Giving Birth to a Controversy : Personal health: Science may have enabled older women to become mothers, but some experts wonder if older moms have the endurance necessary for child-rearing.
Motherhood, it seems, is not necessarily just for the young. Thanks to medical progress, the young-at-heart now qualify, too.
Just ask Barbara Strong who, at 42, gave birth this year to a daughter, years after physicians told her she would never have children because of ovary damage from drug treatment for breast cancer.
On a recent weekday morning, Strong, a psychiatrist, played with Christina, 8 months old, and Juliana, 1, the daughter she adopted with husband Robert Wilson. In a few hours, she’ll dash off to care for patients.
Life is busy and fulfilling, Strong says.
“I don’t think at 40 you’re over the hill,” she says with a laugh, hauling Juliana upstairs.
Strong became pregnant in June, 1989, after doctors implanted an embryo conceived in a test tube from her husband’s sperm and an egg from a donor, a young woman who lives near Strong in El Monte.
Although Strong’s ovaries were not adequately producing eggs, she and other menopausal women are able to bear children successfully if they receive an embryo from donor eggs and hormone injections in the first three months of pregnancy.
The results of one study on seven women, including Strong, were published in last week’s New England Journal of Medicine. Of the seven women, ages 40 to 44, four gave birth to healthy babies.
The use of donor eggs for in vitro fertilization is not new. But what has evoked widespread fascination is the discovery that some women who are technically menopausal can still carry a child. Some researchers now refuse to put an age limit on motherhood.
But the brave-new-world science raises at least one practical question that can’t be answered until long after baby leaves the nursery: How will pregnancy and raising babies play in middle age? While some argue that older parents have numerous advantages over younger ones, others contend that although the spirit may be willing, the body just may be not be able to cope with the rigors of child-rearing.
Some experts point out a downside to middle-aged motherhood: The medical risks to both mothers and babies increase substantially when the parents are over 40. And some sociologists say children of older parents sense a difference in their upbringing.
But according to 40-ish mothers like Strong, babies born as the biological clock is ticking are wholeheartedly--sometimes desperately--wanted. The parents are often financially stable, secure in their careers and calm in their management of children.
Strong and Wilson always wanted to have children, Strong says, but postponed starting a family to pursue careers after their marriage in 1975.
They decided about seven years ago to start a family, when Strong was 36 and Wilson was 37. But the long-anticipated plunge into parenthood was sidetracked by several traumatic events.
Strong miscarried her first pregnancy. She became pregnant a second time, but just a few weeks before the child was due, she delivered a stillborn baby. The couple was determined to try again when Strong discovered she had breast cancer.
The cancer was successfully treated, but the chemotherapy Strong received damaged the function of her ovaries--the organs that produce eggs. Her physicians advised her to forget about having children.
“I still had a little bit of function of my ovaries. But the doctors thought that women at 38 are too old to have children,” Strong says. “But I didn’t give up.”
Strong frequently reads medical journals, and one day she saw a brief article by USC physician Mark Sauer on the use of donor eggs and embryo transfer for women over age 40.
At the time, the couple was considering finding a surrogate, who would be artificially inseminated with Wilson’s sperm, to carry a child.
“I wanted to have a baby so badly,” Strong says. “We were thinking about using a surrogate, but I thought if I could experience pregnancy and childbirth, I didn’t want to give that experience to another woman.”
Strong knew the medical risks of having a child increase after age 40, but they are not considered extreme. Infant mortality increases to 12 deaths per 100,000 live births when women reach age 40, compared to 9 per 100,000 at age 30. Maternal mortality rates are also higher at 40 (80 per 100,000 live births at 40 versus 20 per 100,000 at age 30).
Older women are at greater risk for complications during pregnancy, such as hypertension and diabetes, and often require delivery by Cesarean section.
The risk of genetic defects is also much higher among older women when the woman’s own egg is used. The risk of Down’s syndrome, for instance, is 1 in 30 at age 45 compared to 1 in 952 at age 30.
However, when the egg is donated by a younger woman, scientists don’t know if the rate of genetic defects will resemble that of the younger donor or that of birth mother.
“There is no question that an older woman is going to have a higher risk for her and the baby,” says Dr. Geoffrey Sher, executive director of the Pacific Fertility Centers, which has offices in several West-Coast cities. “There is a higher rate of prematurity, bleeding, high blood pressure and of having a C-section.”
Because the success rate for in vitro fertilization is much lower for women over 40, many infertility programs will not accept these women as patients, Sher says. Sher, who has researched several new techniques for evaluating the chances of an older woman becoming pregnant, believes that practice is discriminatory.
“Should older women get pregnant? Whose choice is it? If a woman is over 40 and wants to have a baby, do you and I have a right to deny her that? We don’t have that moral or ethical right,” he says.
In hopes of carrying a baby, Strong contacted a Southern California fertility clinic that performed the procedure but required the couple to find their own egg donor. Strong placed an advertisement in a newspaper, found a donor and received an embryo transfer early in 1989. But the transfer failed.
