Women and Birth
Volume 20, Issue 3 , Pages 121-126, September 2007

The project: Having a baby over 35 years

  • Mary Carolan

      Affiliations

    • Corresponding Author InformationTel.: +61 3 9919 2252; fax: +61 3 9919 2832.

School of Nursing and Midwifery, Victoria University, PO Box 14428, Melbourne 8001, Australia

Received 21 December 2006; received in revised form 14 May 2007; accepted 16 May 2007.

Article Outline

Summary 

Purpose

The purpose of this Australian study was to evaluate the experiences of a group of first time mothers aged more than 35 years.

Procedures

In depth qualitative interviewing was employed and a total of 22 women were interviewed over three points of time during late pregnancy and the early postpartum period.

Findings

Findings indicated that a percentage of mothers approached childbearing as a major project in their lives. Data analysis revealed that the project progressed through clearly defined stages of: information gathering; planning and preparing and finishing up tasks prior to the birth (clearing the deck).

Principal conclusions

Findings from this study provide an opportunity for greater understanding of the first mothering experiences of women aged more than 35 years, particularly women with significant career investment. Greater understanding, in turn, may enable health professionals to identify specific needs and concerns of this cohort, and thus to provide more meaningful maternal support and woman sensitive care.

Keywords: Pregnancy over 35 years, Midwifery, Career women, Maternal employment

 

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Introduction 

Older childbearing is an increasing trend across the developed world. In Australia, the average age of childbearing has risen to 30.7 years in 2005,1 from just 26.3 years in 1978.2, 3, 4 A considerable portion of this increase relates to mothers older than 35 years and, in 2005, more than 20% of 259,800 births registered to Australian women, were to women in this age bracket.1 Indeed, birth rates for women aged 35–39 years have more than doubled in the past two decades and a similar trend is seen among women aged 40–44 years, although the overall numbers for the latter group remain small.1

Changing social patterns of smaller families and greater female participation in the workforce have contributed to these trends.5, 6 Time invested in career building and completion of higher education also plays a part in delaying baby plans.7, 8 For career women, age 35 or more may represent the first opportunity for pause in the woman's work-life.8 Additionally, in postponing pregnancy women are not always aware of the difficulties they might later face. Those difficulties include fertility issues and original plans to ‘wait a few years’ may eventuate in a time frame not previously envisaged. Older maternity is also considered to be medically risky and the literature is rife with dire warnings of the hazards of advanced maternal age.9, 10, 11, 12, 13 Nonetheless, the majority of older mothers do very well,14, 15 particularly in terms of birth outcomes 13, 16, 17, 18 and psychologists Berryman, Thorpe and Windridge 14 found that older mothers, in general, had skills and life experience to draw on “which they can contribute to their abilities as a parent.” (p. 118). Similarly, Dobrzykowski and Stern 19 and Pridham and Chang 20 considered maternal age and problem-solving abilities to be positively linked, while Gottesman 21 found high levels of competency among older mothers. However, in general term, the journey to motherhood is considered to be onerous for dedicated career women 7, 22 and advanced maternal age is suggested as a further complicating factor.23

Thus, this paper discusses the ‘project like’ approach to childbearing as one aspect of mothering seen among first time mothers older than 35 years. This expose aims to shed some light on the unique mothering experiences of this group, and in so doing, may inform future educational programs for women over 35 years, who currently represent a sizeable portion of the birthing population.

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Methods 

This paper reports on a subset of data drawn from a longitudinal, qualitative study, conducted in an Australian tertiary hospital. It examined the first mothering experiences of 22 women aged more than 35 years.15 Pregnant women were recruited through the booking office of the hospital. Inclusion criteria were:

•primagravid

•aged more than 35 years (had passed their 35th birthday)

•no significant maternal complication

•no significant fetal complication

A thematic analysis methodology was used, in the tradition espoused by Rice and Ezzy [see Ref. 24 p. 193]. This approach aimed to provide a broad overview of first time mothers over 35 years. Data was collected through in depth interviewing, chosen in line with Kvale's 25 understanding of in-depth interviews as ‘conversation that has a structure and a purpose’ (p. 6). This type of interview focuses on the participant's perception of self, her life and experience, expressed in her own words, which is commensurate with the feminist valuing of women's words. The approach has also been influenced by the work of Ellis et al.26 Ellis et al. also espoused a feminist orientation and suggested interactive interviewing as appropriate for researching ‘emotionally charged and sensitive topics (p. 121) such as childbirth.

