Three senior obstetricians from Guy’s and St Thomas’ Hospital in London have caused a stir with an article published in the current edition of the British Medical Journal. Women who delay trying to have children until they are in their 30s are defying nature and risking having no babies at all, they wrote.
You would think that this is no news at all, but that’s not the case. Apparently, because of social changes that have left women with little or no choice – or so they think – but to start trying for their first baby in their mid-30s, they have convinced themselves that this is a normal and biologically acceptable way to go about it. Yet it isn’t.
When these women go to hospital to deliver their children, they are surprised and offended to find the words ‘elderly primagravida’ written on their admission card. They imagine that because society has changed, biology has kept pace, but that’s just wishful thinking.
Whenever I hear of somebody in their late 30s who has had a baby, I mentally wish her luck and think “Rather her than me.” So few women are now having babies in their early 20s – in stable relationships, that is; I’m not talking about teenage mothers here – that people have forgotten how easy it is at that age. You get pregnant without trying; the pregnancy scoots along virtually unnoticed; the baby pops out leaving the body completely unscathed; everything springs back into shape within days and a week after leaving hospital you’re back into your size 8 jeans; if you’re not careful, you might find yourself pregnant again within weeks of the birth.
In her early 20s, a woman is a baby production house. She does it brilliantly and with ease. Biology is on her side, though the conditions of her life may not be. There is no comparison between this smoothness and what happens in the mid-to late 30s: trying to get pregnant and often failing, being careful in pregnancy lest ‘something happens’; struggling through labour and more often than not, having to undergo a caesarean; the body staying baggy for months afterwards.
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Twenty years ago, a woman who gave birth for the first time at 35 was considered an ‘old mother’; she was surrounded by worry and concern, and though no one said anything outright, there was a certain degree of sympathy for the child, who would have an ‘ancient’ 50-year-old mother representing him or her on parents’ day at school. This attitude was shaped by our own experience: most of us still vividly remember the few ‘old’ parents who turned up at school, because they were unusually conspicuous.
I remember being appalled, when I was nine, to see that a class-mate’s mother was ‘really old’ and that she had white hair, when she unexpectedly turned up in the playground. In later life, I found out that she had died at 40, so she can’t have been older than that at the time.
This was the perspective then. Women who gave birth in their 30s for the first time were something of a social aberration. When a woman fell pregnant in her late 30s, it was naturally assumed that the pregnancy was an accident and certainly not a planned event. It was taken for granted that no woman in her right mind would want a baby at that age.
The strange thing is that, deep down, I still think that way. I think it is a shame that so many women are missing out because they feel so much pressure to get the material aspects of life sorted first, and end up pushing ‘having babies’ right down the ‘to do’ list. Life is all about choices, and sometimes, we end up making the wrong ones and then having to face the consequences.
I know that the social condition of women has changed, but all other factors have not, including our life-span, the life-span of our parents (the grandparents, most of whom will now end up being deprived of the satisfaction of seeing their grandchildren move into adulthood, with careers, homes and families of their own), and even strength and energy.
Perhaps this is because I know what lies ahead because I have already been through it. When women have a baby late in life, they are usually only thinking of the baby, not the horrors that begin to manifest themselves some time around the age of 15. Having a baby at 40 can be a breeze when you’re strong, healthy and youthful in outlook, but having a 16-year-old son at 56 is another matter altogether.
I was driven to the brink of nervous exhaustion by that period in my sons’ lives, and I was in my 30s. At one point, when there was brawl and row after brawl and row, and every night I would dream of life alone in a little hut somewhere up a mountainside, I packed a suitcase and announced that I was running away from home. This took them aback somewhat, because until that point, it had never occurred to them that anyone but they could make that threat. I know that at 56 I would probably have had a stroke, or worse, abdicated my responsibilities altogether for the sake of a quiet life, which is what a lot of older parents tend to do.
