Tagged over 35

Suddenly Uncertain: How My Post-divorce Love Makes Me Reconsider Motherhood

Adamantly childfree her whole life, this week’s writer finds herself considering motherhood at the age of 37. 

I was a lifelong “I never want kids, ever” person until divorce at 35 nudged me into some unexpected indecision.  I didn’t think I’d ever be considering children, especially at this age.  I also didn’t know I’d find the type of relationship that I have now, which has revealed how incredibly different one pairing of people can feel from another.  Being with a new partner for the first time in 15 years suddenly revealed possibilities and emotions I never imagined having.

When I was married, I felt secure in my decision to remain childless.  I had someone bound to me by the commitment of marriage who felt the same way, at least at the time, and was relatively fine with it.  Sure, I felt some pressure from society (and maybe a tiny bit from his mother), but most of my closest friends and family knew better than to question me on my decision.  I felt generally accepted; my husband and I were a united front, for the most part.  When I no longer had the partnership of a marriage to lean on, to hide in, I was suddenly exposed.  I was well aware that the possibility of meeting many different kinds of partners was out there:  among them, men who would want children, who would expect them.  Men who would judge me and reject me for not wanting them. I saw my lack of desire for children as a major strike against me.  For the first time in my adult life, I felt afraid to be myself.

The whole landscape changes when you become a single person again.  Lots of people who heard about my divorce would say “Oh, it’s so good that you didn’t have any children.”  Really?  Because it was totally different when I was married and everyone wanted to know why I didn’t have any.  That left me to consider what was so fortunate about not having children with my ex husband.  Was that concern over kids being caught in a nasty or dramatic split?  Maybe it was because then I could make a clean break, and I wouldn’t have to deal with my ex again.  Whatever the reason, those statements and all related discussions stopped as my identity as a single person settled in.  It was as if not having a family was now a foregone conclusion and wasn’t worth talking about anymore.  I guess I’d blown my chance…at something I didn’t even want to begin with.

It’s hard to say what exactly put the current uncertainty over having children into me.  Divorce is hard and terrible because you lose a lot, even when it’s relatively amicable.  You lose future, love, security, money.  I lost a lot of those things, but the scariest thing I lost was time.  If this had happened to me five years ago, I could’ve had a chance to relax and think for a minute.  It takes time to meet someone, and know them and love them.  The relationship I have with my current partner is so different from anything I’d known before.  I can only describe it as a deeper connection, sort of a stronger emotional engagement.  Loving someone and being loved in that way soothed just enough of my fears about the commitment of having a child with another person that I ended up on the fence when I thought my mind had been made up for as long as I’d been alive.

That deeper connection, plus the insight I’ve gained by going through a divorce, has made me uncomfortable with absolutes and that’s where the fence comes in. It seems fair to be honest that I’m not eager to have children, or that I don’t see it is a necessary life goal.  It doesn’t seem appropriate right now to say no to a partner unequivocally.  Sure, I would be most comfortable with someone who knew they didn’t want children, because I think deep down, I don’t really either.  But how can I say I never want something when I don’t even know yet where this relationship will take me?

We’ve got friends who are around the same age, even a year or two older, who recently had their first babies and seem really happy.  My partner sees it too, and I secretly overanalyze his responses to every online picture and status update.  He’s happy when people have babies, like a normal person.  When I hear about people having babies, it’s riddled with anxiety, like it somehow holds a mirror up to some dysfunctional or broken part of me.  It’s not something we talk about a lot, and I realize that’s counter to my earlier description of a deep connection.  Now, I’m approaching 37 and realizing that there isn’t much more time to think about this before it becomes a decision I can’t reverse.  Maturity and hindsight have ensured that my days of rushing into things are over, but rushing is quickly feeling like the only solution.

lyon

Mina Lyon is the pseudonym of a New Englander with incurable wanderlust.  She loves national parks, dirt roads, maple syrup, and solitude.  She is pretty sure she wants to get into bicycle touring and has her whole life ahead of her.

