Home birth after 40
January 3, 2012
Andrea Gordon
FAMILY ISSUES REPORTER
Bonnie Pascal’s son drew his first breath on his mother’s bed, surrounded by women.
It was seven years ago, and Pascal was in her 40th year. The birth, attended by her husband and three midwives, was bloody, wrenching and joyous. And baby Aaron? The picture of health.
Nine months earlier, Pascal had never envisioned she would be delivering a baby in her home. The freelance designer and artist had always wanted children. She met her husband and married at 38. When she found out she was pregnant, her family doctor asked if she preferred an obstetrician or a midwife.
“I said ‘I’m almost 40 years old. How can I go to a midwife if I’m high-risk?’”
He told her a healthy pregnancy was not high-risk and suggested she go straight to the source to find out. At the midwife’s clinic, she clutched a list of two dozen questions, expecting to be told she wasn’t eligible.
She was.
Women hear so many warnings about declining fertility and the risks associated with pregnancy after 35 that they often assume it’s not healthy, says Joyce Engel, an assistant professor of nursing at Brock University who has studied older mothers.
They are labelled as “advanced maternal age,” scrutinized and subjected to an array of tests and screenings. Birth for that group of women is medicalized.
Indeed, Engel says that the level of monitoring that goes on it’s no wonder there’s so much information about risk factors. But the fact is, one in five of all pregnancies ends in miscarriage, but far less is known about miscarriages in women under 35.
Half of women over 40 who give birth have caesarean sections. But Engel questions how many are planned in advance to offset fear and anxiety rather than for medical reasons.
Toronto midwife Jennifer Goldberg says that one or two of every 20 new clients at her collective, the Community Midwives of Toronto, is over 40. They tend to be “super healthy” — they are fit, eat well, don’t take risks and are well-informed. Many, including those who have conceived through in vitro fertilization, are drawn to midwifery care because it gives them the chance to be in the driver’s seat.
Midwives can provide close surveillance and offer screening for genetic abnormalities or conditions such as gestational diabetes. If advisable, they can share care with an obstetrician.
Pascal was worn out after childbirth and struggled with breastfeeding problems. But she says the post-partum care from her midwife sustained her through the early stage of mothering.
“I had absolutely wonderful care.”