Strong and Wilson adopted Juliana but later contacted Sauer, who had donors available and made her part of his study. Strong got pregnant with the first embryo transfer.
“I really wasn’t counting on it working, so I was surprised when I got pregnant,” Strong says. “I guess all you need is one good egg.”
What one needs for 18 years (at least) of intensive parenthood is more complex. But Strong dismisses the idea that younger people have an edge on parenting.
“I think when you get a little older, you are more relaxed and you have more financial stability,” Strong says. “I think maybe your family means more to you at that point.”
Strong says she and her husband thought about the potential for becoming ill or disabled later in life when they are trying to raise teen-agers. But, Strong says, “Life expectancy is 77 or so now. You still have a long productive life in front of you. And illness can happen to a younger woman as well.”
Other women are equally confident of meeting the challenges of motherhood at mid-life. Susan (a pseudonym) is four months pregnant. In her 40s, she thinks her age gives her an advantage at parenting--even if it puts her at a disadvantage for getting pregnant.
She too is carrying a child conceived from a donor egg and her husband’s sperm and was part of Sauer’s study. No one but her doctors and husband knows the genetic makeup of the child she will bear in five months.
“We got married a bit later in life,” she says. “We both wanted to have children. We have established careers. We’re educated, professionals. We really want to be parents.”
Susan admits that rising for 2 a.m. feedings might be more difficult than it would have been back in the days when she didn’t arrive home from a party until that hour.
“I may not have quite the energy I had when I was 20, but I’m sure we’re going to find a way to cope with that,” she says.
And there is precedent for older parenthood. Men have been fathering children into old age since Adam. And women are having babies, naturally, at older ages. According to one Census Bureau finding, the number of women 35 and older giving birth for the first time has quadrupled in the past decade.
“I know quite a few people in their later 30s who are having babies,” Susan says. “I don’t feel like I’m alone. I really don’t know many people in their 20s anymore who are having babies.”
Carol Pulitzer, a Mill Valley woman who underwent conventional in vitro fertilization (her egg and her husband’s sperm) is typical of a growing number of women who are ready for motherhood at a time when their bodies aren’t. The urge to have a baby didn’t hit Pulitzer until age 35.
“I was not crazy to have a child. Then I hit this age where I said, ‘Hey, wait a minute,’ ” says Pulitzer, 44. “I started trying and figured I would get pregnant right away. I was so surprised that I couldn’t get pregnant right away. It got to be something that I had to conquer.”
She succeeded on her third attempt at in vitro fertilization and now has a 19-month-old son. While Pulitzer thinks she is better equipped for parenthood now, she worries that her son might have preferred a younger mother.
“I had a father who was very old. I grew up very worried that my father was going to die on me. I think it’s something we’ll have to deal with. We’d have other problems if we’d had (a child) when I was 20.”
But Los Angeles sociologist Monica Morris, one of the few researchers who has studied “older” parenthood, has a far less rosy view of what is to come for change-of-life babies.
The author of the 1988 book “Last-Chance Children: Growing Up With Older Parents,” Morris’ study of 22 adults raised by parents older than the norm found that many wished their parents had been younger.
“There is no question that children know there is a difference,” says Morris, a sociologist at Cal State L.A. “OK, so women can have babies at 39, 40, God help us, 50. People are still not asking, ‘What will this mean to children? What will it mean to have a parent who is as old as your friends’ grandparents?’ ”
About half the respondents in Morris’ survey were largely unaffected by having older parents. But the other half, she says “really loathed their position.”
Morris says that while older parents are better off financially, she says it is a myth to think that people in their 40s and 50s are as physically fit for parenthood as younger people.
“People will say, ‘Well, things are different now. Now we’re going to live longer and be healthy.’ It isn’t like that. Fifty isn’t 20. You can have a face lift if you want, but the body parts are older. You get more tired.”
Still, Morris does not dispute that these children and their parents often share a deep love.
“I wouldn’t say don’t do it,” she says. “I would never tell people not to have children. The point I was trying to make is you just can’t push these issues aside. You have to think about these things and about what you can do.”
For instance, her research revealed that children of older parents tend to be happiest if their parents spend a lot of time with them.
“Go to the football game with your kid, even if you can’t play football,” she says.
Strong agrees that 40-ish is not a prime time to have children, and, she says with hindsight, she would have done things differently.
“You don’t want to limit your options, which is what I did,” she says. “You don’t want to say, ‘At 40, I’ll have my children.’ But I still think this is a great opportunity for women in their 40s. Having a child of your own is such a great experience.” It’s even kind of fun to have beaten--well, fooled--the biological clock.
Last week, Strong underwent another embryo transfer and will soon find out if she is pregnant. And Pulitzer is set to begin medical tests to evaluate her chances for a second pregnancy.
Childbirth at 45?
“Piece of cake,” Pulitzer says.
