Choosing pregnancy over 40. And not apologizing.

In the 1970’s, the decade of my own birth, pregnancy at 40 was rare, and hardly ever a conscious choice.

Fast forward to now, the futuristic year of 2020. Pregnancy, and the creation of ‘family’, is a completely different game. With the science of fertility clinics worldwide, those who would have never been able to mother or father children outside of adoption, have available a host of opportunities.

Many women of my generation have chosen to pursue careers, second marriages, or even honored sexual orientation attractions they would have never ventured for. All with the knowledge of the many fertility options when the time came to start their own family, however that may look.

The wonders of Intrauterine Insemination (IUI), In-Vitro-Fertilization (IVF), surrogacy, and fertility drugs such as chlomid, are just a few examples of how the miracle of pregnancy has reached new heights of possibility. Many who venture on these alternative measures for pregnancy have tried the “natural way” and failed. These are the women who have weighed their options, know the risks, and forge ahead.

Photo by Carlo Navarro on Unsplash

But what if you are 40 (or more), and you just want to have more children? What if you were the one who pursued that amazing career, or traveled the world instead of conforming to a family of 2.5 children? You explored, grew up, invested and indulged. There was no one depending on you to be at their preschool concert or 5th grade graduation.

What if it was your choice to not have children, or wait to have children, and now you are ready???

There is an underline stigma surrounding women over 40 who do choose pregnancy. As a labor and delivery nurse, I feel it in the words of the twenty-something colleague who reports the woman’s history and labor progression. I know the insinuation coming from the forty something OBGYN, calling me to request their labor induction appointment.

It many be unintentional, but the judgment remains.

There are good reasons to avoid pregnancy at Advanced Maternal Age (AMA), which is determined to be at 35 years. In fact, the term AMA is sometimes referred to as a “geriatric pregnancy”, which intones a whole new level of stigma and discomfort. (Who would ever consider themselves to be geriatric at age 35????).

With it comes the realities of increased risk of miscarriage, chromosomal abnormalities, low birth-weight or premature delivery, or conceiving more than one baby (twins). It can also effect how efficient the placenta is and how quickly it breaks down. Any labor nurse will tell you an “old placenta” is not a desirable placenta, when the mother enters labor and the stress begins to affect the baby. There is also an increased chance of c-section delivery for some of these very reasons (The Mayo Clinic, 01/20/20.

The effects are also not exclusive to the baby. Women are at a higher risk for gestational diabetes and high blood pressure over the age of 35 (The Mayo Clinic, 01/20/20). These health considerations can lead to hospitalizations, a need for medications such as insulin and antihypertensives, and more frequent evaluations for the woman as well as baby’s health. Add to the list any preexisting health conditions such as obesity or asthma, and the stakes only get higher.

Many questions surround a woman’s decision to intentionally get pregnant after age 40, especially if they have already started their family. It’s impossible to escape the scrutiny and judgment of society, and that of the healthcare providers who know the risks involved.

Photo by Camylla Battani on Unsplash

So to answer the question of IF, you must first answer the question of WHY. Humbly, this is so personal a decision it is not for myself, or any of us really, to pass judgement on.

Nearly forty when my third son was born, it was almost expected I would not press on. How fortunate indeed I was to carry three beautiful, healthy, term children. Even more so, I did it without any sign of complication so often associated with pregnancy of any aged mother.

In fact, how dare I even consider pressing my luck?

Still, I had to consider it. I still wanted a daughter for one thing (see Letting Go of My Girl to Fully Embrace Boy Motherhood). But aside from that, I LOVE being a mom. At any stage. Sure, sleepless nights and dirty diapers can strain any desire to re-procreate. But in my mind, the pros definitely outweighed the cons. Even IF it was another little boy.

But age does factor in, and in the end I decided it was unfair to bring another child into this world intentionally, when its parents would be pushing 70 at their high school graduation. Nature decidedly had a point; I was accepting my body may not be up to the challenge again. I was ready to embrace where life had led me, at the stage that it had, without complaint or regret.

I decided to just be grateful and accept this next stage of my life, letting go of my youthful child bearing years. I was embracing my new body and my new life ahead with all the challenges and rewards it may bring.

I did not come to this decision easily. I did not come to this decision without some sense of loss. But I DID come to this decision on my own, without listening to the judgement others feel so freely to pass.

Photo by Kalea Jerielle on Unsplash

It’s your body, your life, your happiness. If it feels right to you, move forward with your eyes wide open, while taking the rest of it in stride.

