Women are often considered of an advanced maternal age if they are delivering their baby after their 35th birthday. While there is some increased risk in pregnancy and birth over 35, most women can look forward to a wonderful and positive birth experience.
Does being 35 make me high risk?
While some research concerning birthing of 35 does show increased problems, the truth is much less clear cut. Actually, for older women there are many things that are not a higher risk for them.
In fact, one large study done in 2005 found:
"No statistically significant differences were noted among the groups [of various aged women] for threatened abortion, gestational hypertension, pre-eclampsia, preterm labor, preterm PROM, and assisted vaginal delivery." ¹
According to this study, many of the things that women over 35 worry about, such as gestational hypertension and pre-eclampsia, are, actually, not statistically more likely for them. This knowledge alone can make a woman feel much less fearful and more capable of achieving the birth she wants.
The researchers go on to say that:
"In summary, the majority of women of advanced maternal age deliver at term without maternal or perinatal adverse outcomes." ¹
One thing that does appear to be more likely as a birthing woman gets older is the risk of stillbirth. Even this risk, though, when examined carefully is still incredibly low in developed countries. This review of numerous studies found that:
"However, the absolute increase in risk was relatively small in studies from developed countries, with crude odds ratios varying from 1.20 to 2.23 on top of baseline stillbirth rates varying from 1.55 to 17.89 per 1000 total births" ³
Even though there is a small increase in stillbirth, it is still very low even for women considered to be of “advanced maternal age.”
Chromosomal abnormalities also show some increase as a woman gets older, but this alone shouldn't preclude a natural birth. 6, 7
Why are women 35 and older experiencing more cesarean sections?
Women, who happen to be 35 or older at the time of delivery, have higher rates of cesarean section birth. In fact, women of this age or older are actually three times more likely to deliver by scheduled c-section.²
Researchers point out that women of this age may simply be birthing surgically more often due to their age alone (and not need), despite the relative safety of natural or vaginal birth.
"Nonetheless, maternal age alone may be a factor influencing physician decision making. It is uncertain whether the increased rates of cesarean delivery are due to a real increase in the prevalence of obstetric complications or whether there is a component of iatrogenic intervention secondary to both physician and patient attitudes toward pregnancy in this older patient population." ¹
In essence, the researchers believe that it may be the attitudes of the physician and the patient regarding maternal age that increased these surgical births, not necessarily need. (Iatrogenic refers to an intervention or illness caused by medical treatment.) In fact, some studies found that the increased “surveillance” of these older mothers may even cause iatrogenic prematurity or babies born too early due to medical induction.²
How can I increase my chances of natural birth if I am over 35?
Just because you are over 35 doesn't mean you can't have a great natural birth! Research shows that this is true.
“...most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centers may also contribute.” ⁸
Being healthy before you get pregnant, no matter your age, can improve outcome and possibly increase your chance of having the birth you want. For example, one common risk for older women is gestational diabetes. Gestational diabetes however has other risk factors independent of maternal age that contribute to it, including pre-pregnancy weight, health, and nutrition before and during pregnancy. Another risk factor for women over 35 is chronic hypertension, but research shows that advanced age alone is not responsible for these complications. Simply having a healthy blood pressure pre-pregnancy can be helpful. ¹
Leading medical groups point out that simple choices, such as eating well, exercising, and getting prenatal care, can be helpful in creating a healthy pregnancy over 35 or at any age. If you desire a natural birth, a comprehensive natural birth class will prepare you best. Look for one that includes instruction on both staying low risk and navigating common hospital procedures and testing. These issues are especially relevant to women over 35 who are often encouraged to test excessively.
Can a woman over 35 achieve a natural birth? The answer to this question is a resounding yes. Being healthy, educated and aware can help you get what you want from the birth process. Are there some risks to birthing over 35? Yes. But many of them can be minimized with a healthy lifestyle or do not prevent a natural birth.
1. Cleary-Goldman J, et al. Impact of maternal age on obstetric outcome. Obstetrics & Gynecology. 2005;105:983. (If you would like to view this entire study, copy and paste the entire title into your search bar.)
2. Advanced maternal age and pregnancy outcome (British)
3. Maternal age and risk of stillbirth: a systematic review
Ling Huang, MD MSc, Reg Sauve, MD MPH, [...], and Carl van Walraven, MD MSc
4. Very advanced maternal age
5. Midwifery. 2011 Dec;27(6):793-801. doi: 10.1016/j.midw.2010.07.006. Epub 2010 Oct 2.
Obstet Gynecol. 1981 Sep;58(3):282-5.
6. Rates of chromosome abnormalities at different maternal ages.
7. Table, Down Syndrome rates by maternal age
8. Very advanced maternal age