From the Editors: We recently interviewed Sarah Thayer, a certified and trained birth doula who is now a nursing student with plans to become a nurse midwife. With eleven years experience working with pregnant and laboring women, she offers us an observer’s perspective on pregnancy over 35.
MS: Can you describe your role as a women’s health care professional?
Sarah: I worked as a certified and trained birth doula from 2003 until 2014. I am also a licensed massage therapist and have been licensed in the state of Connecticut since 2004. In my massage practice I see both men and women but have specialized training in pregnancy massage. I have an undergraduate degree from Central Connecticut State University in sociology. I am a nursing student at Capital Community College in Hartford, CT and will graduate with an associates degree in nursing in 2017. Upon receiving my RN license, I intend to continue to graduate school to become a nurse midwife with a clinical doctorate degree.
As a birth doula I worked with women and their families to help them have their own best birth experience. Birth doula’s do not provide clinical care, but rather help their clients during pregnancy, labor, birth, and the immediate postpartum to have a positive birth experience. This is different for every woman and family. This element made my job endlessly interesting.
Primarily I listen to women. I try to understand how I can best support each mother and family in a way that empowers her to make her own best choices. Because I am familiar with the policies of hospitals and different medical practices, I can give referrals, when asked, to providers and facilities that may be a good match for the goals of an expectant mother. There isn’t a wrong way to have a baby, but knowing all of your options and picking the provider and place to birth that is in alignment with your goals is the first step to a positive birth experience.
The over all arc of my work with families includes informational support in pregnancy, connecting women and families to community resources, 24/7 on call availability from 37 weeks of pregnancy through birth, continuous labor support with guaranteed back up doula support in the event of emergency or illness, immediate postpartum support, and a postpartum follow up visit in the first 6 weeks after the birth.
MS: From our perspective, there seems to be some fear mongering when it comes to tests,for women having geriatric pregnancies. Can you share your perspective on that?
Sarah: We have the ability to know more about fetal development because of new genetic tests and advances in technology. I think it can be difficult for patients to navigate understanding what the tests are, what the purpose of them is, what the results mean and don’t mean, and if they have to undergo all the screenings that they are sent for. For example, some screenings simply say that there may be an abnormality that may indicate that further testing is needed to see if there is, in fact, something not developing normally. Further testing could reveal everything is progressing perfectly fine, but more invasive tests, like amniocentesis, come with risks of their own like infection or miscarriage. It can be a roller coaster for women who feel anxious and frightened while waiting for results when, in fact, everything is fine.
It is true that there is a higher increase in fetal genetic abnormalities when a mother is over 35. It is also true that there are higher risks of miscarriage and other complications when a mother is over 35. I think that women need to soul search a little bit and make informed decisions about the purpose of testing. Is there a family history of congenital abnormalities that warrants exploration? Does the mother have a history of recurrent miscarriage that would indicate genetic testing? Is the woman thinking she may end a pregnancy that has markers of genetic abnormalities, or is that not a choice that she is considering? Is this a woman that finds comfort in more information rather than less? I think one of the problems is that the medical system doesn’t always do a great job of educating patients about which tests are mandatory and which tests are optional and what the pros/cons of a test are. In general, the medical establishment functions in a “More is Better”, mentality without the shared decision making between patients and providers which would empower patients to decide which tests are most valuable to this woman in this pregnancy. Again, this is where provider choice is extremely important. Pregnant women should never hesitate to leave a practice where she doesn’t feel listened to or where she isn’t given informed consent of every test or procedure that is entered into.
I think pregnancy can feel so overwhelming that women forget that they can ask questions or change providers at any time. Women should learn to ask “what is the benefit of x, what is the risk of x”? and “is there any reason why I can not do x?”.
MS: If a woman is deciding /trying to get pregnant for the first time over 35, what health-related considerations do you advise?
