The mommy gets older

Women are pushing pregnancy till after 40 to make room for their careers. They know the dangers of a late pregnancy but trust medicine to take care of it, finds Geetanjali Jhala

The Mehtas were having a baby. Two years ago, Apurva had decided to give up her career and start the family they always talked about. After two miscarriages, the 42-year-old was pregnant and doctors said that this time, everything looked normal. Her pregnancy was complicated. She had to go through a battery of tests and was prescribed “almost every supplement available,” says Apurva. “Thankfully, this time I managed to get through eight and a half months with no serious problem. I don’t think I could have lived with the grief of losing a third child.”

Her daughter Shreya is a year old now and though she’s small for her age, the “angel is just as naughty as other one-year-olds,” says the doting mother. Apurva says that pregnancy was tough — and very scary. For the first three months she was a bag of nerves, but her husband helped her through the fear, guilt and depression. She’d done well for herself as a marketing executive, but after putting off pregnancy by eight years, she decided it was time to have a child.
 
The number of first-time moms over 40 is increasing, say doctors in the city. “I see many more 40-year-old mothers-to-be in my practice,” says Dr Indira Hinduja, gynaecologist and obstetrician at the Jaslok hospital. “A few years back there was 0nly the odd case of late pregnancy. But off late, it has almost become a regular thing.” Agrees Dr CN Purandare, obstetrician and gynaecologist: “With the marriage age being pushed further, more women above 35 and even 40 are planning and going through with late pregnancies.”

The reasons are many, say doctors. “Late marriages and careers are the main reasons women push pregnancies till later,” says Dr Purandare, adding that the trend is more common among urban women, usually working executives and the likes. “These women choose to carry on working because they are confident about medicine,” says Dr Hinduja. “With the advances in treatment today, many women are confident that conception is possible in case they can’t conceive naturally.”

Women who put off pregnancy till after 35 sometimes have problems conceiving. “But this is hardly an issue anymore,” says Dr Kiran Coelho, head of gynaecology department at Lilavati hospital. “Why should a woman be discouraged if she wants to have a baby? Fertility treatment today has advanced, and more women are open to the treatment.” Fertility treatment includes ovulation induction — to stimulate follicles in the ovaries; intrauterine insemination — placing sperm into the woman’s uterus when she is ovulating; and stimulating of the ovaries. “Apart from that, there are screening tests to monitor the development of the foetus at every stage of the pregnancy.”
 
Another reason most women plan late pregnancies is because they’re concerned about bringing up the child, say doctors. “Many women feel that life has become difficult and expensive, and they need to be financially and emotionally prepared for a baby,” she adds. Apart from financial demands, women over 40 have to be prepared to accept the risks involved. And there are a number of risks. “With late pregnancies, the chances of a miscarriage are much higher,” says Dr Purandare. “Over the years, a good number of eggs present get exhausted. The remaining eggs aren’t of very good quality, and the foetus may not be able to carry out a full nine-month term.”

With age, eggs in the ovaries are more likely to undergo genetic mutation too, “so chances of congenital abnormalities such as Down’s syndrome are higher,” warns Dr Purandare. However, even this can be tracked at an early stage of the pregnancy. “Two-dimensional and three-dimensional sonographies allow us to see the baby closely,” says Dr Coelho. “Different tests every few weeks and amniocentosis — amniotic fluid is tested for genetic abnormalities — make it easier to monitor the pregnancy at every stage.”

Ailments such as diabetes and hypertension that are very common in this age group can complicate the pregnancy. “During a pregnancy, medication dosage is usually increased because blood pressure and blood sugar levels become more erratic,” adds Dr Hinduja. “However, this increased dosage can cause problems for the foetus, resulting in a miscarriage.” There is also an increased risk of premature delivery and a caesarean section, she says.

After having trouble conceiving and carrying the pregnancy to term, Hollywood actor Nicole Kidman announced in January that she was pregnant. The 40-year-old Oscar-winner is wary after a few miscarriages. Now, concerns that a mother may have about her child’s health or her own can be detected and looked into early in the pregnancy. “Older women are well-discussed on the issue of pregnancy,” says Dr Hinduja. “They know the risks involved and are usually regular with tests and visits to the gynaecologist.”

The joy of being a mother, even at 40 brings a glow within that mothers say is indescribable. “If planned well, the pregnancy could be smooth-sailing and things may work out for the best,” says Apurva. “I know I’m much older than other moms, but I also know that I’ll be a good mother and friend to Shreya. As she gets older, we’re going to work on the age difference.”  Also, women who plan late pregnancies are usually more aware and well-read about pregnancy and motherhood. “Most late mothers know the risks of a  late pregnancy, and are prepared to deal with complications,” she says.

“Older mothers are usually mature, so bringing up the baby is easier, especially when they are not influenced by in-laws,” she adds. Many companies give up to six months maternity leave; some organisations have provisions such as day-care centres for children of employees. “The age difference, in most cases, is something the mother and child get accustomed to.”

(Some names have been changed)

j_geetanjali@dnaindia.net