Still from Grey’s Anatomy (ABC)

In the recent Grey’s Anatomy season finale, Carina DeLuca referred to Teddy Altman’s pregnancy as geriatric. Not surprisingly, Teddy was less than thrilled, saying it added to her labor pain.

“It’s just the term!” Carina explained.

A surgeon herself, Teddy was well aware of the medical terminology. That didn’t make it any easier to accept, especially during the throes of labor and birth.

Even in the world outside of TV hospital drama, “geriatric pregnancy” is a real medical term used to describe a pregnancy in a woman age 35 or older. It’s also sometimes called elderly pregnancy — again, not a particularly likeable phrase for most childbearing women.

You may be most familiar with the words advanced maternal age (AMA). That seems to be the least harsh term and the one we prefer.

Why is advanced maternal age worthy of discussion, anyway? And does being older risk women out of receiving care and delivering at a birth center? (Spoiler alert: The short answer to the latter question is no.)

It’s such an important subject because delayed childbearing is common these days, and nearly half of the women we serve are older than 35.

The history of advanced maternal age

You may be wondering, is there something magical that happens to a woman when she turns 35? Actually, no. There is no AMA fairy who sprinkles glittery dust on 35th birthdays.

The number is based on a 1978 recommendation from the National Institutes of Health to offer amniocentesis to women, age 35 and older. At the time, amniocentesis was a new technology that allowed for testing a fetus for Down syndrome. The procedure carried a risk of miscarriage, so it was suggested only for those with an increased chance of having a baby with chromosomal defects.

These days, amnios are not as risky, and there are much less invasive methods to screen for chromosomal defects. Still, that number 35 has held on, drawing for us a line in the sand.

At San Francisco Birth Center, we offer evidence-based care, and we recognize that line of age 35 as a guide. More importantly, though, we use it as a conversation starter, helping women understand their risks while encouraging them to make confident decisions.

San Francisco Birth Center’s approach to advanced maternal age

You may have heard that a woman of advanced maternal age automatically has a high-risk pregnancy. While older women can be high risk, determining risk is very personal and depends on each woman’s bigger medical picture.

When we first meet with women of advanced maternal age, we certainly talk about risks. Because research indicates that older pregnant women can have high levels of concern and anxiety, even if their pregnancies are perfectly healthy, we reassure them and normalize their experiences. We have worked with many women over 35 and witnessed lots of beautiful pregnancies and normal births. The team at San Francisco Birth Center doesn’t catastrophize AMA, but we are honest that the experience may not be the same as it would be for a 25-year-old. This direct approach helps ground our clients as to what to expect.

It’s important to note that we have a conversation about risk with every family we serve, not just those mamas who are older than 35. This is because every pregnancy and birth carry risks, no matter where the care and birth take place or how old the patient is. We are honest and build trust; we want families to know we’re going to be real with them. Women of advanced maternal age are no different. All of our clients are making choices every single day about various risks, and we are here to help them navigate the experience.

We support women in a caring way, not in a manner that stirs fear of complications or implies requirements for screenings or monitoring. We present the information and allow women to decide what they want to do with it. We don’t automatically funnel our older mothers into a high-risk category.

Understanding advanced maternal age and its risks

When we’re talking about conception, pregnancy, labor, and birth, age is definitely an important factor. These things can be more difficult and sometimes more complicated when women are older.

For example, women who are 35 or older are more likely to have trouble conceiving or to miscarry than women in their 20s or early 30s. In addition, studies have shown that women of advanced maternal age have higher chances of the following:

  • Chromosomal defects
  • High blood pressure
  • Gestational diabetes
  • Preeclampsia
  • Placenta previa
  • Preterm birth
  • Low birth weight
  • Stillbirth
  • Cesarean section
  • Postpartum hemorrhage

However, these same risks also exist for younger women. 

If clients are concerned about AMA risks and choose to have genetic screening, we support them. If they decide to forego additional testing, we continue to stand by them. This is the midwifery model of care.

Takeaways about advanced maternal age

We love working with all moms, including women of advanced maternal age. They are healthy and knowledgeable, and we find them to be particularly thoughtful about the kind of care they want.

In speaking with women in the Bay Area, we sometimes hear statements like, “If I’m over 40, I can’t go to a birth center.” That is absolutely false, especially if age is the only risk factor.

Simply put, advanced maternal age does not necessarily equal a high-risk pregnancy. Age alone is not a reason to exclude looking into San Francisco Birth Center.

If you’re over 35, come check out San Francisco Birth Center by registering for a Meet the Midwives Information Session. Occurring twice a month, these free sessions offer a chance to ask questions, tour the birth center, and meet us!