We need to banish the myths about "late" pregnancy. Photo: Getty Images
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What's wrong with older mothers? Nothing. Time to dispel the "fertility cliff" myth

We read between the lines of newspapers' scare stories about infertility and "late" pregnancy to find the science doesn't back them up at all.

There has been a fanfare of publicity, mainly involving ova, over the past month. Frontpage headlines splashing on differing deadlines for when a woman should have children. According to the Mail, Telegraph and Mirror, among others, women should start having children before 30,  or by 30, or before 37 (which is it, guys?) to avoid the risk of infertility:
 

 

 


Alternatively, according to the papers, women should freeze their eggs by the age of 35.

This is irresponsible scaremongering. It also undermines the biological complexities associated with a women’s fertility, which is further complicated by socio-economic factors, as well as the sex and gender hierarchies that still exist.

In a new study published in Harvard Business Review, sociologists Pamela Stone, Robin J Ely and Colleen Ammerman surveyed more than 25,000 men and women who graduated from Harvard Business School over the past several decades. Around 40 per cent of the "Generation X" and "Baby Boomer" women said their spouses’ careers took precedence over theirs. Compare that with men, where more than 70 per cent of Generation X and Boomer men say their careers are more important than their wives.

And the numbers on childcare responsibility may induce hyperventilation: 86 per cent of Generation X and Boomer men said their wives take primary responsibility of childcare. And the women are agreeing: 65 per cent of Generation X women and 72 per cent of Boomer women – most of whom work full-time – say they are prepared to do most of the childcare in their relationships.

It seems society is still, whether consciously or not, conforming to outmoded notions of which behaviours are masculine or feminine.

In the UK, it’s not generally biology that drives a woman's approach to reproduction; it’s the access to effective contraception, giving women the choice to construct their lives around partners, careers and friendships. Although hotly-debated, having children later in life is neither good nor bad – it’s autonomous. A decision entirely dependent on the person in question. 

One common argument against older mothers (30+) is their inability to get pregnant and give birth to a healthy child. This simplifies and distorts the science around fertility, and this is further perpetuated by the media for the sake of a sensationalist headline.

Delving deeper into the truths about fertility: the stats and scientific reports

The Office for National Statistics (ONS) reports that the total fertility rate (TFR) in 2010 for all four constituent countries in the UK was higher than a decade previously. After a steady decline in TFR through the Nineties, there was a gradual increase from early 2000s onwards – with the exception of 2009. The drop in fertility experienced by all UK constituents in 2009 is most likely related to the Great Recession. Fertility in England and Wales peaked in 2010 with the highest fertility rate since 1973.

Total fertility rate in the UK and EU15 (1985 to 2010). Graph: ONS

The ONS reports that in 2010, the average age for a woman to give birth has steadily increased over the last 25 years. In Northern Ireland it reaches 30 years, 29.6 in both Scotland and England and 28.9 in Wales.

Age-specific fertility rates the UK (2010). Graph: ONS

The ONS reports that in 2012, almost half (49 per cent) of all live births were to mothers aged 30 and over. More specifically, 29 per cent of births are to women aged 30 to 34, 16 per cent are to women aged 35 to 39, 4 per cent are to women aged 40 to 44 and less than 1 per cent are to women over 45. One in 25 babies are now born to those over forty, a four-fold increase in 30 years.

Live births by age group of mother (1938 to 2012). Graph: ONS

The term "period of optimum fertility" doesn’t mean a woman becomes barren the second she turns 35. If a woman wants just two children, the chances of her conceiving in her mid to late thirties still remain high.

"It is important to remember that the great majority of pregnancies in older women are relatively uncomplicated and end quite satisfactorily," says WR Cohen in a 2014 commentary published in the British Journal of Obstetrics and Gynaecology

In a 2004 paper published in Obstetrics and Gynecology, statistician David Dunson of Duke University and colleagues found that if a woman has sex twice a week, 82 per cent of woman aged between 35 and 39 would fall pregnant within a year.

The frequency here is important because if a woman had sex once per week instead of twice, "the rates of infertility increase substantially to 15 per cent, 22 to 24 per cent and 29 per cent for women aged 19 to 26, 27 to 34, and 35 to 39 years, respectively".

The paper concludes: "Increased infertility in older couples is attributable primarily to declines in fertility rates rather than to absolute sterility. Many infertile couples will conceive if they try for an additional year".

So women in their thirties might have to try harder to get pregnant, particularly if their partner is also in his late thirties. However, their age alone is unlikely to shut down their fertility.

Population-level data cannot predict when in individual woman will experience infertility. A woman in her late thirties may experience infertility, not because it’s common for women of her age, but because she is atypical (eg, premature menopause affects one in 100 women before the age of 40, and 5 in 100 women before the age of 45).

Therefore it is misleading to automatically associate infertility with age – like any problem that may occur in the human body, premature menopause is a problem with oestrogen production.