The in depth interviews were conducted across three points in time, at 35–38 weeks gestation; at 10–14 days postpartum and at approximately 6–8 months postpartum. The initial contact interview of approximately 30min was used to collect demographic data such as employment and educational status and to ascertain what prenatal preparation the mother had engaged in. Questions included:

•How have you prepared for the birth?

•What is important to you as the birth approaches?

The first in-depth interview (lasting approximately 1h) was conducted at 10–14 days postpartum and aimed to capture the woman's birth experience and her experiences of early mothering. Opening questions included:

•How was the birth?

•How well prepared were you for this stage?

•What sorts of things are important to you now?

•What worries have you for yourself, for your baby?

At the final in-depth interview mothers were questioned about their overall experiences of becoming a mother. At this stage participants were also asked ‘what, if anything, would have made their experiences of early mothering better?’ All interviews were taped. Consent was obtained at first interview.

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Theoretical framework/data analysis 

A poststructuralist feminist framework underpinned the study. The key characteristic of this framework is the post-structuralist approach, wherein the individual is viewed as being shaped by the discourses of the day. Discourses, in this context, refers to ‘broad social, cultural and historical systems of meaning’ as described by Hardin.27 Feminist theory contributes as understanding the lives of women and as appropriate for researching sensitive topics such as childbirth. Similar understandings have been espoused by a variety of researchers.26, 28, 29

Data analysis took the form of systematic content thematic analysis and proceeded through the following stages:

•Audiotapes were transcribed verbatim and full interview texts were read and re-read several times

•‘Open coding’ was employed and many headings were used to describe all aspects of the data.

•Categories were grouped together under higher-order headings.

•Similar headings were removed to produce a final theme list.

•Validity was enhanced by asking two colleagues to independently generate a theme list.

•Transcripts were reviewed again next to the final list of themes and alternate explanations were sought.

•Each transcript was coded according to the list of themes.

•Each coded section was moved to the theme where it belonged.

Similar methods have been described by Burnard 30 and Downe-Wamboldt 31 and traditionally, qualitative data has been analysed in this manner. This close attention to detail, according to Bowling,32 allows the researcher to ‘maintain(ing) a close relationship and awareness of the original data’ (2002, p. 345).

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Results 

Participants 

During planning, it was expected that women from a range of socio-demographics would be represented in the sample. However, such was not to be the case. Ethics clearance permitted approach to all women giving birth at the hospital, nonetheless, when it came to recruitment most women meeting study inclusion criteria were found to be attending a private obstetrician for care. These women planned to give birth in the private unit attached to and sharing facilities with the tertiary hospital. Almost all had private health insurance. That is not to say that pregnant women older than 35 years did not attend for care within the public hospital. Many such women presented, however, most were having a fifth or sixth baby, having commenced childbearing many years prior. Others had been transferred from provincial hospitals for the advanced care options available at the tertiary centre, and did not meet the uncomplicated pregnancy criterion. Despite ongoing efforts, few women giving birth in the public hospital satisfied study inclusion criteria.

In the final sample of 22 women, it was clear that participants fell into two main groups: women who considered themselves career orientated (n=16) and those who did not (n=6). Career orientated women tended to be well educated (tertiary level degree/diploma) and frequently described themselves as ‘driven’ ‘professional’ or ‘very interested’ in their career. This group included a doctor, a journalist, accountants,2 lawyers,2 businesswomen,4 an academic, computer specialists,2 a project manager, a teacher and a registered nurse. All had postponed having a baby, though the length of postponement varied from 2 to 20 years. Postponement was later complicated by conception difficulties for approximately one third of the women. Most had worked towards achieving a certain level of career advancement prior to conceiving. By comparison, non-career orientated women tended not to have delayed pregnancy but were late having a baby for a variety of reasons such as: lack of a partner; reluctance in a partner; economic reasons and fertility issues. All participants were in heterosexual relationships.