You’re over 40 and want to get pregnant? Think through your options, risks and desires. If you decide to go for it, NEVER apologize for wanting to embark on this beautiful, life fulfilling journey no matter what circumstances led you here.

How could I have ruined my baby’s teeth??? What EVERY expectant mother should know…

One of my lovely co-workers is also a mother of three beautiful children. We treated our pregnancies very similarly. Conscious of every food choice, staying active (admittedly she more than I), getting ourselves to every prenatal visit with our midwife.

In other words, we both took the very best care of ourselves and our unborn children from the moment of conception. My friend was even a little braver than I, delivering her children at a local birth center. All went smoothly, she has three beautiful, perfect, lovely kids.

Well, almost perfect.

Her first born started showing signs of tooth decay because of poor tooth enamel at a very early age. She hadn’t expected this turn of events, being that she fed her kids a very healthy diet – sugary foods and drinks not even available – and had breastfed her children as long as her body and baby would allow.

They all had healthy dental hygeine habits…singing ABC’s along with their light-up toothbrushes, ensuring they brushed long enough twice a day.

So how did this happen?

Photo by: Sarah Pflug on Burst

The culprit? A Vitamin D deficiency.

Now wait. Didn’t she eat a healthy diet? I know she did. I watched her eat salads, fruit and veggies, feeding her unborn baby organic, untainted food.

Certainly these foods would have provided her baby enough Vitamin D?

Not always.

It’s a common misconception that when eating a generally heatlhy diet, along with prenatal vitamins that have enough folic acid, you will consume exactly what you need to feed your body and baby duirng pregnancy.

Actually, it wasn’t until recently, (the first article I found was dated 2008) that scientists linked the lack of Vitamin D in utero to a child’s dental health. Click here to read more of the facts.

Basically speaking…low vitamin D levels in pregnancy may affect tooth calcification, leading to enamel defects (the coating that protects our teeth), which in turn leaves the tooth subject to cavities.

What can I do?

It’s actually pretty easy.

Prenatal vitamins will not give you enough of the good stuff to protect your baby. The bottom line is you need at least 2000 IU of Vitamin D a day in pregnancy. Most prenatal vitamins have between 400-800 IUs. (Don’t double your vitamin! Getting too much of the other stuff is not okay!).

Vitamin D is found in milk, cheese, fatty fish (such as salmon), cod liver oil (ummmm yuk???) and eggs.

Fortunately for our taste buds science has found a way to give us cod liver oil efficiently through supplements…just look for fish oil or cod liver oil supplements at your local vitamin supplier (yea for our taste buds!).

Photo by Dakota Monk from Burst

There’s also plenty of Vitamin D in sunshine…but don’t count on living in a sunny state like Colorado as being enough. It wasn’t for my friend. And of course there are risks of too much sun exposure.

So…no, you can’t get your doctor to write a prescription to spend your nine months on a tropical beach for health benefits (sigh….).

Taking the extra supplements, as well as getting higher doses of dietary Vitamin D and some of that good ‘ole sunshine, will give your baby the best chance of forming good enamel on their teeth. Plus it is also shown to aid in brain and heart health, as well as decreasing the incidence of inflammatory linked diseases. Plenty of good reasons – besides good teeth – to get plenty of it throughout your pregnancy.

Teeth start forming as early as 14 weeks of pregnancy, so don’t wait! You cannot overdose on this fat-soluable vitamin so taking it even before conception is okay.

Photo by: Tamara Chemij on Burst

The lesson.

Guilt plagues my friend, as she watches her daughter struggle with the result of something so easily avoided. She knows intellectually – as a nurse – that there was nothing she could have done differently, soley beacause she didn’t know. But as a mother – it is difficult not to blame oneself. Your job is to promote your child’s health, and in her eyes she failed at that.

The fact that my children don’t have the same issues is actually a surprise. It’s possible the glass of milk a day my mother got me in the habit of drinking is the only thing that saved my kids from the same fate.

Whatever the case, the lesson is to keep your eyes and ears open because there is always something new science uncovers. I’m simply lucky that this didn’t happen to my kiddos, and my friend is happy to share her story with others so they don’t have to go through the same trauma.

Natural or medicated? How to experience bliss after labor.

One of the most common dilemmas as a pregnant mom is whether to have a baby naturally or with some sort of pain management. There is so much controversy, conversations and opinions surrounding this subject. There is such judgment placed on the mother’s choice; by friends and family, caregivers and spouses. The people I find to be most unforgiving are the pregnant moms themselves. The perception being that an epidural or other medications during labor is like admitting a weakness, disqualifying them as a good mother. The ultimate failure.

