Madeleine Murphy Editor
EDITORIAL BOARD Professor Dame Tina Lavender, Professor of Midwifery and Director of the Centre for Global Women’s Health at the University of Manchester Yana Richens OBE, Professional Global Advisor at Royal College of Midwives and Consultant Midwife at University College of London Hospital Karen Barker, Senior Lecturer Midwifery, University of Salford Lesley Briscoe, Senior Lecturer in Midwifery, Edge Hill University, Ormskirk, Lancashire Corina Casey-Hardman, Head of Midwifery, Halton Midwifery Services, Bridgewater Community Healthcare NHS Trust Elinor Clarke, Senior Lecturer (Midwifery), Coventry University Jonathan Cliffe, Registered Midwife, Warrington and Halton Hospitals NHS Foundation Trust Tracey Cooper, Consultant Midwife in Normal Midwifery, Lancashire Teaching Hospitals Foundation Trust Jacqueline Dunkley-Bent, Head of Maternity, Children & Young People for NHS England Julie Jomeen, Professor of Midwifery, Associate Dean: Research and Scholarship, Faculty of Health and Social Care, University of Hull Kevin Hugill, Senior Nurse Educator – NICU, Hamad Medical Corporation, Qatar Paul Lewis OBE, FRCM, Professor of Midwifery, Bournemouth University Patrick O’Brien, Consultant Obstetrician, Elizabeth Garrett Anderson Institute for Women’s Health, University College London Hospitals, London Jessica Read, Local Supervising Authority Midwifery Officer for London Gillian Smith MBE, Director RCM Scotland Catherine Warwick CBE, General Secretary of the Royal College of Midwives Sian Warriner, Consultant Midwife, John Radcliffe Hospital Zita West, Clinical Director, Zita West Clinic Ltd
The British Journal of Midwifery aims to provide midwives, students and maternity services professionals with accessible, original clinical practice and research articles, while also providing summaries of high-quality research evidence, promoting evidence-based practice.
Advancing attitudes towards maternal age
Aformer school friend of mine, who had her first child this year, told me about her anger when an obstetrician referred to her pregnancy as ‘geriatric’. Inappropriate though this term may seem (indeed, it has largely dropped out of use in health care), my erstwhile classmates and I must face the fact that we have now crossed the line into what is known as ‘advanced maternal age’. Having been born in August, I was always the youngest person in my year at school and spent the first two decades of my life constantly being told I was too young for this, that or the other—so it’s almost refreshing to find out I’m supposedly too old for something. But how seriously should we heed the warnings that come with our advancing years, and how can midwives best support pregnant women in their 30s and 40s?
Advanc ed maternal age is associated with a higher risk of complications in pregnancy and childbirth, including Down syndrome, preterm birth, poor fetal growth, gestational diabetes, pre-eclampsia and miscarriage (Cavazos-Rehg et al, 2015). Of course, to face such risks one must be able to conceive in the first place—something we are told is increasingly unlikely. In 2015, a lead consultant for reproductive medicine hit the headlines when she warned of a ‘fertility time bomb’ ticking away for women who do not have a baby before the age of 30 (Walton, 2015). Statistics, meanwhile, tell a different story: in my lifetime, the fertility rate for women aged 40 and over has more than trebled (Office for National Statistics, 2016).
A recent study published in BJOG (Fitzpatrick et al, 2016) focused on pregnancy at ‘very advanced maternal age’ (VAMA); in the case of this study, this refers to women aged 48 or over. Predictably, the researchers found that women in this age group were more likely than the comparison group (women aged 16–46) to experience a range of complications. However, they also pointed out that older women were more likely to have assisted conception and, therefore, had a higher rate of multiple pregnancy. When the results were adjusted for these factors, most of the effects of VAMA were diluted; only gestational diabetes, caesarean birth and admission to intensive care remained significantly associated with VAMA. While this study confirms that pregnancy-related risks increase with maternal age, it is interesting to note that it is not necessarily age itself that is the crucial factor.
Midwives and other health professionals have a responsibility to educate women about risk factors associated with pregnancy and birth, enabling them to make informed choices. But it is essential that these risks are not exaggerated or misunderstood. To build a strong, trusting relationship with the women in their care, midwives must provide up-do-date, evidence-based information, and then support the decisions that women make. While advanced maternal age does present some higher risks, there are numerous cases of women in their 30s and 40s having healthy, uncomplicated pregnancies. Individualised care is key to achieving the best possible outcomes for women and infants. Women face huge societal pressure regarding whether and when to conceive, how to behave while pregnant, and how to be a good mother. Midwives have the potential to offer a safe haven from this barrage of ‘advice’, by advocating for individuals and being with women, not against them. BJM
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, Subramaniam
H, Peipert JF, Bierut LJ (2015) Maternal age and risk of labor and delivery complications. Matern Child Health J 19(6): 1202-11. doi: 10.1007/s10995-014-1624-7 Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M (2016) Pregnancy at very advanced maternal age:
a UK population-based cohort study. doi: 10.1111/1471-0528.14269 Office for National Statistics (2016) Births in England and Wales: 2015. http://tinyurl.com/jjarj85 Walton G (2015) Senior NHS doctor tells women ‘have baby before 30’. http://tinyurl.com/phlvtap
British Journal of Midwifery • October 2016 • Vol 24, No 10