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The warning of these obstetricians has been greeted with the clamour of journalists and commentators in Britain, where the average age at which women are giving birth for the first time has been rising steeply since the mid-1970s, with a sharp increase in the rate of first-time births to women in their late 30s and even in their 40s. Human evolution and biology, however, have not kept up with these rapid social changes. The biologically perfect time for childbearing remains 20 to 25, but stays pretty good until 35.
“Women want to have it all, but biology is unchanged,” the obstetricians wrote. “If women want room for manoeuvre, they are unwise to wait till their 30s.” Although the risk to individual mothers remains low because of much improved health care, the rate of complications and abnormalities is increasing.
There is more infertility, because when you start trying for a first baby in your mid-30s your chance of success is drastically lowered, and among those who give birth in their 30s and 40s, birth by the normal route often proves impossible, risky or dangerous, and a caesarean has to be performed. Doctors including Lord Winston, the renowned fertility pioneer, have been warning about the late-first-birth trend for some years already, but the obstetricians who wrote the article appear to have been prompted into doing so by the fact that more than a quarter of the women giving birth at Guy’s Hospital are now over 35, and the proportion is even higher in some other London hospitals.
Susan Bewley, consultant obstetrician at Guy’s and the lead author of the British Medical Journal piece, told one London newspaper: “People are aware that ageing is a bad thing (where birth and fertility are concerned), but the bio-panic that women had on their 30th birthday has moved up to the 40th birthday. Surveys of older mothers show that half of them delayed conceiving because they had not met a suitable partner. Maybe instead of waiting for Mr Right they ought to wait for Mr Good-Enough, if they want children. There is a sense that we are healthier than we have ever been and that it’s OK to wait, but as obstetricians we see people falling off the cliff and it saddens me.”
The warning by Susan Bewley and her colleagues was backed by the Infertility Network UK, a charity that supports couples with fertility problems. Clare Brown, the charity’s chief executive, told a newspaper: “Delaying having children until you are in your 30s is a choice many women make, but they need to be aware of the problems.”
The obstetricians warned that many couples wrongly believe they can fall back on IVF if natural conception fails – but the procedure they describe as “expensive and invasive” also has a high failure rate. Seven out of 10 women who have IVF treatment do not deliver a live baby, they wrote, and the failure rises to nine out of 10 in women over 40.
In Malta, the situation is moving towards that described in the BMJ editorial, and though at least one obstetrician has sounded a warning in the newspapers that the increase in the number of couples who cannot have babies is the direct result of their attempts beginning in their 30s, the alarm bells seem not to have gone off yet in the minds of those who plan to have a baby ‘some time in the future, when we’re settled.’
There is no way out of this personal dilemma without taking some quite harsh decisions, of course. It’s all very well knowing that babies are best born to women in their early 20s (I can vouchsafe for this personally, having had three in rapid succession before the age of 24, with next to no bother), but how many women are in a position to take on responsibility for a baby at that time in their lives?
Very few – or perhaps they are not prepared to take the gamble. Our lives have now become so rigidly planned that we are unable to go with the flow, taking our babies with us. Yet going with the flow often produces the best results for us. If I had used my mind at 20, I would probably be childless today, so I’m delighted that I didn’t.
It is not just that more and more women are now going into tertiary education and coming out aged 22 or 23, or that understandably they want to build something of a career and some savings for themselves afterwards. It is also that marriage, or its contemporary version, has been shoved off the agenda until the 29th birthday, which serves as a wake-up-and-smell-the-coffee alarm for many women today.
When I was 20 (in 1985, but so much has changed that it might as well be another planet) we considered women who were in their late 20s and unmarried as being firmly on the shelf.
We were surprised if they managed to so much as get a date, and the thought of their getting married was akin to an announcement that they were about to take a trip to the moon. Most women I knew were married by the time they were 24. Most men were married by the time they were 26.
Compare that to the current attitude: we think of women in their early 20s as ‘girls’, with many years of exciting life ahead of them before they need even begin to turn their minds to having a baby or settling down, or both. They dress like 15-year-olds, and they think like 15-year-olds.
