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Looking for a baby on the other side of 35

WOMAN'S INSTINCT
By | August 22nd 2009

By Crystal Okusa

Scientific evidence and cultural norms have long cast a shadow on motherhood past the age of 35. Women who choose to have their first pregnancy at that age are warned of ridicule at best, and the likelihood of getting babies with Down Syndrome.

These women fear that they have drunk too much alcohol, smoked too much, taken in too many drugs, or pumped their bodies with too many contraceptives to be able to conceive and carry the pregnancy to term.

However, the dangers of motherhood past 35 have been overly exaggerated. Research has actually shown that if a woman has been living healthy, she can have a successful pregnancy at that ‘late’ age. Of course, like any other system, the female reproductive system is likely to develop complications with age, as is explained by Dr Stephen Maina, a gynaecologist in Nairobi.

Abnormal baby

Says he: "A woman can conceive between the ages of 14 and 52, but the optimum health required for a woman’s body to conceive is enjoyed between the ages of 18 and 25. That is when the woman is most fertile. After the age of 30 fertility decreases, putting you at a high risk of having a baby with chromosomal disorders like Down Syndrome, a combination of mental retardation and physical abnormalities caused by an extra chromosome."

Many career women are putting off child bearing until their mid 30s and beyond, not realising that this may cause a strain on their fertility and their ability to carry the pregnancy to term

Research from the American College of Obstetricians and Gynaecologists shows that at the age of 25, a woman has about a one-in-1250 chance of having a baby with Down Syndrome, while at age 30, the odds are at one-in-1000 and at age 35, at one-in-400. At age 40, a woman has a one-in-100 chance of having a retarded baby. Pregnant women at and after the age of 35 should, therefore, be offered meticulous prenatal care to diagnose or rule out Down syndrome.

Chromosomal abnormalities are the most common cause of miscarriage, which also increases with age.

"Apart from the babies being at risk, the mother is also at a higher risk of getting hypertension or diabetes as well as featuring of fibroids during pregnancy. She is also predisposed to placenta praevia- where the placenta lies low in the uterus, partly or completely covering the cervix, causing difficulty in delivering due to inelastic muscles," states Dr Maina.

There is also the risk of Intra Uterine Growth Retardation (IUGR) which results in pre-term delivery and thus, the risk of infant mortality.

Linet Nyambura, 40, got her first baby at 36. She narrates her ordeal.

"I was brought up in a huge family so I did not have the urge to get married or have children. After a while, my older and younger siblings left — some went for further studies and others got married — and I felt alone for the first time. At 31, I decided to fill the void by getting a baby and got married at 34, I had to give myself two years to finish my PhD. So at 36, when I was preparing to have a baby, I went to the doctor he diagnosed high blood pressure. I had to be on medication for sometime because of my age before I could be fit to conceive. When I thought the worst was over, I had a miscarriage at four months after I had travelled to the village," she remembers.

Her doctor explained that it was due to the chromosomal abnormalities. It was only after she tried again that she delivered a miracle baby girl. Says she "I would never try that again!" she avers.

Dr Maina dismisses as myth the issue of long term use of contraceptives making pregnancy difficult.

Contraceptives are safe

"Contraception does not really play a role in delayed pregnancy. However, there are attendant risks. If, for example, a patient using the Intrauterine Contraceptive Device (IUCD) gets an infection, she is at risk of having her fertility affected because the infection will affect the tubes and cause tubal pregnancies," he explains.

Injections like Depo-Provera, he says, do not have any such risk. For oral pills and injections, you only stop using it a couple of months before conception so that the body gets rid of the medicine and goes back to normal.

As to whether abortion can cause delayed pregnancy, Dr Maina answers "Yes" and "No". "If the abortion brought about complications then it may cause one to have difficulties in the future," he says.

Take the case of Emma Chebet, a 34-year-old lecturer. At 22, while in University, she got pregnant and had an abortion.

"I was still naÔve and my friends from campus took me to some random doctor who hurriedly performed the abortion because I didn’t want my parents to know. Unfortunately, since this was a back street clinic, they did not run tests first to see if I was fit for the abortion. After the operation, I was in so much pain and I was bleeding so heavily that I had to call my aunt who then took me to hospital. The doctor found out that I had Chlamydia and that’s why I had developed complications during the abortion. I got operated on and my uterus was removed. I’m now married and have had to adopt a child because I will never get my own," explains Chebet.

Dr Maina advises that when a couple can’t have a baby, before concluding that it is because of the wife’s earlier abortion, they should check the husband’s virility status first.

It is uncommon for abortion to cause pregnancy complications when it is safely carried out.

Fertility is also another factor associated with delayed pregnancies. Research has it that fertility starts to drop dramatically at the age of 35 and women wishing to conceive at this age should see a fertility doctor. If you have tried without success for six months, it is time to visit the doctor. There are a number of causes, such as irregular ovulation — which manifests as irregular periods — and stress. Irregular ovulation as the number one cause of infertility, but in most cases makes pregnancy difficult, not impossible.

Boosting fertility

Women with low fertility or whose partners have a low sperm count have a one-in-20 chance of getting pregnant. There are a number of ways to boost secondary fertility, such as changing the diet: high-fat dairy products boost fertility and low-fat dairy products decrease your chances of conceiving.

Dr Maina advises women to stop using left over eggs and keep within the optimum child bearing age to avoid complications with late pregnancies. Most studies show an increased risk of needing to deliver by caesarean section for women over 35, due to the likelihood of hypertension, diabetes and the risk of ante partum haemorrhage, caused by prolonged labour.

However, many women who have delayed pregnancy until they’re over 35 are surprised to find that, given generally good health, they are likely to have perfectly healthy babies.

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