest point. For example, a woman in her 40s is 13 times more likely to have a baby with Down's syndrome than a woman in her 20s, the National Center for Health Statistics reports. It also is easier for younger women to conceive than older women. Women in their 20s also may feel more rewarded by motherhood. A study of 294 women found that those in their 20s scored higher on maternal gratification at their baby's first birthday than did older women. "This may be because women in their 20s didn't have other roles developed yet. Only a third of them had finished their college degrees," says the study's author, Ramona T. Mercer, Ph.D., professor emeritus of maternity nursing at the University of California at San Francisco. Mercer based her book, Becoming a Mother (Springer, 1995), on her findings.
Certain challenges Anemia — an iron deficiency that can be remedied by supplements — is the greatest physical problem for pregnant women in their 20s. According to 1995 figures from the National Center for Health Statistics, 24 of every 1,000 pregnant women ages 20 to 24 have anemia. Speculation about the cause ranges from younger women possibly being less scrupulous about nutrition to the belief that a larger pool of this age group comes from a lower socioeconomic group. Women in their 20s also are the most likely to have unplanned pregnancies, and they are more apt to experience psychological difficulties before and after the baby is born. In a 1986 study of 45 pregnant women, nine of the 10 women in their 20s had unplanned pregnancies. "They were unhappy that they were becoming mothers when they did not want to, and there was still so much they wanted to achieve," says the study's author, Mary M. Gottesman, Ph.D., R.N., professor of pediatric nursing at Ohio State University in Columbus. "Some were still in college, and some weren't where they wanted to be in their careers." Social bias toward young mothers also affects the 20s set. Jennifer, a 24-year-old medical research analyst in Rochester, Minn., who asked that only her first name be used, unexpectedly discovered she was pregnant five years ago. "Some people weren't supportive," she says. "They looked at me like I was crazy to have a child at that age. There was a stigma attached to being pregnant, because I was at a college where that just didn't happen." With support from her husband, family, friends and professors, Jennifer prevailed, taking only a semester off. Now pregnant by choice, she says this pregnancy is wholly different. But comments about her being too young for motherhood persist. "Generations ago, I would have been the norm," she says. "People don't give [young mothers] enough credit."
the 30s: Baby Boom Time
The trend today is to postpone childbearing until the 30s, when women are most likely to have married, settled into a job and come to terms with who they are. Since 1980, the birth rate for women in their 30s has nearly doubled. One projection states that by the millennium, roughly one of every 12 babies will be born to women 35 and older. "We planned on getting pregnant now," says Lisa Boone, a 33-year-old administrative assistant in Los Angeles who is expecting her first child. "We have a house. We are both making money. We are at a point in our relationship where we are ready to have something more." Boone became pregnant but miscarried during her first trimester. Three months later, she was expecting again. Women in their 30s who participated in Mercer's study had a more developed sense of self, a more positive view of themselves and generally felt better about themselves than younger women did. Not surprisingly, a woman's self-esteem was the best predictor for how she would function as a mother. Generally less egocentric than their younger peers, women in their 30s are more likely to have completed college, done some soul searching and established a career than younger women, Mercer says. This maturity leads to a less rigid approach to pregnancy and mothering.
Rating the odds With pregnancy in the 30s come higher rates of chromosomal abnormalities, diabetes, hypertension, eclampsia and Cesarean sections. In 1995, out of 100,000 births to women ages 30 to 34, 49 babies were born with Down's syndrome. That rate more than doubled for women ages 35 to 39, according to the National Center for Health Statistics. Increased medical complications also can lead to deliveries by Cesarean section. Roughly 27 percent of women ages 35 to 39 delivered by Cesarean in 1995, the National Center for Health Statistics reports. Another slight concern is the possibility of preterm delivery. From ages 35 to 39, preterm delivery rates rise but still are less than 10 percent, says Michael B. Aldous, M.D., associate professor of clinical pediatrics at the University of Arizona in Tucson. Simply getting pregnant also is more difficult. Pregnancy rates per ovulation cycle drop at age 37 and fall even more after 40. This is because egg quality is compromised by age, says Guy Ringler, M.D., reproductive endocrinologist at California Fertility Associates in Santa Monica, Calif.