The additional complications of pregnancy and birth for women over 35

2005 study in Obstetrics and Gynaecology reports that:

The majority of studies are optimistic with regard to maternal and neonatal outcomes' in older mothers. This study found that ages 35 to 39 were associated with a statistically significant increased risk for fetal/neonatal congenital anomalies, gestational diabetes, placenta praevia, macrosomia, and caesarian delivery. Crucially, however, the clinical significance of these associations in practice was less clear. That is, while women aged 35 to 39 years were significantly more likely to experience one of these outcomes statistically, the level of increased risk was not overly large and should be interpreted cautiously.  

How foetuses are affected by later maternal age

Most of the common risks associated with later maternal age are foetal anomalies, particularly Down's, Edwards' and Patau syndrome. However, about 75 per cent of babies with Down’s syndrome are born to women who are under 35. This is because older women tend to have fewer babies. Despite this, the risk of any woman having a child with a foetal anomaly is low: 99 out of 100 per cent of women will not have a pregnancy affected by Down’s syndrome.

Older women are more likely to have twins or triplets, which, as well as having a higher risk of birth defects (5 per cent higher than singleton pregnancies), are at risk of growth restriction and preterm birth – these risks are associated with cerebral palsy and learning difficulties.

Moreover, women are more likely to suffer from multiple illnesses like diabetes and high blood pressure if they carry more than one baby. If the illnesses are thought to be a serious threat to the mother or babies, the clinician may suggest an abortion of the foetus(es). In general, there is a one in 25,000 risk of maternal mortality during singleton pregnancy or birth versus a two in 25,000 risk of maternal mortality during twin pregnancy or birth, and so on.

Moral of the story?

Doctors like Geeta Nargund need to tread carefully when advising a woman on the best time to have a child. It is important to be honest – yes, women who are below 30 are likely to conceive more easily, but women in their thirties and fourties have no problem conceiving either – and this fact shouldn’t be brushed under the carpet. 

Part of this honesty means we should not blow the problem out of proportion by intentionally presenting the worst-case scenario, scaring women in their early thirties into rushing into pregnancy.

The way things are going, women are likely to have children in their mid to late thirties, and the most likely outcome of that is that most pregnancies, births and babies will be healthy. 

In fact, women don’t respond to media headlines, scientific articles or what a bloke from the Royal Society says; they base their circumstances on those around them. And what they’ll find is that having children in your thirties is quite normal.

As the British Pregnancy Advisory Service (BPAS) puts it in a briefing on older mothers: "Being aware that fertility treatment exists as a last resort does not encourage women to 'put off' having babies, just as knowing that abortion is there when contraception fails does not stop women from using contraception."

BPAS adds:

If policymakers are worried by the consequences of later maternal age, they should be focusing on supporting prenatal screening services, preparing maternity services to be better able to cope with obstetric complications, and funding decent miscarriage care and fertility treatment. What they should not be doing is nagging women to get pregnant before they are ready, just so they fit neatly into the "period of optimum fertility"".

Tosin Thompson writes about science and was the New Statesman's 2015 Wellcome Trust Scholar. 

This article first appeared in the 01 July 2015 issue of the New Statesman, Crisis Europe

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Meet the hot, funny, carefree Cool Mums – the maternal version of the Cool Girl

As new film Bad Moms reveals, what the cool girl is to the diet-obsessed prom queen, the cool mum is to the PTA harpy.

I suppose we should all be thankful. Time was when “mum’s night off” came in the form of a KFC value bucket. Now, with the advent of films such as Bad Moms – “from the gratefully married writers of The Hangover” – it looks as though mums are finally getting permission to cut loose and party hard.

This revelation could not come a moment too soon. Fellow mums, you know all those stupid rules we’ve been following? The ones where we think “god, I must do this, or it will ruin my precious child’s life”? Turns out we can say “sod it” and get pissed instead. Jon Lucas and Scott Moore said so.

I saw the trailer for Bad Moms in the cinema with my sons, waiting for Ghostbusters to start. Much as I appreciate a female-led comedy, particularly one that suggests there is virtue in shirking one’s maternal responsibilities, I have to say there was something about it that instantly made me uneasy. It seems the media is still set on making the Mommy Wars happen, pitching what one male reviewer describes as “the condescending harpies that run the PTA” against the nice, sexy mummies who just want to have fun (while also happening to look like Mila Kunis). It’s a set up we’ve seen before and will no doubt see again, and while I’m happy some attention is being paid to the pressures modern mothers are under, I sense that another is being created: the pressure to be a cool mum.

When I say “cool mum” I’m thinking of a maternal version of the cool girl, so brilliantly described in Gillian Flynn’s Gone Girl:

“Being the Cool Girl means I am a hot, brilliant, funny woman who adores football, poker, dirty jokes, and burping, who plays video games, drinks cheap beer, loves threesomes and anal sex, and jams hot dogs and hamburgers into her mouth like she’s hosting the world’s biggest culinary gang bang while somehow maintaining a size 2, because Cool Girls are above all hot.”

The cool girl isn’t like all the others. She isn’t weighed down by the pressures of femininity. She isn’t bothered about the rules because she knows how stupid they are (or at least, how stupid men think they are). She does what she likes, or at least gives the impression of doing so. No one has to feel guilty around the cool girl. She puts all other women, those uptight little princesses, to shame.

