Despite Increased Risk, Number Of Over-35 Moms Rising
By Jen Rini, The News Journal
Heather Rooks didn't write out a master life plan, but she had thought that by 29 she'd probably be married, and a bundle of joy would be on the way by her early 30s.
"That's not the way the cookie crumbles," Rooks said. As a young woman she says she wasn't really into the dating scene. It seemed natural to put a hold on things until she met the right person she could see herself starting a family with, without giving up her medical career and travel ambitions.
"There were some moments there where I was like this may not happen for me," she said of motherhood.
Fast-forward to today. The Wilmington resident holds a chiropractic doctorate, has her own practice specializing in functional medicine and as she approaches her 40th birthday in March, is engaged and regularly chases a 2-year-old.
"I was never that girl that could only picture her life as a mother. There were things I wanted to do, things I wanted to accomplish before I committed. Once you are a mom, you give a lot of your time."
Rooks is not alone; over the last 12 years the number of first-time moms in their late 30s or early 40s jumped in 33 states, according to an analysis by the Centers for Disease Control and Prevention. Between 2000 and 2012, the rate of Delaware moms ages 35 through 39 giving birth for the first time increased 26.5 percent. For moms between 40 and 44, the number of births rose nearly 54 percent.
"Folks are putting off pregnancy for a multitude of reasons, because they are pursuing education, because they want to get financially really stable before starting a family. Most people nowadays are two career parents," explained Dr. Anthony Sciscione, director of Christiana Care Health System's Delaware Center for Maternal & Fetal Medicine. Of the 6,000 deliveries at Christiana Care, there were 1,277 mothers 35 and older who gave birth during 2014.
However, with the increased age comes some increased risk for mom and baby.
Protecting the bun in the oven
As maternal age increases there's an increase in the rate of chromosomal abnormality, said Sciscione. A woman is born with all the eggs she will have throughout her life. The eggs age as she ages. If a woman is 23, her eggs are 23. If she's 42, they will be 42, too. Scientists believe the genetic material in a woman's eggs can be distorted as the eggs age, which can lead to birth defects, miscarriages or conditions such as Down syndrome
"When you are 25, the risk of Down syndrome is lower than if you were 35," Sciscione said.
In the most recent Pregnancy Risk Assessment Monitoring System survey for Delaware, 21.4 percent of women surveyed over 34 had a miscarriage, fetal death or still born, a year before getting pregnant, compared to 13.63 percent of 25- to 34-year-olds and 11.37 percent of 20- to 24-year-olds.
"Miscarriages are relatively common. The most common reason for miscarriages is there is a genetic abnormality," he said. He's says he tells moms that miscarriages are nothing they did. "They happen on their own."
Chances are, after a loss, the next time a couple tries to conceive, the baby will make it, he said. Rooks, for instance, had an early miscarriage, but was able to conceive her son months after. She says the first time was a "fluke."
The risks increase exponentially, however, if a woman has diabetes, hypertension or an underlying medical condition.
"One of the things that is absolutely stunning is the rate of obesity in pregnant women. Now with that increasing rate of obesity and increasing age we are seeing more of the co-morbitities. Hypertension and diabetes can have profound affects," he said.
Sciscione recommends talking to a trusted obstetrician and developing a strategy if you have a health issue or if you are at risk for certain diseases. For instance, a teacher may be at risk for parvovirus infection – a highly contagious childhood disease characterized by a distinct face rash – which is much more severe in adults, or cytomegalovirus a rare virus that causes infectious mononucleosis.
Infertility issues may come up during a consultation as well. Sciscione defines infertility as one year of unprotected sexual intercourse without conception. Many women consider in-vitro fertilization, an assisted reproductive treatment where mature eggs are collected from the ovaries and fertilized by sperm in a lab. Though it has gotten safer over time, he says there still are some risks including premature delivery, multiple births and miscarriage, so women should weigh them carefully before jumping on board. On top of that, they should consider its expense; treatments can cost between $10,000 and $15,000 and are not normally covered by insurance.
Still, Sciscione estimates about 800 women at Christiana underwent the treatment, sometimes multiple times.
