Mar 07, 2002 (The News & Observer) CHAPEL HILL - Holly Riddle knew the clock was ticking. She was almost 37 and newly married, and she wanted a baby. She knew it might be harder to get pregnant as she got older, so when she saw the little piece of paper turn pink, she hugged her husband and celebrated their good luck.
Her pregnancy, in the early 1990s, was labeled high risk.
Older pregnant women used to almost automatically fall into that category -- doctors called them elderly primigravida, and other odd terms. But as more and more women have babies later in life, things have changed.
Old just isn't what it used to be.
Now doctors look more at other risks, such as diabetes or hypertension, than at age alone. And many of those problems, more common in older women, can be managed safely.
In the past, women over 30 having babies was more unusual than it is now: The rates have been increasing steadily since the 1970s, according to the National Center for Health Statistics. From 1990 to 2000, there was a 27 percent increase in the birth rate of women 35 to 39, and a 44 percent increase in women 40 to 44. In 2000, more than 250 women had babies in their 50s.
Carol Winkelman, a Chapel Hill medical writer, just wrote a book outlining risks, numbers, issues and questions women should ask as they think about having a baby. "The Complete Guide to Pregnancy After 30" (Adams Media Corp., $17.95) is a thick paperback that pulls together advice from doctors, midwives, doulas (counselors who help women through childbirth) and moms to help women make healthful decisions about conception, pregnancy and delivery.
Winkelman became interested in the topic as she explored her own options for having a baby in her 40s. "It can be overwhelming," she said, with so much information out there -- from natural conception to fertility treatments to egg donation -- from so many sources.
So she wrote a guide that includes familiar pregnancy themes -- choosing the right provider, planning for delivery, learning different birthing positions, coping with a miscarriage and juggling work and motherhood -- but directed toward older moms.
Winkelman has not had a baby, though she hasn't ruled it out. Her book is encouraging. She writes about getting pre-pregnancy health screenings, overcoming age-related difficulties such as fibroids, preparing for possible complications or interventions. She writes about managing problems such as gestational diabetes, and how to analyze the increased risk of chromosomal abnormalities. But she also reassures readers that, chances are, they will have a healthy baby.
It's so common now for women to have their first child in their 30s that sometimes they don't even realize that there are risks, said Dr. Amy Murtha of Duke University Medical Center. "There is an increased risk of chromosomal abnormalities to babies born to women over 35, but I've taken care of many patients that just didn't even realize that was the case. It's actually amazing." She recently talked to a woman about getting an ultrasound and genetic counseling about possibilities such as Down syndrome. "She said, 'But I'm a young 37!'"
Most women just don't feel old at 37 anymore.
By that point, they may have just gotten married and gotten to a comfortable spot in their careers.
Riddle had just finished about 110 years of school when she got pregnant, she said lightly -- she has a master's degree in special education and a law degree. When she was eight months pregnant, she was hired as director of the N.C. Council on Developmental Disabilities.
So she was both excited and nervous about the pregnancy. She jumped back from the microwave and stayed away from alcohol. She had some bleeding that sent her rushing to the hospital, to be reassured each time that she was right to come in but the baby was fine.
"I was just scared out of my mind of having a Caesarean," she said: She wanted as natural a birth as possible and worried about missing too much work if she had a C-section. Older women have twice the rate of Caesareans as young women, Winkelman said. "Some doctors think they labor differently and have longer labors," she said. And patient and doctor anxiety may contribute as well; some call it "premium pregnancies" when women have tried to have a baby for a long time, or worry that this is their last chance. Riddle's son, Soren, was born -- without a Caesarean, though with the help of forceps -- almost nine months to the day after her wedding.
"Just when you thought you'd arrived in your career and thought everything was what you wanted it to be, you realize that there is so much more," Riddle said. " ... When you've got a complicated life like I've got, and you come home every day to a handsome, gifted, caring, wonderful son, it does put things in perspective."
