“I hate to remind you of this, but you do fall into the category of Advanced Maternal Age…” said my obstetrician at one of my early prenatal visits, the one when you’re supposed to discuss options for prenatal testing. Unwisely, my husband started chuckling, but shut up immediately when I glared at him with one of those hormonally-charged looks of scorn that only pregnant and peri-menopausal women can muster.
Of course, as a pediatrician, I already knew that at thirty-seven, I was solidly part of that demographic. But somehow, having my doctor tell me this as a prelude to discussing whether and why we should do any specific genetic tests was somehow shocking. I didn’t feel old. Maybe I felt hungrier, crabbier, and fatter, but not old. Nevertheless, there I was, weighing the option of extra testing on my unborn child, offered solely based on my age. A few years later, while trying to conceive a sibling for my son (before adopting the brother he was actually meant to have), I briefly rode the infertility treatment roller-coaster, during which time I was constantly reminded of my “diagnosis” of Advanced Maternal Age.
The term “Advanced Maternal Age”, or A.M.A., is one used mostly by obstetricians to describe women over the age of thirty-five who become or are trying to become pregnant. When you’re older, even a little bit, lots of things are more likely to challenge you. First, you may have a hard time conceiving in the first place. If you do become pregnant, there are a whole slew of complications that are more likely to affect you (like diabetes, high blood pressure, and delivering your baby prematurely) and your baby (not only the litany of complications that accompanies prematurity, but also, among other things, the increased risk of genetic abnormalities). So though Advanced Maternal Age is an objective, descriptive term, it conjures vaguely ominous images, especially to a medical person like me.
Interestingly, the abbreviation “A.M.A.” is also used in medicine to refer to someone who is doing something against medical advice. Being older, whether you’re trying to be or are already pregnant, creates a distinct set of worries for the doctors who are caring for you.
Anyway, Advanced Maternal Age is one of those terms used mostly by obstetricians before, during and immediately after delivery, which alerts those who are taking care of mom and baby that there may be additional medical challenges to face. But the term kind of fizzles away once the baby is born and mom recovers. I wonder, though, as a health care provider who takes care of lots of moms who fit into this category, whether there is something more to this term once we get out of the delivery room, or off the plane, or however we end up being a parent.
Obviously, our age is just one part of us, but it does contribute to the issues that we face as parents, just as our family background, our religious beliefs, our sexual orientation and so many other factors contribute. It provides part of the framework from which we parent. Some of it may be good, some not so good. For example, an older parent may be wiser, further along in her career and thus be more financially stable and better equipped to provide for the needs of a child. On the other hand, despite being more established in the world, older parents are more likely to experience physical health problems (anyone over 40 knows what I’m talking about here – lots of little things start happening in your forties that remind you that your are not invincible). Emotional health may also be different for older parents, especially when dealing with newborns and very young children (in addition to the general exhaustion that comes with the territory, there are other issues, such as the craziness – and I use that term loosely – that many women – including my forty-seven-year-old self – begin to experience as they enter peri-menopause). But that’s a whole other story.
The bottom line is that while parenting at an older age is an amazing opportunity to grow personally and to learn about our capacity to love, stepping up to the starting line later in life comes with a unique set of challenges, physically and emotionally, that may not have presented themselves to any of us had we begun this journey earlier in our lives. Acknowledging these challenges and being careful to take care of ourselves can only make us better parents, not to mention keeping us alive for longer so that we may actually have a chance of living to see our grandchildren.
But I’m trying not to worry right now about whether I’ll become a grandmother someday. At this point in my life, with two young boys, I’m mostly just thinking about strategies for keeping them alive and out of the emergency room, and keeping up with them without causing serious orthopedic injury to myself…