As for men – or should that be ‘boys’ – I have noticed that nowadays most of them lose their hair before they gain a child. They forget that nowadays even men can end up on the shelf merely through over-exposure. When people have been seeing you around for years, it’s hard for them to think of you erotically. Men, too, can lose their looks, but they seem not to realise this.
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The thing is that our outlook on life has changed, permanently. When I was a teenager, the mothers of a couple of my friends had babies and our reaction was one of muted horror and disgust. A baby! And so old! Almost old enough to be a nanna! Looking back, I realise that those ‘old’ mothers could not have been more than 35. They had had their first child at 19 or 20, that’s all. Earlier generations, my own included, were programmed towards marriage.
This was not necessarily a good thing for the individuals concerned, but it was certainly a very good thing for society, the pension fund, and child-bearing in general.
It was also better for the children. Because our parents had us so easily and naturally, we had a great deal of freedom and were not over-protected or treated like ‘special projects’, as so many children of older mothers are today. My own children ran wild in the fields and I seem to have spent a great deal of time in the A & E Department, but it has done them a lot of developmental good. I hate to think how those children will turn out who are barely allowed to take a step without a panicky mother pouncing.
Many of those early marriages ended up in disarray, but meanwhile, they gave the country plenty of children and I don’t remember hearing of more than a couple of people with fertility problems. What I do remember is the very opposite during those interminable afternoons with pushchairs and prams on the Sliema sea-front: the exchange of ‘cast-iron’ information on how not to get pregnant, consoling huddles round those who had fallen pregnant yet again, and joyous little choruses at the merry exclamation that the unwanted pregnancy had resulted in miscarriage (“Guess what! I finally got my period this morning!” – congratulations all round).
Nowadays, the exchange of cast-iron information is on how to get pregnant, the consoling huddles are round those who have failed to do so, and announcements that a period has arrived after two or three months, signalling miscarriage, are met not with general remarks of relief but with expressions of grief. Women don’t say “Thank God, girls – my period has arrived” while rocking a pram with one foot and feeding a toddler with one hand. They call up their friends and family to break the sad news that they have miscarried.
That’s why I say that I feel my own experience, and that of my contemporaries – so many of whom were, like me, mothers in their early 20s – might as well have occurred in another world, so far removed does it seem in time and space. Our own experience was of trying our damnedest not to get pregnant, because when you’re young it happens so easily. We took what we called ‘missed periods’ – which are now apparently called miscarriages – in our stride, and didn’t even think of them except to pause briefly to whisper thanks in between the endless round of nappies, bottles and potties.
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Is it better to have children when you’re young? Well, I think so, definitely – but then, I’m biased. When you’re older, you have the advantages of more money and patience (when you’re 20, you have neither, and suffer greatly because of it) but when you’re young, time and life are on your side. The generations line up, children grow up knowing their grandparents as real people rather than as oldies from another planet, and they even know their great-grandparents.
They are able to slot themselves neatly into the frame of things, with the generations in perspective. Nowadays, there are countless children who will never know more than one or two grandparents, and to whom the concept of a great-grandparent is unimaginable. I feel sympathy for the grandparents, too. The arrival of a first grandchild is a joyous occasion, but if that first grandchild arrives when you are nearing 70, the joy is tempered by pain at the fact that you may not see your precious descendant reach adulthood, still less marry and have children. Younger grandparents can also participate more fully in the life of their grandchildren, and tend to have a better relationship with them.
But if you ask me what the greatest benefit of having children young is, I’ll have to tell you that it’s being scot-free at 40. My children are not at kindergarten; they’re at university. It’s not just they who have all of life ahead of them, but me, too, and there’s the added pleasure of knowing that I also have, in a manner of speaking, all of life behind me, because I have used the past two decades to raise a family, instead of searching, searching, for God knows what, and wondering whether I will ever find it.
Yes, the greatest benefit of having babies at 20 is this: not having to go to parents’ day when you’re 50. At 50, I don’t want to be talking to some irate teacher about disruptive behaviour in class. I want to be dangling a grandchild on my knee and then handing him back to his parents.