What is it in our culture that has brought us to this point? I cannot imagine a time when a woman will go to the dentist and choose to have a tooth extraction without any kind of analgesia, just to prove their strength and worth as a human being. Even less likely still, a man who would choose this with his wife’s encouragement. Telling him he is less of a man if he gives into the novocaine. Really????

My nursing perspective

As a labor nurse I have watched many struggle with this choice. The peer pressure typically steamrolled by the ultimate choice made in pain, with regret and self hatred soon to follow. I will never forget a teenage girl I cared for, holding so dearly to a fear of paralysis that she refused to listen to knowledge and reason. In more than eleven years, I have not witnessed nor heard of an epidural causing permanent damage. Unfortunately she refused to listen, and consequently was completely miserable in her experience. She was so exhausted and in so much pain by the time her little one arrived she did not seem to enjoy the precious moment of holding her newborn son. It was incredibly sad to watch, mostly because it was unnecessary.

As a momma

I can speak about this from the other side of the bed as well. I have labored three times, and had very different and beautiful experiences with each one.

My firstwas very typical of a first time mom. My water broke at home, the contractions started and slowly built in intensity. I was able to manage well until I hit about 6 centimeters, and then was overcome by the intense pain so many fail to describe. I went from walking the halls with my husband to doubled over with tears streaming down my face. I was unable to fathom the will of a woman who chooses to endure such an experience. The epidural soon followed and I delivered my beautiful baby boy eleven hours later. It was bliss.

My second son was a different story. I had planned on an epidural again, remembering the intense pain and ultimate relief of my first experience. When my water broke promptly at 11pm, I thought this baby would be the same. By the time we were halfway to the hospital my husband was driving close 100 miles per hour, mostly because I was scaring the bejeezus out of him. When we arrived at 12:18 AM I declined to wait for a labor nurse to pick me up, desperately needing that epidural I knew would save me. My husband eagerly drove my wheelchair to the labor unit and an IV was placed…I was almost there! Alas, the urge to push prompted my labor nurse to check; I was indeed 9 centimeters dilated. She was nice enough to pretend the epidural was on its way (thank God for kind labor nurses), and as I delivered my son at 12:37 AM the doctor hardly had time to put her gloves on. It was the most intense, exhilarating and surprisingly wonderful experiences of my life. I now understood what the hubbub was all about! This was amazing! This was bliss.

So I had nine months with baby number threeto decide. What was my choice going to be? I knew I had the physical strength to be without medication for my delivery. Now it came down to making that my choice. Honestly I wasn’t sure I could do it. But as these things go, I was presented with the option. My labor was not strong like my second one, I had decided to go for it! I could do it, what was the big deal? I had already passed the test. The test of all mothers…I was a superwoman!!! When my midwife wanted to break my water I avoided her at all costs. I was waiting for my husband. Then I walked the halls. I couldn’t bring myself to let her do it, I knew what was in store. Oh the doubts that floated through my mind! Was I crazy??? Why would I intentionally go through such an experience a second time? I was so torn.

The decision

Eventually I gritted my teeth and got it over with. I warned my labor nurse I would beg for the epidural at some point, and asked for her help though that moment. It wasn’t much later that my husband recognized my behavior as the same in the car ride 6 years before (he was pretty grateful to be in the hospital room at that point!). I wanted nothing more than to wipe the smile off my nurse’s face when she told me I was almost completely dilated. Didn’t she hear me? I CAN’T DO THIS!!!! But she was a dutiful nurse, and a very dear friend, so she did what I had asked when I was lucid and sane. (Come on… was I really sane when I made that choice?) She got my my midwife and they both coached me through the last few minutes of my labor (wait…it wasn’t hours???). One very intense hour and 15 minutes after my midwife broke my water, I was holding my sweet precious boy. It was…bliss.

Your power

It was so empowering to deliver my baby like this. With nothing but my own strength as a woman, a mother, hell a HUMAN BEING to guide me. The truth??? I did not feel any less empowered or any less like a strong beautiful momma with the epidural. Nor so when I had no choice in the matter. It really and truly didn’t matter. Each birth was special, unique and incredible beyond words.

The bliss

I am convinced it has nothing at all to do with how you deliver your baby but is really about the belief you have in yourself. So many factors go into your birth, many of which are completely out of your control. My advice? Trust your doctor or midwife, trust your labor nurse and trust yourself. And above all…know yourself for the beautiful mother you are and are about to become. Nothing in the universe can change that. It doesn’t matter how you get there, participating in and bearing witness to the amazing beautiful miracle of your child’s birth is simply put…bliss.