Overall findings 

For women who had chosen to delay pregnancy, the project approach was common and, in general, commenced well in advance of conception. These women spoke of having a baby as the ‘next project’ or the ‘next thing on the list’. Following a decision that ‘this year would be the year’ the majority of career women dealt with childbearing as any other major project in their lives in terms of accessing relevant information, preparing for conception and once pregnant ‘doing it (pregnancy) properly’.33 This approach was described almost exclusively by the study's career orientated women and thus, findings here, refer principally to that group. Participants who had experienced delays in conception were primarily interested in getting and staying pregnant and often abandoned earlier project like plans.

In general, the project progressed through a clear trajectory of: information seeking; planning and preparing for conception, and, once pregnant, clearing the decks, a term used by participants to mean finishing up outstanding projects and completing work tasks prior to the birth. Throughout each phase, there was considerable discussion with the woman's partner. Concerns were raised about being adequately prepared for the next step, including ensuring that the woman did not miss a window of opportunity for particular events such as rubella vaccination or pre-conceptual folic acid.

Information seeking 

Many participants read enthusiastically, conducted internet searches and collected information from doctors’ surgeries and hospitals. Some undertook extensive literature searches in their quest for information. Several had read entire pregnancy guides and were later confused and distressed to find the advice offered was contradictory. One woman described her approach as ‘doing a crash course on pregnancy’. The principal aim of this approach was, as one participant succinctly explained to ‘get a handle on the key concepts’ of pregnancy and birth. This then allowed participants to plan to facilitate events. For many, this was a normal work approach and one regularly employed before commencing any new project, particularly a project of some importance. Women described how, on commencement of a project, they would read all the available literature and then approach the new situation as knowledgeably as possible. For these women, a similar approach to childbearing seemed sensible. Abigail explains:

Well, I like to do things well so I usually put a lot of effort into the planning stage … this (having a baby) was a really big thing for us and I wanted to get it right … I did spend a lot of time reading up on what I could do to improve my chances …

While for Harriet, being as well informed as possible, was really important:

That was very important for me, to be as knowledgeable as I could be about the process that my body was going through. I did read a lot … I read everything under the sun …

One point of difference was the type of information many career women preferred. Many sought information written for a medical or midwifery audience. Here, Margaret describes her information preferences:

Well, we read a lot of books … I had about 6 or 7 really good reference books on pregnancy … some of the books are really terrific, we had a couple of very authoritative ones, one from the Royal Women's’ [hospital] in Sydney, I think it was written by obstetricians and nurses …

And although Jane realised in retrospective that her extensive knowledge, of ‘what could go wrong’ in pregnancy, had made her anxious, she also reflected that it simply was not possible for her to approach pregnancy any other way:

We’ve come to a certain point where we know a lot more than we would have 20 years ago, and we want to know, the risks and all that, so I don’t know if I could approach it any other way … if my doctor didn’t give me enough information I would’ve got it somewhere else … I think despite everything you’d find out the statistics

Planning and preparing for conception 

For many participants, having a baby was the culmination of a 10 or 15 years plan and although most were excited at having reached this point in time, they were also nervous and spoke of a limited opportunity to ‘get it right’. Most were seriously concerned about the long-term repercussions if things did not go to plan. Thus, participants spent considerable time preparing physically and mentally for the pregnancy, with an emphasis on maximising health prior to conception. For some, this meant losing weight, going on special diets to ‘detoxify’, joining a gym and ceasing hormone contraceptives some months prior. Here Jennifer describes her efforts:

The plan was to go away and have a big holiday and to come back and start trying … so we came back, went off the pill for 6 months before we started trying, did the-prepare your body, lost some weight, took folate and whatever … I wanted to give her the best start you could possibly …