Healthy indulgences Women in their 30s tend to have a stronger sense of self than younger women, which helps them accept pregnancy and indulge in its transient moments more fully. These women typically are also more inclined to involve their husbands in their pregnancy experiences. "They would find ways for their husband to be a part of the pregnancy, growing frustrated if he wasn't engaged," Gottesman says of the women in her study. Kirsten Larson, a 33-year-old who is pregnant with her second child, describes having children in her 30s as ideal. "I wasn't fresh out of college," says the San Diego County social-work counselor. "I had been working for 12 years, and we had bought a house. But I did want to be finished having children by 35, when the risks go up." Just past her first trimester, Larson's blood was measured for alpha-fetoprotein, an early indicator of chromosomal and other abnormalities in the fetus. When the results came in at low levels, her obstetrician ordered amniocentesis. To Larson's relief, the test results indicated that the baby was normal but that Larson's hormones were haywire. "They say there's still a 40 percent chance of the placenta breaking down, which could cause preterm delivery," says Larson, adding that this period of her pregnancy was filled with feelings of dread and anxiety. Despite the early scare, Larson, who had her first child at 31 and is 32 weeks pregnant now, feels relaxed about the pregnancy.
the 40s: Chronologically Advantaged
"As women grow older — a group I like to refer to as chronologically advantaged — there is a greater respect for the process of pregnancy and an awareness of the potential danger," says Raul Artal, M.D., professor of obstetrics and gynecology at State University of New York at Syracuse. There also are great rewards. While women in their 40s might be at a slight physical disadvantage when it comes to bearing children, they are at their prime psychologically. Women in their 40s often have well-established careers and have waited so long for motherhood that they feel time spent with their baby is their right. "These women were thrilled to be pregnant," Gottesman says of the women in her study. "They spent a lot of time thinking about what the baby might look like and imagining themselves pushing the stroller." Women in their 40s also had a greater repertoire of soothing behaviors with their infants, had less financial and marital stress, and were more likely to breastfeed, according to Mercer's research. Perhaps the most interesting advantage to bearing children in the 40s is that doing so may prolong a woman's life, granted that she conceives without medical intervention. Research conducted at Harvard Medical School found that the genes that allow a woman to bear children in her 40s also may be responsible for longevity. The study compared 132 women born in 1896, 78 of whom lived at least 100 years, and 54 of whom died at age 73. The researchers report that the centenarians were four times as likely to have had children in their 40s than those who survived only to 73.
Know the risks Despite the good news, there are increased risks of bearing children in the 40s. For example, medical complications and chromosomal abnormalities go up dramatically with age. "At the age of 45, the risk of chromosomal abnormalities is one in 20," Artal says. Just as the rates of abnormalities increase with age, fertility rates plummet for women in their 40s. A couple in their 30s with no reproductive problems have an 18 percent chance of becoming pregnant per ovulatory cycle. But for every 1,000 women ages 40 to 45, only seven have babies, according to 1996 statistics from the National Health Center. The rate is .3 for every 1,000 women ages 45 to 49. The drop is attributed to lower egg quality, which decreases the chance of normal embryo development and increases the risk of chromosomal abnormalities. "At age 43, a woman has a 5 percent chance of getting pregnant per cycle, but it goes up to 50 percent using a donor egg," Ringler says. "The dramatic difference can be seen by [reducing] the age of the egg." Costume designer Shelley Promisel-Ryan, 43, is aware of the problems that can accompany pregnancy. After taking fertility drugs combined with in-vitro fertilization, Promisel-Ryan, who divides her time between New York and Los Angeles, is 32 weeks pregnant with her first child. The path to pregnancy has been arduous. Two years ago, Promisel-Ryan became pregnant, but her fetus died in utero in the first trimester. She later learned that she suffered from ovarian failure, a condition in which the ovaries stop producing eggs. Infertility treatment enabled her to become pregnant again at 42, but Promisel-Ryan's body began producing antibodies in response to the fetus, which increased her chances of miscarriage. Her obstetrician remedied the condition by having Promisel-Ryan give herself twice-daily injections of the anticoagulant heparin to help her body sustain the pregnancy. During the fourth month, she stopped taking the heparin and now is taking baby aspirin. "I wanted two or three children," says Promisel-Ryan, who didn't marry until she was 40. "When the baby is born, I will be 43. ... I always say, 'We charged our baby.' After we pay the infertility expenses off, we'll adopt."
Mothers Superior While each age group brings its own strengths to mothering, women in the different decades of life are equally competent in their roles as mother, Mercer says. And women of all ages describe the process of becoming responsible for another human being as one that weighs heavily on them but fills them with joy. But it is this rite of passage that they have felt driven to win for themselves. "Somebody came to my baby shower with a stroller," Promisel-Ryan says. "I wheeled it across the room and started crying. It was the moment of realizing 'God, I'm going to be a mother.' It's really happening. And I can't wait."
Further reading: Mothers' Nature