Sarah: In my present roles as doula, massage therapist, and nursing student I am unable to give medical or health related advice. That said, my best non medical advice is to think about the type of care you want to receive, how you want to experience pregnancy, what kind of birth experience you think you want. Ask other women about their doctor and midwife recommendations. Women generally like to share their birth stories, so ask them! What did they like about a doctor, midwife, or hospital/birthcenter/home birth experience? Midwifery care is different from OB care. Hospitals that look very similar from the outside may have vastly different policies on the inside that impact patient satisfaction and health outcomes for mother and baby.
Living an active, healthy and balanced life is a great way to start a pregnancy. Common knowledge like being at a healthy weight, eating a balanced diet full of fruits, veggies, whole grains; these are great things to do for general well being. Everyone’s experience of pregnancy is different. Some people just feel awful the whole time, while others glow and adore every aspect of pregnancy. Most of us fall somewhere in between with highs and lows across the full 40 weeks.
MS: In your role as a doula, did you find significant differences in pregnancies of women over 35 vs. those not over 35?
Sarah: There are differences between a pregnancy in your 20’s and early 30’s vs. over 35. Again, I am harping on the point of choosing the right provider again. Some providers view pregnancy as a normal physiological event that only requires intervention once there is a deviation from normal. Other providers see pregnancy as inherently risky that requires constant vigilance to avoid complications. Healthy women, age 35 and older often have normal boring pregnancies. Finding a provider who views pregnancy as a normal process is the first step to having lower interventions. Women over 35 are more likely to be offered higher level screenings that may not be necessary or helpful if the results are not something that you need.
Sometimes women who are over 35 may have had history of pregnancy losses, fertility difficulties, or complicated fertility treatments to become pregnant. Even women who have had hormone therapy, IVF or IUI to become pregnant can have a low tech, low intervention pregnancy. It can be difficult to change gears from frequent progesterone shots and ultrasounds to monthly appointments with no tests at all. We bring all of our life experiences, hopes and dreams right with us to pregnancy and birth. Our journey to pregnancy certainly shapes our experience. Someone who has tried for a long time with losses and disappointments along the way will have a different pregnancy than someone who conceived the first try. A complicated conception doesn’t mean a hard pregnancy and birth, nor does an easy conception promise a care free & easy pregnancy and birth. I do think that the harder the journey to pregnancy the more difficult it can be for expectant families to decline higher levels of screening which may or may not be needed. More information does not always illicit better outcomes; it can create anxiety where it doesn’t need to be experienced
MS: As a doula, nursing student, and mother yourself, what do you believe a woman should think about when deciding whether or not to have a baby when she reaches 35 + ?
Sarah: Deciding to have a baby is deeply personal. Pregnancy, childbirth, and motherhood are nearly ubiquitous roles for American women in their 30’s; so much so that my friends without children can be made to feel like outsiders as women. I wholly respect the decision to have or not have children. In my opinion there often isn’t a ‘perfect time’ to have a baby. Physiologically, a woman’s fertility does start to decline in her 30’s and significantly declines at 40 and beyond. If a woman is 35 and knows she would like to have a baby but isn’t ready or hasn’t found the right partner, harvesting and storing eggs is an option, although a pricey one. There are better IVF outcomes with younger eggs than older ones. So if a woman has the means and wants some more time, this can be a decent option.
If you are 35 or older, you shouldn’t let the whole ‘geriatric’ pregnancy label dissuade you. Consult with your MD or midwife about your plans to get pregnant and ask questions about how long it should take if you are coming off of hormonal contraception. There are ways to track ovulation to make sure your cycles are the appropriate length while also determining the best window for conception.
There are many things to consider when starting a family and every woman’s priorities are different. Motherhood and parenthood is a rollercoaster that impacts every single area of who you are as a person. Once a new baby enter’s a family their entire lives are totally changed. You learn to know yourself as a mother, your partner as a father/mother, and what was amazing and or horrible about your own childhood and parents. The desire to have children is great and biological. No one really knows what they are doing, but overwhelmingly we parents get a lot right and some wrong along the way.