It was also important that Jennifer and her partner were mentally prepared:

I guess it was important that we were emotionally, together, that we were happy and that there weren’t any kinks in our relationship … we could then cope with another person in our lives …

For others, preparation meant attending specialist doctors and allied professionals to pre-empt possible difficulties. Jane, for example, visited a specialist physician, as she was concerned that her blood pressure might present some later problems. She had previously been well but knew from her reading that high blood pressure was often associated with advanced maternal age. Jane also attended a dietician for dietary advice:

I was very careful! I went and spoke to a dietician and … I wanted to make sure that at least my diet was giving him the right things. … We went to lots of doctors to make sure I did everything right. I went to a blood pressure specialist, to make sure my blood pressure did not get out of hand, I mean, it had not been a problem, but we thought that it was a possibility …

Participants also spent considerable time choosing hospitals and birth care options. This included visiting on hospital open days, attending organised tours of birthing units, calling maternity care providers for lists of practicing obstetricians and comparing facilities offered at various venues. Most women spoke of choosing hospitals where ‘all the facilities’ (neonatal intensive care facilities), were available. Risk management strategies seemed to underwrite the decision process, which was also influenced by friends’ stories. Harriet, for example, had a friend whose son had cerebral palsy as a result of a birth injury and, for Harriet, minimising similar risks was all important:

It was very important to me to have a really good doctor. As soon as I realised I was pregnant which was 2 days after my period was due, I went to the GP and booked into my doctor and everything... I chose a hospital where there was al, ... everything ... all the medical … [facilities]

For most, the availability of emergency services such as an anaesthetist and the ability to perform an urgent caesarean section was important. Gayle explains:

I wanted to go somewhere where they could do an emergency section, just in case and I thought at my age and everything, I thought I might just need to have one …

Setting up a plan/clearing the decks 

Once pregnant, the majority of women seemed to relax and spoke of the ‘first phase’ as being completed successfully. These women were now free to concentrate on ‘clearing the decks’ and making room for a newborn in their lives. Interestingly, many participants were less concerned with the birth than thereafter and this is at odds with accounts of average aged or mainstream mothers. Accounts of childbirth educators and antenatal education classes indicate that the principal interest among pregnant women is on preparation for birth 34, 35, 36, 37 with many educators bemoaning the fact that it is difficult to orientate pregnant women to a time beyond the birth.

Moreover, for the career orientated mothers of this study, maternal employment presented as a major concern. For these women, paid work had long occupied a central position in their lives and thus impacted largely on the timing of pregnancy and decisions about leave and future employment. For some participants, leaving work even temporarily was a huge wrench while others were wistful about future promotions that they saw as incompatible with raising a family. This stage of clearing the decks included: completing tasks prior to leaving; late commencement of maternity leave and an emphasis on not wanting to waste time when off work. Some women went to elaborate lengths to organise their own replacements and to set in place structures to ensure the smooth running of the business/work in their absence.

Completing tasks 

An emphasis on the completion of important tasks prior to leaving was common and many women were concerned about ‘letting work down’. Harriet, for example personally recruited her replacements:

I wanted to get my project pretty much completed and sorted … I did all my planning well in advance for when I left … I found replacements for me, we broke my job up to 4 and I actually found the replacements in advance …

Late commencement of leave 

For a number of the participants, particularly those employed in a position of seniority, late commencement of maternity leave was usual. Some commenced maternity leave only in the week preceding their due date, sometimes against medical advice. Gayle, for example, finished work on the day of her scheduled induction of labour for elevated blood pressure, taking a taxi from work to the hospital. Gayle explains:

On Tuesday I started to get protein in the urine, he [doctor] said to me ‘You’re going in [to hospital] tonight’ and I was supposed to go in that night and I said I think I’d be better off at home tonight ... Then I was supposed to come back in and I was not supposed to go to work the next day but I went in [to work] and I was there until 4 ‘o clock ... I had to go and hand over to the new girl … at 4pm I got in a cab and I was back at 5 and everyone was saying you’re late! He's going to induce you in half an hour!

