New mothers over 40

By Vicki Viotti
Advertiser Staff Writer

Margaret Taylor reads with daughter Julia. After an earlier ectopic pregnancy, Taylor conceived again when she was 40. Kyle Sackowski • The Honolulu Advertiser

"Well," he said, "I can see you're going to talk about kids. I'm going outside." And he stepped onto the lanai.

Taylor, then 40, could see that her life, her relationships, everything, was just about to change. Having her first baby in her 40s caused a great deal of upheaval, in her life and in the lives of others who had firmly established expectations of her.

It's a reality that a growing number of women who have delayed childbearing are discovering.

And the happy event is not always greeted as such. Nancy London, at 44, finally had become pregnant; after years of infertility, the miracle occurred when she and her husband settled in Maui and decided to give it one last try.

The joy of her blessing soon tarnished when she started with the obstetric visits.

"Because I had so many miscarriages, I was considered a high risk," London said. "Every time I left, I was terrified, absolutely terrified.

"All they could talk about were the terrible things that would happen," she added. "I thought, 'I am a Caesarean waiting to happen, in their eyes.'"

There are medical reasons for concern about childbirth after four decades of life, but that's only the beginning. Although late pregnancy has gained acceptance in the past few decades, the social implications are felt especially acutely by women who first embark on motherhood in their 40s.

London found ample fodder in this for her new book, "Hot Flashes, Warm Bottles: First-Time Mothers Over Forty" (Ten Speed Press, June 2001, $14.95, paperback). And she found lots of company; in her book, she cites national figures showing that from 1980 to 1995, against a background of declining births overall, the birth rate for women ages 40 to 44 has climbed 81 percent.

An extreme case was just recorded this month. On July 6, a 61-year-old San Francisco woman, whose name was not released, gave birth to a healthy boy at San Francisco Medical Center. London's not sure she can endorse starting a family quite that late, but neither does she feel comfortable about drawing the line at some arbitrary point.

Now living in Santa Fe, N.M., the 57-year-old mother of Sasha, 13, is a licensed therapist charting her own course through late motherhood. London opted for a home birth through a midwife as her counter to what she saw as medical alarmists, but her book is largely a recounting of experiences by other women, facing every challenge from redefining their relationship with their career to coping with both aging parents and child-rearing at the same time.

Waimanalo resident and clinical psychologist Barbara Alethea, now 58, has two teenagers about ready to fly the coop, less than two years after the sudden death of her own mother. Alethea weighed the pluses of her late start in childbearing against the minuses.

"You have a little more wisdom than you did when you were 20," she said. "You have a little more patience ... on the other side, you have less energy.

"And it throws off the developmental schedule of the family," Alethea added. "You end up dealing with aging parents at the same time as separation from your children."

Added health risks

New parents usually aren't thinking this far ahead . It's a challenge even to picture anything beyond the nine months of the pregnancy, beset as they are by worries about the health of the child.

Many of the danger zones of gestation flash red for fortysomething moms-to-be, said Dr. Greigh Hirata, perinatologist at the Fetal Diagnostic Center for Kapi'olani Medical Center for Women and Children. Among the problems he cited: prematurity, low birth weight, hypertension and pre-eclampsia, a dangerous condition with symptoms that include swelling and elevated blood pressure.

It's the heightened risk of chromosomal defects, though, that causes the most worry. For mothers over 40 at the mid-point of their pregnancy, the total risk of all chromosomal abnormalities is one in 40, he said; the chance of Down syndrome alone stands at one in 110. Those risks rise exponentially through the decade, however: At age 49, a mother's risk of chromosomal defects is one in seven. That compares to a 1-in-201 chance of the defects in women age 33.

There are more options for diagnosing defects today, ranging from simple blood tests to the more invasive amniocentesis procedure. Tammy Stumbaugh, the diagnostic center's genetic counselor, has observed that older first-time moms consider these options carefully.

"Those that are older and this is their first pregnancy tend not to get invasive," Stumbaugh said. "It may be their only chance, and they don't want to take that risk that they could cause a miscarriage."

Pregnancy, like nature's stress test, generally shows up physical problems that otherwise might have remained hidden for years, said Dr. Keith Ogasawara, a perinatologist at Kaiser Permanente. If you are predisposed to hypertension or diabetes, for example, that may be what shows up during gestation.

The older woman's problems lie that much closer to the surface due to age, he said, and because pregnancy causes physical duress, the body may succumb to these problems more readily.

There are some conditions that improved medical surveillance can correct, Ogasawara said, but largely the advantage of fetal diagnostics lies in enabling the couple to prepare for whatever difficulty looms ahead.

"The older first-time moms really focus on their pregnancy and are informed," he added. "These women tend to be much more career- or goal-oriented. This is their new life goal, and they're going for it, both feet forward."

Sometimes it isn't a choice

In London's case and in many others', infertility has precluded parenthood any sooner. But as with some moms, attorney Robyn Au, simply hadn't considered motherhood a priority until it simply happened to her at age 42.

"I was surprised," she said, and then revised that statement. "I want to say I was in awe. I never considered terminating the pregnancy, but I wondered, 'What's my life going to be like?'"

Baby Jenna is now 4, and Au knows what life is like, at least at this point. She was firmly established in her career with the Army Corps of Engineers, which gives her a great deal of leeway in scheduling work around a preschooler's activities. She's altered her goals to take her away from home less ("I don't do litigation anymore," she said) and takes her daughter along on many of her trips.

Down the hallway sits Pat Billington, another Corps lawyer who, at 40, formally adopted her sister-in-law's daughter. Baby Laura was born in the home Billington and husband Taka Alphons shared. The birth mother, a native of Pohnpei, moved in while pregnant and told her eldest brother that she wanted the couple to adopt her child, true to the tradition of her Micronesian culture.

Having just suffered a miscarriage of their own baby and feeling certain they'd not have another chance, the couple saw the offer as a godsend. But Billington said they urged the young woman to take her time before making any final decision, and they secured the agreement of the birth father.

"That was part of the function of being 40, having the maturity to do that," said Billington, now 53.

In both Billington's case and in the case of Margaret Taylor, being late parents was simply the result of meeting Mr. Right in their 30s. Taylor had suffered one ectopic pregnancy, and was told her chances for normal pregnancy were slim.

When she finally conceived Julia on her 40th birthday, the landmark occasion became doubly a reason for celebration. Now that baby's a bubbly 3-year-old who joyously leaps into the arms of her father Tony as he arrives home from work.

That part of parenting has produced the obvious measure of delight. The Taylors are feeling their way through other aspects. Trying to keep their immaculate Waikiki apartment in reasonable order despite the pull toward kiddie clutter. Working duties of their property management jobs around the new parenting paradigm.

And, of course, holding on to cherished friendships with childless couples while meeting a new circle of parents.

"We're in the evolving stage right now," she said. "We're embracing it ... I think our friends are, too."

Above all, there is the joy of gaining an entirely new perspective on life, at a stage when people used to be resolutely entrenched.

"I talked to one woman who said, 'My child brought back the wonder of life,'" London said. "She told me, 'I was this super-high-powered career woman, and now I stop and watch ants crawling up a tree with my 3 year old ... I am awed by the wonder of things, by my willingness to slow down.'

"Sometimes it isn't a choice," London added. 'We're just slower. We're trying to pretend we're perky and 25. The real trick to being an older mom and surviving in style is acknowledging the limitations, and that liberates you to realize what the gifts really are."

Vicki Viotti can be reached at vviotti@honoluluadvertiser.com.