In the Waiting Room

From the editors: In this beautiful essay, Tara Parmiter, writer and writing instructor, explores the emotional landscape of infertility.

The official term she used was “missed abortion.” Five minutes earlier we had been sitting in the scanning room, the technician gliding her ultrasound wand through the sticky gel on my abdomen and broadcasting grainy black and white blurs on the computer monitor. It was the day of our nuchal transparency test, about 10 weeks into the pregnancy, and we nervously but giddily waited to learn about that mysterious fold on the back of baby’s neck and whether it warned of any chromosomal abnormalities. I knew our chances for such problems were increasing—I was already 34, after all, just a year shy of the dreaded 35 mark—but it hadn’t occurred to me to think the test could reveal anything worse. Suddenly, we were learning a whole other story about pregnancy, about miscarriages that occur in silence, about clinical procedures to empty out the remains of our hopes.

Since by profession I am a writing teacher, that afternoon I started a pregnancy journal and for the next five years I recorded our disappointments, longings, confusions, and failed attempts to recreate what had happened so simply that first time. “Everywhere I look I see women with bulging abdomens, birds nesting, trees blossoming, fathers snuggling a baby against their chests, and I felt so wonderfully connected to it all, “ I wrote that afternoon. “I had a second heart beating inside of me, and now it’s stopped.”

Two days later we were in a very different waiting room, the waiting room of an abortion clinic where the doctors were going to perform a “D&C,” or dilation and curettage, to remove the contents of my uterus. Wrapped up in my own grief, I didn’t give much thought to the other patients in the room or what had brought them there; I supposed we were all sitting on those uncomfortable seats because we had to be. My husband witnessed one woman, though, who must have been in our situation and a bit more fragile. After slogging through all the paperwork, probably landing on the form that painfully asked you to sign that you agreed to have an abortion, she accosted the ladies at the front desk. “Do I have to be here?” she cried, loudly enough for all her fellow patients to hear. “My baby died, I’m not killing it.” I’m glad I wasn’t there at that point, for I’m not sure I could have held it together. I too wanted to ask, “Do I have to be here,” not just in the clinic, but in this situation. I didn’t want to be experiencing this pain, and as the years passed and we seemed forever stalled in the waiting room, I kept returning to that question: Why do we have to be here?

My husband and I had consciously chosen to wait to have children. Though we had met in college—we even lived on the same floor freshman year—we had waited five years before dating and then ten more before marrying. Waiting was an essential part of our romance, a story line I loved to retell when others asked how we got together. When we finally did try to conceive, we lucked out so quickly that I assumed all we had to wait for was that happy due date nine months down the road. The missed AB shook us of our complacency, however. In the months and then years to follow, I finally had to acknowledge that clichéd ticking clock: what if we had waited too long? What if my body could no longer produce a viable life? What about those frightening health risks that multiplied for both baby and mother at a staggering rate once you passed that 35th year? I found myself thinking wistfully of all the periods I had grumbled about in my lifetime, wondering if my ovaries had already squandered the best I had to offer. After all these years of waiting, could there be any Faberges left in those baskets?

I cannot say whether this experience is necessarily different for younger women—even if you have years to try, the desire for something now is undeniably powerful—but I can say that because of my age I was intensely aware of the passage of time. Each month started a new cycle of hope and possibility, ending with the depressing red proof that we needed to try again. As an academic, I thought research might help me cope with my anxiety, so I started scouring the Internet and library shelves for insights on how to help us conceive. I turned to nutrition and altered my eating habits, grabbing more leafy greens, choosing the organic strawberries to avoid pesticides and increase my intake of iron—I even considered swallowing those slimy-looking oysters for their amazing doses of zinc. I turned to science and learned how to listen to my body, charting cervical fluid to maximize our peek conception days, peering at saliva under a tiny microscope to judge by the ferning patterns when I would be ovulating, starting each morning with a thermometer under my tongue to count the twelve days of elevated temperature in my luteal phase (the time between ovulation and the start of menstruation). When I grew tired of playing science fair, I read through on-line forums written by other women trying to conceive (or TTC, as they put it), and as I learned to decipher their comments about their DHs (dear husbands), the abhorrent AF (Aunt Flow), and their “angel babies” (miscarriages, like mine), I found myself wishing them “sticky thoughts” (i.e., hoping that a fertilized egg would implant). But none of this research got us any closer to success—instead of sticky thoughts we were just stuck.