What the cool girl is to the diet-obsessed prom queen, the cool mum is to the PTA harpy. The cool mum doesn’t bore everyone by banging on about organic food, sleeping habits or potty training. Neither hyper-controlling nor obsessively off-grid, she’s managed to combine reproducing with remaining a well-balanced person, with interests extending far beyond CBeebies and vaccination pros and cons. She laughs in the face of those anxious mummies ferrying their kids to and from a multitude of different clubs, in between making  cupcakes for the latest bake sale and sitting on the school board. The cool mum doesn’t give a damn about dirty clothes or additives. After all, isn’t the key to happy children a happy mum? Perfection is for narcissists.

It’s great spending time with the cool mum. She doesn’t make you feel guilty about all the unpaid drudgery about which other mothers complain. She’s not one to indulge in passive aggression, expecting gratitude for all those sacrifices that no one even asked her to make. She’s entertaining and funny. Instead of fretting about getting up in time to do the school run, she’ll stay up all night, drinking you under the table. Unlike the molly-coddled offspring of the helicopter mum or the stressed-out kids of the tiger mother, her children are perfectly content and well behaved, precisely because they’ve learned that the world doesn’t revolve around them. Mummy’s a person, too.

It’s amazing, isn’t it, just how well this works out. Just as the cool girl manages to meet all the standards for patriarchal fuckability without ever getting neurotic about diets, the cool mum raises healthy, happy children without ever appearing to be doing any actual motherwork. Because motherwork, like dieting, is dull. The only reason any woman would bother with either of them is out of some misplaced sense of having to compete with other women. But what women don’t realise – despite the best efforts of men such as the Bad Moms writers to educate us on this score – is that the kind of woman who openly obsesses over her children or her looks isn’t worth emulating. On the contrary, she’s a selfish bitch.

For what could be more selfish than revealing to the world that the performance of femininity doesn’t come for free? That our female bodies are not naturally hairless, odourless, fat-free playgrounds? That the love and devotion we give our children – the very care work that keeps them alive – is not something that just happens regardless of whether or not we’ve had to reimagine our entire selves to meet their needs? No one wants to know about the efforts women make to perform the roles which men have decided come naturally to us. It’s not that we’re not still expected to be perfect partners and mothers. It’s not as though someone else is on hand to pick up the slack if we go on strike. It’s just that we’re also required to pretend that our ideals of physical and maternal perfection are not imposed on us by our position in a social hierarchy. On the contrary, they’re meant to be things we’ve dreamed up amongst ourselves, wilfully, if only because each of us is a hyper-competitive, self-centred mean girl at heart.

Don’t get me wrong. It would be great if the biggest pressures mothers faced really did come from other mothers. Alas, this really isn’t true. Let’s look, for instance, at the situation in the US, where Bad Moms is set. I have to say, if I were living in a place where a woman could be locked up for drinking alcohol while pregnant, where she could be sentenced to decades behind bars for failing to prevent an abusive partner from harming her child, where she could be penalised in a custody case on account of being a working mother – if I were living there, I’d be more than a little paranoid about fucking up, too. It’s all very well to say “give yourself a break, it’s not as though the motherhood police are out to get you”. Actually, you might find that they are, especially if, unlike Kunis’s character in Bad Moms, you happen to be poor and/or a woman of colour.

Even when the stakes are not so high, there is another reason why mothers are stressed that has nothing to do with pressures of our own making. We are not in need of mindfulness, bubble baths nor even booze (although the latter would be gratefully received). We are stressed because we are raising children in a culture which strictly compartmentalises work, home and leisure. When one “infects” the other – when we miss work due to a child’s illness, or have to absent ourselves to express breastmilk at social gatherings, or end up bringing a toddler along to work events – this is seen as a failure on our part. We have taken on too much. Work is work and life is life, and the two should never meet.

No one ever says “the separation between these different spheres – indeed, the whole notion of work/life balance – is an arbitrary construct. It shouldn’t be down to mothers to maintain these boundaries on behalf of everyone else.” Throughout human history different cultures have combined work and childcare. Yet ours has decreed that when women do so they are foolishly trying to “have it all”, ignoring the fact that no one is offering mothers any other way of raising children while maintaining some degree of financial autonomy. These different spheres ought to be bleeding into one another.  If we are genuinely interested in destroying hierarchies by making boundaries more fluid, these are the kind of boundaries we should be looking at. The problem lies not with identities – good mother, bad mother, yummy mummy, MILF – but with the way in which we understand and carry out our day-to-day tasks.

But work is boring. Far easier to think that nice mothers are held back, not by actual exploitation, but by meanie alpha mummies making up arbitrary, pointless rules. And yes, I’d love to be a bad mummy, one who stands up and says no to all that. Wouldn’t we all? I’d be all for smashing the matriarchy, if that were the actual problem here, but it’s not.

It’s not that mummies aren’t allowing each other to get down and party. God knows, we need it. It’s just that it’s a lot less fun when you know the world will still be counting on you to clear up afterwards.  

Glosswitch is a feminist mother of three who works in publishing.