MS: How can an older woman best prepare for pregnancy, birth, and/or motherhood?
Its really hard to prepare for something so unknown. My best advice is to have community. Read books, listen to the stories of women and mothers you aspire to be like, and attend childbirth classes that empower you to make your own best choice. Dream with your partner about how you will parent together and get through the big scary fears we all have, and go for it! My oldest child is 11 and there wasn’t quite the deluge of information on the internet when I was pregnant and home with a newborn. I distinctly remember being at home with a 2 week old baby, pouring through a baby manual, and coming to the realization that no one really knows what the hell they are doing. As parents we are all winging it to some degree. There is something comforting about this because it allows you to let go and get in touch with your instincts. Since then I have had clients show me elaborate graphs generated from Apps that show the number of feedings, diaper changes, burps, etc over the course of a day, week, month. This would not have been helpful to me. Read encouraging things, and not frightening things. There is no shortage of internet advice, child raising books, or anecdotal information that will undermine the power of your presence and your expertise about what your own child needs. Once you have read the facts about something, make an informed decision, follow your gut, and don’t look back.
My first baby what what we call a ‘high needs baby’ who wanted to be in arms and nurse constantly. I learned quickly to try my best to have a short memory, to not calculate how much sleep was accomplished or lost. Be in the moment. Try to find the joy in right now, or the hard in the moment with the knowledge that this too shall pass. In my mothering of older children now, I have to remind myself of the same lessons. Enjoy right now and let tomorrow worry about itself. That joyful/annoying stage is fleeting and will be different next week.
MS: Describe a doula’s role and how a doula can be important to a geriatric pregnancy.
Sarah: A doula provides physical, emotional, and educational supports to women and their families during pregnancy, childbirth, and the postpartum period. One of the things that can be a pro and con of a ‘geriatric pregnancy’ is that there is more life experience for expectant families. Older women who have careers and are used to being in charge of things can be really broadsided by how little control we actually have in pregnancy, birth, and the early days of mothering. Older women are used to be being competent and knowledgable about things, and suddenly they find themselves having no idea what to do. It is an uncomfortable yet completely normal part of the experience. Having an experienced doula to listen to you and normalize something that feels foreign can be very useful. Doulas are supportive of dads and partners too. Partners do not have to feel like the experience is solely riding on his shoulders. Birth is extremely intense for loved ones as well. They want to be helpful but often don’t want to do the wrong thing. The doula is like your birth consultant. She knows what is most important to you and will help you achieve it. The doula will let your partner be at his or her best. The birth partner should be there to love you and experience this with you. The doula can remind the partner to eat, take breaks, show how to rub the laboring mom’s back etc. Older couples often see the value in this type of service because it is like having expert comfort advice right at your finger tips. Doulas also have a knack for placing a cool cloth on your neck or feeding you ice chips without you needing to ask.
MS: Anything else you’d like to share with our readers?
Sarah: You have options. Just because you have been seeing the same OB/GYN for 20 years doesn’t mean that they are the best fit for your care during pregnancy and birth. Your birth experience is something you will remember for your entire life. I have heard the most beautiful and appalling birth stories from elderly women who can recall very specific details about their births. Women remember.
Talk about your fears! Don’t hide them and foster them without the care of others. If you are being kept awake at night because of fear of childbirth, talk to your care provider and get connected with people who can share their positive stories. Our bodies are structured to do this. Look around at all the people around us and know that a mother somewhere birthed that person. There would be far fewer people on the planet if childbirth were always as horrible and scary as the worst story you have heard.
Lastly, ignore the cultural hazing of pregnant women. People scare pregnant women. You will never hear more awful birth and death stories or parenting nightmares as when you are pregnant. Unfortunately, women who are hurting often don’t have a place to share their pain about births that have gone wrong and a lot of that sharing lands at the feet of pregnant women. Its okay to not listen to that. More importantly, find positive and realistic stories rather than the worst case scenario tales.