The other downside of my obsessive researching was that it made me hyper-vigilant, prompting me to analyze each little creak in the settling house of my body and to wonder, “Could that be a sign that I’m pregnant?” It is amazing how many pregnancy symptoms the imagination can conjure in the two week wait between ovulation and menstruation, particularly considering that few women actually sense any definitive symptoms at such an early stage. Rationally I knew I couldn’t know anything until I menstruated or not in roughly two weeks, but that didn’t keep me from spending the intervening days reading pregnancy web sites to review, yet again, those indeterminate early signs.

What I hated was being on the far side of the moon; in those early years of space exploration, the astronaut’s wives had had to wait forty-five heart-rending minutes to hear whether their husbands would return triumphant to earth or shoot off into space. I knew I shouldn’t compare my uncertainty to theirs (if it doesn’t work this month, we would always say, at least we can try again!) but being out of communication range with my uterus for two whole weeks was almost too much to bear. My body couldn’t divulge its secrets yet, and so I would have to wait, wait for a chemical message to leak its way out and eventually whisper its news to the smiling face on the pee stick. If only conception could be like one of those carnival games, I wrote in my journal, something that flashes neon and immediately blares a congratulatory siren to announce that you’ve won—bull’s eye! You flipped the frog onto the lily pad, you whacked the mole, you toppled the cans, you smacked that yellow haired clown in the kisser, you scored big! Winner! Winner! Winner! But instead, you have to sit in the silence of the waiting room, trying to get your mind off your body, and preparing yourself for good or ill. My research had told me there’s a 20-25% chance of getting pregnant each month you try, and suddenly I found those odds remarkably slim.

This sobering realization did not take long to impress itself on us. In the months after the missed AB, we kept trying to conceive, but I seemed burdened by the feeling that I needed to make up for lost time. I think I had placed too much emphasis on a single square on the calendar: I was determined to be pregnant again by my original due date, for if not, what was the point of having lost the first pregnancy? I had some sort of idea about the balance of the universe, the fairness of things: well of course I needed to be pregnant by the due date, otherwise there wouldn’t have been any reason for the first pregnancy to have ended. But there was no point to the missed AB, I reminded myself; it happened, without malicious intent, without the desire to punish us or hurt us or make room for someone else.

We even learned that the missed AB was caused by a chromosomal abnormality called Turner syndrome, in which a misalignment in early cell division leaves the baby with only one set of chromosomes instead of the usual two, one each from mom and dad. Turner syndrome is not related to maternal age and does not suggest any problem with the parents’ ability to conceive again; it just happens, and most of the time, as with us, these babies spontaneously abort. All this information was mildly encouraging—the loss was still hard to bear, but at least I understood the science behind it and that science suggested we still had hope of conceiving a healthy child.

I found myself thinking of the mother goose in E. B. White’s Charlotte’s Web: when asked why she had seven chicks but eight eggs, the goose simply replies that the last one hadn’t hatched. “I guess it was a dud,” she says and lets Templeton the rat take it off to add to his horde of random treasures. It may sound a bit callous to shrug off that unhatched egg as a dud, but at the same time there’s an honest recognition of life in that statement. I wouldn’t call our first time around a dud, but I did realize that I had to accept the loss and move on with life. I had placed too much significance on getting pregnant by my due date, as if that would negate the pain. My deadline, though understandable emotionally, was arbitrary, and I hoped that once it was passed, I could relax and trust nature to do its work.