Not wanting to waste time 

This late commencement of maternity leave related principally to a need to complete tasks prior to leave but also to a concern about wasting time on maternity leave, prior to the birth. Gayle explains:

Geoff [obstetrician] had been telling me about 3 weeks before that I had to leave and I said Geoff, I can’t leave, I have to run maternity leave from the day it happens and secondly, I said I’ve got to hand over to the person …

While for Kerri, being at home prior to the birth simply represented a waste of time:

I didn’t want to be 2 weeks late and be thinking ‘oh, now I’m hanging around’ so I tried … I worked right up to the end … I thought I would need the time off after more …

And Carol planned to use her maternity leave to complete some units of higher education:

That was the next task, to complete the masters, I planned to do a subject on my maternity leave, it means I won’t lapse in my professional development …

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Discussion 

Within the mothering literature, pregnancy preparation is discussed as occurring among mothers of all ages. The greatest efforts, however, seem to be concentrated among well educated mothers of better social circumstances.38, 39 In this study, participants went to considerable effort to be prepared and this tendency was seen particularly among career-orientated mothers. Similar tendencies of greater attention to detail, among older well educated mothers is reported in the literature.14, 40 Most participants undertook broad information searches, researched widely on the internet and read all the available literature, including information aimed at health professionals. This approach seemed to be underwritten by an anxiety to perform well as a mother. Using a project like approach offered the women some measure of perceived control, in addition to being a successful work strategy. Indeed, several women described simply being unable to approach pregnancy in any other way. Moreover, although a tendency towards information gathering has been previously reported among well-educated and older mothers,21, 41, 42, 43, 44 the project like approach is less well documented. What literature does exist, tends to explore notions of older mothers as task orientated and overly concerned with order.19 In all, this project like approach may relate more to what Hewlett 45 terms a ‘worsening time famine’ among professional women (p. 236), than to any other consideration. A lack of time is later succeeded by a need to manage time expenditure, which becomes such a part of the woman's world that it informs all her plans, including pregnancy.

The notion of having to ‘clear the decks’ to accommodate the newborn represents another area that seems peculiar to this group. It is not specifically addressed in the literature, however, some parallel notions present. For example, Dobrzykowski 19 coined the term ‘no unfinished business’ to explore the way in which women older than 30 years completed major tasks prior to embarking on pregnancy. Dobrzykowski found that participants who considered themselves to have no ‘unfinished business’ were able to move forward with their lives, whilst those women who considered they had unfinished tasks were less well able to deal with the issues of new maternity. Smith-Pierce,23 meanwhile, found that mid-life working mothers reported many conflicts juggling work and family and coped by making time or creating space for the baby. Finally, it may also be that ‘managing’ pregnancy and the early mothering period may have ramifications for maternal attachment. For example, Carolan 15 found that such women reported a delay in pregnancy engagement and subsequent transition to motherhood.

Finally, much of the literature reporting on maternity among women over 35 years has focussed almost exclusively on medical risk and maternal age related risk of maternal and perinatal morbidity.9, 10, 11, 12, 13 Most of that research did not address lifestyle influences, such as smoking, weight and general health. It also did not address the contemporary trend of older maternity by choice among a population likely to be healthy, financially secure, and to exercise prudent health choices. Further research is needed to identify the real risks of advanced maternal age among this healthy cohort. Such research may shed light on the real risks of delayed pregnancy and provide some positive information on mature mothering.

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Conclusion 

In conclusion, this unique approach of ‘the project’ sheds important light on the experiences of older primiparae. Close attention to the ‘project’ may promote greater understanding of the mothering experiences and concerns of this group of women and may thus inform future midwifery strategies to assist their maternal transition. For many participants here, considerable tension around work-related decisions in the later stages of pregnancy was also evident and it may well be that such women need additional support as they step down to a different pace during late pregnancy and maternity leave.

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PII: S1871-5192(07)00051-0

doi:10.1016/j.wombi.2007.05.004

Women and Birth
Volume 20, Issue 3 , Pages 121-126, September 2007

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