In either case, nutrition counseling, exercise and weight loss are crucial to protecting the baby. Smokers need to put out the cigarettes for good, Sciscione added.
"If you are smoker there's no doubt that increases the risk of pregnancy. We would ask you go into a smoking cessation program. As far as nutrition ... really it's what my Italian grandmother told me – eat healthy, eat a balanced diet, eat your fruits or vegetables."
Prenatal vitamins containing folic acid are a crucial supplement to balancing diet. Folic acid is a B-vitamin that the body uses to make new cells. Taking 400 microgram supplements a day can prevent birth defects in the baby's brain and spine, according to the CDC.
Forty-year-old Emily Cunningham started taking prenatal vitamins by the time she was 34, around the same time she married her husband, Tim, in 2009. They both knew they wanted to have children, and tried immediately.
"For me making sure my body was continuing to get those vitamins was very important," said Cunningham.
At 35 she got pregnant, but wound up losing the baby. The pair tried again when she was 36 and got pregnant with their daughter Olivia. Two years later, they had Ellie when Cunningham was 38. During her pregnancy she progressively visited the doctor more and more for well-checks. During her second trimester, three months into pregnancy, she visited the doctor once a month. During the last month of her pregnancy it was once a week.
She said she breast-fed both for a year after they were born and exercised regularly during that time. Both girls, now 4 and 2, are healthy and enjoy life by the beach where the family lives in Rehoboth.
"Tim and I are very active with the kids. We are out every weekend taking them to the beach, doing all the things that younger parents do. We have a wonderful appreciation for our children. Because we lost a child it makes you appreciate a healthy, fun kid. There are lots of people that will never have that opportunity," Cunningham said.
Work, play and baby
Birthing rates are also connected to marriage rates says Kathleen Turkel, assistant professor of women and gender studies at the University of Delaware.
"People are marrying late or not at all," Turkel said. "If we are looking at babies born to unmarried women 23 percent are born to teenagers. The largest increase of births to unmarried women has been to women 30 and older. The speculation is the fact that women are marrying later or not at all contributes to increases to births outside of marriage."
The trends are consistent among all cultural backgrounds, and correspond with changes in social trends. More women are going to graduate school and building a career, Turkel said, which equates to more money.
According to the PRAMS survey, Medicaid helped pay for births for 30 percent of women surveyed over 34, compared to 36 percent of women between 25 and 34 and 75 percent of women between 20 and 24.
"We see more financial security. Women with college degrees who marry after age 30 earn more money than women who marry earlier and that is also true with women who have high school diplomas and no college," she said.
Both Cunningham and her husband hold down high-power jobs. She's been appointed deputy chief of staff to newly confirmed Del. Attorney General Matt Denn, after leading his staff during his lieutenant governor term. Tim, 18 years her senior, though technically retired, was recently appointed to the position of director of public safety at Delaware Technical Community College.
Both girls go to daycare, but Cunningham said she doesn't skimp on the time they spend together.
"When I was younger it was about me. Now it (motherhood) helps me balance my life a little bit and I know I have to leave my job at a certain time. As long as you love your kids and are involved ... you have a really good relationship with your kids. It doesn't matter if you are older or not," she said. "I think I have a lot to offer my kids. I want them to see me work and enjoy my job and enjoy my life."
Rooks said her family always put education first. Her grandparents were refugees from Cuba, who instilled in her the notion of freedom and a solid work ethic. They gave up everything for a chance at a better life, she said.
"I took it seriously," Rooks said.
Education, travel and pursing her practice, PATH Integrative Health Center, now based in Chadds Ford, Pennsylvania, became her calling. It may have been awkward in her 30s being the only single one out of her girlfriends, but she wouldn't change how things turned out.
"I'm not just a mom, I'm also a partner to his dad," she said.
"You can't have your cake and eat it too. I can't expect to have gone through chiropractic school built a business and sold it, traveled to four continents and do the things I'd be able to do and have a baby."
She doesn't care that she will be 55 when her son Rook is a senior in high school. Age doesn't matter when it comes down to love.
"He is the light of my life. It's all for him," she said. "I want to set him up for the best I can."