But no, soon years had gone by and with conception still evading us, I began to marvel that anyone ever makes it through to birth. The alchemy of our existence is mind-boggling. Just think of all the complications that can happen in that rapid nine-month growth spurt, not to mention the odds of starting the journey in the first place—transmuting lead into gold seems a much more likely prospect. I couldn’t help thinking of all the warnings we had been told as teenage girls that it only takes one time… Twenty years later, I wished pregnancy would be that inevitable!

I finally had to confront another unsympathetic medical term: infertility. Just writing that ugly word brings up images of barren, blighted landscapes in my mind when I had hopes, instead, of being a lush and green earth mama. The medical profession doesn’t mince with words: if you’ve tried to conceive for a year without success, you are infertile. That doesn’t mean you’re incapable of conceiving, but it sure sounds like that to a frustrated layperson. At first I couldn’t bring myself to accept such a damning diagnosis; in one of my lower moments, I spent an afternoon in the stacks of the public library reading a book on infertility—I couldn’t bear to check the book out, or even take it to a chair to read in a more comfortable spot, for that would require admitting that I needed such a book. So instead I leaned against the cold metal shelves, turning through the pages and silently crying. What if all our waiting was for naught?  Each year of trying our chances of conceiving were probably plummeting, and perhaps some day all the obsessive scrawlings in my pregnancy journal would amount to nothing more than a record of frustrations and lost hopes.

Given my intense longing, it surprises me how long we waited to visit fertility specialists. Perhaps our optimism kept us pushing off that trip, hoping that this last try would be the one; we both believed that what would be would be, and we told ourselves that if we never managed to conceive, we would find another way to have children in our lives. I liked to joke about a baby dropping from the sky, our own little Kryptonian we could raise as our own and whose secret powers we would hide from the world; a tiny part of me held out hope that perhaps that’s how this quest would truly end! But perhaps we were also frightened off by that bleak word “infertile,” unwilling to claim that name for ourselves.

We waited a year after I got a referral from my OB-GYN, treating that little slip of paper like an emergency button, a last resort, something we would only press when all our other hopes were dashed. When we finally did seek help, we were relieved to find out that nothing was actually “wrong” physically, so the doctors set out instead to speed our chances of fertilization. At first they gave me Clomid, an ingestible medication that stimulates the growth of multiple eggs instead of the usual one per month; when that didn’t work, they upped the dosage, and when that still didn’t work we moved on to Follistim, a more aggressive injectable medication. Every month we’d go through a new cycle of blood tests, fertility drugs, ultrasound, IUI (intrauterine insemination), and then a two-week wait before we started again. It finally felt like we were gaining some traction, but it still took a year of these medical interventions before the wait was over: for the first time since the missed AB, I was pregnant.

Of course, that’s when I remembered that in life the wait is never really over; we just move from waiting for one thing to waiting for the next. In the first few months of pregnancy my anxiety did not subside; if anything, the waiting between doctor’s appointments became even more intense. Perhaps I was still so shaken by the missed AB that I could not wrap my head around the idea that a baby could thrive inside of me. All my earlier research had consoled me with the assurance that many fetuses spontaneously abort in the first trimester; before the days of home pregnancy tests, many women wouldn’t even know for certain if they had been pregnant or if their cycle was just off. Though this information had been mildly comforting the first time around, I did not want that kind of consolatory comfort now. Every time we went to the doctor in the first few weeks I had a nagging fear that the baby would be gone; the first one had slipped silently away, what was to stop this second one from doing the same?

I was in a new kind of waiting zone, wanting to leap up and down with joy but still unwilling to let myself get my hopes up too high. I must have been one of the only crazy pregnant women longing for unpleasant symptoms rather than the subtle “maybe I am, maybe I’m not” discomforts I was experiencing. Why couldn’t I just do something dramatic, I wondered, like throw up in the middle of class? That would be pretty solid evidence that the baby was still there, and would certainly give my students an interesting story to write about.

