Problems that can affect the mother-to-be or her child are less likely to occur in a younger woman. The longer you wait to have your first baby the more problems you may encounter - you, and your obstetrician.
Evidence showing the advisability of reproduction while you're young has been accumulated over the past few years. With older women so many problems arise and escalate that anyone over 35 years reproducing for the first time is referred to by the experts as "'an elderly primigravida" (in simple terms, an aged mother).
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This may sound disconcerting to women in their mid-30s. But if they take note of the examples given below they'll see reason in the caution. Several major investigations have been carried out. one of the most recent involving 20.000 deliveries over a five-year period.
Of this number, 127 were having their first baby at 35 years or over: 34 were over 40. This was only a small percentage, but the problems encountered in these age groups were far in excess of normal. And without pulling out the panic buttons here are some of the outstanding disabilities incurred by "elderly" first-time mothers.
Pregnancy disorders: a marked increase over the normal range. Blood pressure and a more serious disorder called preeclampsia (fits or coma associated with high blood pressure) were considerably increased. These require special treatment and there is greater risk.
Fibroids: non-cancerous growths in the wall of the womb. They can mechanically impede labour when large, or when located in a vital area.
Prolonged labour: If allowed to proceed naturally, labour could be up to 25 percent longer than in a younger woman. This may increase risks to the baby and may exhaust the mother, who is less equipped to cope with such hard work.
Induction of labour was carried out far more often, mostly because the mother had high blood pressure. There is now an increasing tendency for obstetricians to initiate labour, but the rate in older women is still in excess of average. In the series under investigation about 19 percent had labour induced.
Forceps: There was an unusually frequent need to apply forceps to assist deliveries (in about 30 percent of cases).
Cesarean operation: A very high rate, 31 percent of babies, were born by cesarean section. Here, the baby is delivered through an incision made in the wall of the womb via the lower abdominal wall.
There is little doubt that this surgical approach (a major undertaking) benefited both mother and baby. But certainly it is not desirable if normal procedures are suitable. The experts reviewing the series said: "While cesarean section may help both mother and baby escape some of the obstetric difficulties, it is by no means a panacea."
So much for the problems encountered by the 35-years-and-over mother. What about the baby? What were its chances of developing into a normal, fit child?
Perinatal mortality. This relates to babies who perish in the first few hours or days following birth. The rate was 94 for each 1000 births. Discounting babies weighing less than 1 kilogram the rate was still 47 for each 1000 births - about twice the normal average figure.
Small babies. It is significant that the older woman tends to produce a smaller baby than her younger counterpart. These infants are called "light-for-date," and they have much less chance of survival than normal weighted babies. The usual average is around 11 percent, and twice this percentage seems to occur for the elderly first-time mother. In this series of tests the figure was more than five times the normal.
Sick babies. Often the babies are sick or congenitally abnormal. Eighteen percent had an Apgar score of less than the normal six. (This scoring is an indication of the babies' fitness at birth.)
Congenital abnormalities. A greater than usual number had these problems. There was one case of Down's disease (mongolism), common in infants whose mothers are in the upper age group.
Three percent had abnormalities, with one cleft palate. The major comforting factor was that there were no maternal deaths. There were six stillbirths and six neonatal deaths, and of all these only one infant was fully mature.
The problems of the elderly first mother are considerable. But doctors do say they are similar, for mother and baby, to those faced by younger women and their infants, only the older woman and her child seem to be at slightly greater risk.
Women today have practically total control over the age at which they will produce. With rising costs (including the rearing of a family), many women are waiting until they are financially secure before embarking on family life.
The advice of the experts is to give this careful consideration. If your age is advancing toward 35 and you are still attempting to pay off the house, the car and the electric appliances, don't forget the small individual to whom much of this planning is being directed - your first baby. It would be a pity if you took all this trouble only to run into even greater difficulties.
It certainly underscores the necessity, or at least advisability, of promptly finding a competent obstetrician who is linked with a major hospital, complete with total facilities, if you look like coming into this general "elderly" category.
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