Patient information leaflets

 

 

 

Having a baby after the age of 40

 

 

This information sheet is for mothers having a baby when they are over forty. Please ask your midwife or doctor questions if you don’t understand any of the information in the leaflet.

 

Introduction

Congratulations on your pregnancy. The rates of women getting pregnant in their forties is increasing and has more than doubled since 1990,and nearly one birth in five is to women over the age of 35. Most women over forty have healthy pregnancies and babies. However, as an older mum, you’re more likely to conceive more than 1 baby. This may be through natural conception or through assisted conception such as IVF. Carrying more than 1 baby can make pregnancy more complicated, especially if you’re older. Being an older mum sometimes means that your body has to work harder than if you were younger.

 

Advantages to being an older mum?

It’s possible that you are eating more healthily and exercising more than when you were younger. Older women are also less likely to be smokers.

The confidence you may have gained from having more life experience may make it easier to enjoy pregnancy and having children. It’s also more likely that you are emotionally and financially stable and ready for children. Try not to worry too much about your age. Just concentrate on having a healthy pregnancy and bonding with your baby. If you have any worries or concerns, it might be helpful to talk to your GP or midwife.

 

Is there an increased chance of complications?

It has been known for many years that older women are more likely to experience problems in pregnancy and childbirth. However what is unclear is whether the increased chance of complications applies to all pregnant women over 40; first time mothers over 40; pregnant women over 40 who have a large number of other children; or pregnant women over 40 who have additional health problems.

 

What are the complications and how can these be detected?

Your midwife is trained to care for healthy pregnant women in their forties. However they will refer you to a hospital clinic if they are concerned for either your health or that of your baby.

Women with complex healthcare needs, or women whose previous pregnancies or births that have been less straightforward, will be referred in early pregnancy to a hospital consultant.

Some mothers can safely be looked after by their midwife after receiving minimal support from the consultant, or after tests have been arranged. Women who require hospital care will have appointments sent to them.

 

The potential problems might include:

• Developing gestational diabetes. This is approximately four times more likely in mothers over 40 when compared to women in their twenties or early thirties (about 1 in 25 compared to 1 in 100). Your midwife will test your urine for sugar at each antenatal check-up and arrange further tests if sugar is detected.

• Having a big baby (about 5 in 100 will have a baby over 4.5kg) or having a small baby (with growth restriction). Your midwife /doctor will have arranged regular growth scans. Big babies are often linked to the mother having gestational diabetes.

• Sadly there is an increased risk of miscarriage, ectopic pregnancy and preterm birth in women over 40.The rate of miscarriage rises with age, with 1 in 2 pregnancies in women over 45 ending in miscarriage.

• Having a stillbirth, once you are ‘overdue,’ is about twice the risk of a younger mother. We advise all mothers to keep aware of their baby’s movements and, if they change, particularly if they become less noticeable, you should contact us promptly to arrange to be checked over.

• We offer all mums aged 40 or over the chance to be induced around their due date, to reduce this risk of stillbirth.

• Your midwife should arrange for you to be seen in the hospital clinic at 39-40 weeks to discuss the plan for delivery if your baby has not arrived by your due date. Induction following a previous Caesarean Section (CS) can be offered to most women quite safely, but some of these mothers may need / prefer to have Caesarean Section booked if their labour does not start naturally.

 

• Needing a Caesarean birth for any reason is about twice as likely in older women. It is thought that this may be due to the uterine muscle being less effective, particularly in first time older mothers. The chance of needing a Caesarean is around 1 in 3 after labour has started.

• If there are additional concerns, such as a large baby, maternal health problems etc, then you may be advised to have a planned Caesarean birth before labour starts. Mothers who have had a Caesarean Section (CS) delivery in the past will be offered a counselling appointment to discuss the risks and benefits of a repeat CS versus vaginal birth.

• Labour may be slower due to the muscles of the uterus not working as effectively and there is an increased risk of needing an instrumental birth (with forceps or ventouse).

• An increased risk of heavy bleeding after birth, active management of the third stage of labour with a hormone injection is recommended to minimise this.

• You are encouraged to discuss your birth options with your named midwife or consultant and have a personalised birth plan based on this discussion and your preferences in your notes.

 

What can I do to make sure I have a healthy pregnancy over 40?

The best thing you can do if you are pregnant at any age is to concentrate on trying to be as healthy as possible by:

• not smoking
• eating a healthy, balanced diet
• losing weight before pregnancy if you are overweight or obese
• managing your weight gain if you are overweight or obese in pregnancy
• trying to avoid certain infections during pregnancy, including rubella
• avoiding certain foods in pregnancy
• not drinking alcohol or using illegal drugs in pregnancy
• staying active
• limiting your caffeine intake before and during pregnancy.