But though my symptoms were relatively mild, this pregnancy stuck, and soon we had passed the day of the infamous nuchal transparency test, the one that had sent us spiraling all those years ago, and then the day of the full body scan, where we could see a little well-formed skeleton and a blithely beating heart. With each new scan the baby grew bigger, and with each new week its movements became more pronounced, more reliable, more like the blaring carnival games I had mused about years before as we struggled to conceive. Those nine months were still a long wait, but the nagging doubts gradually gave way to more hopeful anticipations. Our daughter even kept us waiting in the end, arriving a week after her due date, but by that point I was more than willing to overlook the slight delay.

Looking back over my journals I vividly remember the strain of our continual wait; as a woman steadily getting closer to 40 and thinking that her chances of conceiving were slipping away, my voice in those journals sways back and forth between optimism and dejection, between a Pollyanna-ish determination that all would work out well to an angry resentment that everyone on the planet seemed to be popping out babies except us.

Now that we’re out of the waiting room, it would seem like I could just close that book and move on—our daughter is a gift who keeps surprising us with joy every day and we’re so delighted we kept trying through all the disappointments. But that is all the more reason to share the story, because these stories are the often unspoken histories behind the children we bring into the world. My mother told me at one point that we don’t usually hear about the long struggle couples go through to have a baby; those stories can be full of pain and longing, uncertainty and embarrassment, jealousy and despair, and if we’re lucky enough to conceive and bring a healthy child to term, we focus on that shining narrative, not the murky days before. But just as our long years of waiting are an essential part of my husband’s and my romance, the long years of waiting are also an essential part of my daughter’s story, one that I plan to tell her and that I want to share with others who may be struggling through their own waits. Perhaps we need more often to break the silence of the waiting room, turning to face those couples sitting by us and remembering that while we were all brought here by our private woes, our stories might bring each other solace while we puzzle out why we have to be here and why we choose to stay.

parmiter_taraTara Parmiter received her B.A. in English from Cornell University and her Ph.D. from New York University, where she teaches in the Expository Writing Program. Her research interests include literature and the environment, urban nature writing, children’s literature, and popular culture. She has published on topics ranging from the imagined landscapes of L. M. Montgomery’s Anne of Green Gables novels to the green gothic landscapes of Stephenie Meyer’s Twilight saga to journey narratives in the Muppet movies.

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From Certain to Ambivalent back to Certain: An Interview with Liz

An elementary school teacher and part-time unit coordinator in a birthing unit, Liz is 38 and 14 weeks pregnant at the time of the interview. Liz immigrated to the U.S. from England when she was six and she became a U.S. citizen at the age of 36.

MS: Have you always known you wanted kids?

Liz: I always knew that I wanted kids and then I started to doubt that I wanted kids. I always wanted kids. When I was six someone asked me what I wanted to do for a living and I said that I wanted to be a mom.  But then, years went by and I was single and I think I was pretty depressed about being single and then

around 30 I was like, maybe I just won’t be a mom and that’ll be fine.

And all of my friends were having kids and whenever I hung out with them it felt very overwhelming and I thought, oh maybe not, maybe I don’t want that.

MS: So you went from certain to ambivalent and then you met Jeff?

We had been dating maybe a month, and he said one morning, do you want kids and I said, yeah. And that sort of surprised me too. And I said, does that make you nervous? And he said, yeah.  But it was my gut response.

Liz: When you were younger you envisioned yourself having kids, when did you think you would start?

Probably my mid-twenties. My mother had her kids when she was 24, 26, 30 and then I started to be those ages and I thought, I could not have a kid. Even if I had been in a relationship, I don’t feel like I was capable of having a kid at that point.

MS: What do you think is different?

Liz: My mom met my dad when she was 15. It’s just generationally different. They got married and had kids. And, I think that because of the internet and travel being cheaper, we have a million other things to do, whereas marrying young doesn’t happen as much.

MS: Do you think there are any drawbacks to waiting until you are over 35 to have kids?

