A recent Twitter argument broke out, as they do: A woman tweeted, sarcastically, “oh, please let me read another story about why it is bad to wait until your mid-to-late 30s to have children, I have not read enough.” I responded with, “when patients stop coming in to my office panicked, crying, baffled, the articles cease.” The woman went on to ask me if I was saying that it’s impossible to have kids at 35. I told her no, but not to hate on science because she’s annoyed by it.
So what is all the anguish and anger about? And for god’s sake, how did I find myself on the wagging finger end of the argument?
According to The Pew Research Center’s The New Demography of American Motherhood study from 2008, more women over age 35 gave birth than did teenagers. According to Centers for Disease Control (CDC) 2011 data, birth rates are “at historic lows” for women in their 20’s and rose for women aged 35-39 and 40-44. Just 20 years ago, those statistics were reversed. In fact, I recall a whole lot of hand wringing about the epidemic of teen pregnancy – seems quaint now, doesn’t it?
We all know the backstory: Women have been taking longer to complete their educations, pursue careers and enjoy the journey to themselves. This has led to delayed coupling (if that happens at all) and delayed childbearing. Ok, great, so what could be bad about a more emotionally prepared, financially secure and personally enlightened parent? Not much, unless it means that the person who wants to be a parent has a much harder time actually conceiving, sustaining a pregnancy and completing that pregnancy healthily.
Here is where science, culture and politics walk into the proverbial bar together. Not sure if you’ve noticed, but they don’t always get along so well, especially when they’re drinking.
Women over 35 have higher rates of spontaneous genetic mutations, such as Down’s Syndrome, but also other problems that are not compatible with life, like Trisomy 13 and 18. Women over 35 have higher rates of miscarriage. They also have higher rates of gestational diabetes, hypertensive disorders and placental problems that can lead to growth restriction in the fetus and pre-term delivery. Women over 40 have all of these things, as well and also higher rates of and cesarean section.
Age-related declines in fertility rates are well documented: We see a steady decline from the 20’s onward with more precipitous drops at 35 and again at 40. Some have argued that in fact these rates are erroneous because they are based on historical data that may not reflect today’s better health. These authors argue that it just takes longer to conceive after 35, but I don’t see a lot of folks comfortable with a 2 year delay in conception that the “modern” approach to statistics supports. I also don’t know how many women are willing or able to commit to the process of assisted reproduction and fertility treatments that also accompany the stress and pressure to conceive at a later age.
What I do see are women who are caught between what they want, need and expect; a culture that emphasizes both immediate gratification (get what you desire with the click of a button) and delayed gratification (work and benefits will come… eventually). A lot of the women I talk to and take care of labor under the illusion that they are the masters of their destiny, in control of any and all aspects of their lives, including the physiologic demands of their bodies – no matter what the biologic imperatives may be.
Most of my patients don’t live in caves without wifi, so they are educated about pretty much everything I’ve outlined above. Of course, there are always exceptions to every rule, but the evidence demonstrates what will apply to most of us, whether we like it or not.
Dr. Suzanne Gilberg-Lenz is involved in women’s empowerment and education, and appears frequently as an expert on women’s health on TV, online and in print.