I think the drawbacks to having kids later probably measure out to the same as having them earlier. You have less time with them more than likely. My kids will have less time with me than I have with my parents.

Hopefully, I’ll be a more patient and better parent than I would have been ten years ago.

I think I have more empathy than I used to. As a teacher, I am more able to put myself in another parents’ shoes and look for the best in kids rather than just reacting to them.

MS: How has teaching impacted your perception of parenting?

Liz: I think that teaching and seeing so many parents and families makes me realize that for 95% of people everyone is trying to do what’s best for their kids. I can’t always figure out how that works in their minds.

MS: Do you think your age has affected your pregnancy in any way?

Liz: I doesn’t seem to have. I’ve been to the maternal-fetal medicine specialist because my mom had problems and because I am advanced maternal age, and they said, everything looks really good. I can’t complain about anything in my pregnancy except for the nerves. I haven’t felt sick; I haven’t thrown up. I feel fine.

MS: What is making you feel nervous?

Liz: I know that this baby needs another ten weeks of gestation. It’s just that unknown. Every ache pain, cramp, everything I put in my mouth, can I eat that, can I not?

MS: Do you think you would’ve been as nervous if you were younger?

Liz: Yes. All my lab results are good. I just think until this child comes out and both of us are responsible for it, I’m the only one responsible for it. I wanted a sip of wine the other day and our doctor said no, and I said to him, it’s not about the alcohol, it’s about feeling normal. I feel fine, but I never feel normal anymore because every single thing I put in my body, every action I do, I think about this baby.

MS: Do you think that’s healthy?

Liz: No. I do think that because the American College of Gynecologists wants to cover their asses they are doing a lot of telling you you can’t have certain things so I then look up, well does Europe do that? If Europe and America agree, then I won’t eat it, but smoked salmon, England eats, so I’m going for it.

MS: How has working in a birthing unit impacted your perception of pregnancy and delivery?

Liz: I switched to a midwife recently and I was talking to the nurse when making the appointments and she said I had to have a doctor to go along with my midwife and she said this particular doctor is very blunt and then this other doctor will talk to you for hours. And I said, who has the lowest C-section rate? That was my deciding factor because, when a woman has been in labor for hours and the red sox game is coming on, I’ve seen doctors make the call to do a C-section.

MS: If you could give your 25 year old self advice about pregnancy and motherhood, what would you say?

Liz: Vanity speaking, I now show and most people at 14 weeks don’t show. I read that because my core was not solidly in shape, that there’s no muscles holding in my uterus. I would tell myself to be in good shape. The better shape you are in, the better your recovery will be.

MS: Sometimes there’s friction between mothers and non-mothers, have you ever experienced this tension?

Liz: So many of my friends have kids and I always tried to be very understanding. I always really liked babies and I would go over and help out. I think I had a hard time when I was a non-mom not by choice. I had a particular friend who, it was right around when my dad died, and she found out that she was having a second boy and she told me about the “grief” she was experiencing, from this planned, health pregnancy!–because she was having a boy instead of a girl, and I had a really hard time forgiving that. She and I had talked very openly about how much I did want kids and it wasn’t in the cards. So for her to use the word grief, I was so taken aback.

MS: Do you think it’s a trend of moms to be insensitive to nonmoms?

Liz: I was just at a cocktail party with a woman who told me she was trying to get pregnant and had done six rounds of IVF, and everyone who came into our conversation and just found out I was pregnant would try to talk about it, and I would try to steer the conversation to anything else.  I was not feeling guilty but feeling this poor woman does not need to hear about all of these things when she is going through this.

MS: Do you think being pregnant at an advanced maternal age helped you develop the sensitivity to steer the conversation that way?

Liz: Yes, knowing the feeling of longing to have kids and not being in a position to have them. Those conversations are not where you want to be. I didn’t always want to hear the pregnancy talk from my friends with their big bellies, but I listened.

A Doula’s Wisdom: Interview with Sarah Thayer

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.