Our Fifth Birthday

Five years ago in early 2012, I felt that I needed to share a story. It turns out that it was actually many stories, both mine personally and those of other women. My aim was to dispel a myth in a way that would encourage and motivate my younger sisters to contemplate their life plans around starting a family. The Advanced Maternal Age Project was born. It’s now a five year old.

Fast forward to 2013 and numerous traditional media outlets thought that the work was compelling. The Project was covered by the local Austin, Texas TV stations, newspaper, and a magazine. Interest in the Project was at an all-time high and women across the world heard about it through social media as well. It turns out that there was a trend a foot in the developed world around waiting until age 35 or better to start a family.

2014 was the time that the Project truly became an organization, with both an advisory board and a board of directors. We formed a nonprofit 501(c)(3) corporation. This structure still feels new and we are growing into it.

In 2015 and 2016, I took a hiatus from writing and curating original stories and interviews. It was not that I lost interest. Far from it. I continue to follow the trend of midlife motherhood in the news and support many local women who are making the choice to start their family at age 35 or better. I had to deal with a health crisis, work part-time, and focus on raising my children, who are now five, six and nine.

There is still much information and support to share, including for women who are well into their midlife and raising young children. Stay tuned.

As always, I welcome your feedback. – Sharon

Expert Voices: Dr. Ivy Margulies

Dr. Ivy Margulies

Dr. Ivy Margulies

We are honored to have an expert voice on a very difficult topic to learn and talk about. This is an important addition to our information resources.

Getting Support for Pregnancy after a Stillbirth

No matter what month of pregnancy you were in when your baby died, it is a devastating experience. After experiencing such a loss, you have just as much right to grieve and have a memorial service and/or funeral for your 21-week-old infant as does the woman who birthed her deceased baby full term. Your life has changed forever by this tragedy and you will always be a mother to your baby and you have the right to honor that. 

Pregnancy after a loss, or several losses, makes it more difficult to believe you will actually have a baby one day.

Unfortunately, it also places your body and mind in a constant heightened state of anxiety and worry.  There are things you can do to manage the anxiety during your pregnancy such as having the reassurance that your doctor’s office will see you as often as you need outside the routine prenatal visits.

  • Many women are reassured by hearing their baby’s heartbeat, particularly when they haven’t felt the baby moving too much. I had one patient audiotape the baby’s heartbeat on her phone so that if she were having a moment of worry she could play the soundtrack to calm her down and bridge the gap between appointments. Most doctors who have had a patient with pregnancy loss will offer this to you. 

    But you are your best advocate.

  • Educate yourself on terminology and recent findings surrounding pregnancy loss and stillbirth. Be curious to learn that a woman of advanced maternal age should be receiving antenatal testing beginning at 37 weeks and delivering her baby by 39 weeks thereby reducing the incidence of unexplained term stillbirths. Being your best advocate will allow you to feel more actively engaged in your pregnancy, a feeling that many women are comforted by. The mind/body approach is equally important. So during subsequent pregnancies learn about the influential power of breathing.
  • The breath has the capacity to calm your nervous system down and help you remain present when you start to feel insecure or panicky. • Our in breath is generally shorter than our out breath, so please focus on the breath going into your lungs to the count of 3 and watch the breath go out to the count of 4. Do this for 3-5 minutes and you will feel calmer and more in control and less chaotic.
  • Create a journal. It is a wonderful way to manage the emotional ups and downs of your pregnancy. By doing so, you can help you track your daily emotional state, be aware of any negative triggers in particular; did you have an interesting dream or was there an anniversary date that prompted an intense reaction, etc.
  • Lavender aromatherapy is very helpful in producing a calming effect and it will also help you sleep. There are other aromatherapy oils that produce relaxing, sedating and anti-anxiety benefits. Such as, Bergamot (relaxing), Mandarin (calming), Jasmine (sedating) and Sandalwood (sedating). If you can, pregnancy massage is another useful support to help you get through the last few months. No matter what particular way you have of pampering yourself and/or distracting yourself from anxiety, write those down and look at them when you need ideas.

Some people find Color Therapy a helpful tool; the color green is useful for calming and balancing the heart chakra, it promotes emotional harmony and balance. Green is a healing color to look at, wear and surround yourself with. Another useful color to wear or visualize around you is the color white. Just about everyone has heard of surrounding people with the “White Light of Healing and Protection.” So directing white light around you helps you to facilitate healing yourself and give you the comfort of knowing you are surrounded by a protective light aura. Sometimes no matter what we do we find we cannot relax.

This would a good time to add a psychologist or psychotherapist to your ‘birth team’ to help you with your more complicated thought patterns. A psychologist or psychotherapist can teach you some cognitive behavioral techniques that challenge the thoughts that are causing you distress. This therapy can be very effective at helping you find relief from the unrelenting thoughts, thereby helping you to enjoy your pregnancy more than you would have otherwise. Social support is also critical during this time. It is important to know you have a few close friends besides your partner that you can rely on to support you emotionally. It may also be a good idea to look for a doula or midwife to companion you through the pregnancy and/or a support group with women who because of their similar experiences not only understand and validate what you are feeling, but can ‘hold’ you through what can still be a joyous 40 weeks.

To increase your odds of having a successful pregnancy make sure you optimize your health prior to pregnancy with folic acid, vitamins, maintaining a healthy weight, exercising, having genetic counseling tests performed and reducing any stressors possible. Prepare your body, your mind and your spiritual self to welcome conception and bring your baby through to your waiting arms.

I wish you peace, love and white light,

Ivy Margulies, Psy.D.

Dr. Ivy Margulies is a Clinical Psychologist, Certified Death Midwife and the Founder of Angels Born Still. Her website is www.drivymargulies.com Twitter: @DrIvyMargulies. If you need any advice or have any questions please feel free to email her at ivy@drivymargulies.com.

Rachel’s Story

While contemplating a second Advanced Maternal Age pregnancy, Rachel from California found our work and shared some of her story.

mom and tyler 7.5 M

Rachel and Her Son Tyler

We conceived Tyler shortly after my 37th birthday. We got engaged on my birthday and decided to try to get pregnant right away not knowing how long it would take me. I got my IUD out on December 21st. We went on a trip to Thailand leaving December 29th returning mid January. I knew while we were there that I got pregnant. I could feel it, I can’t explain, but I knew.Tyler was due October 2nd and he was born on September 26th, 2013. I had a great pregnancy, I worked out almost every day and stayed healthy.I did have one scary trip to the hospital. Right after my wedding, which was during a heat wave last summer, I had a small gush of blood come out after standing up. We spent the night in the hospital and everything was fine. They told me to take it easy. I think I was over active and the wedding stress didn’t help!During labor my anesthesiologist said I was one of the healthiest women he had seen.

It was a vaginal birth. Postpartum wasn’t fun, but I’m sure that’s the case with everyone.

I know when I was looking around for “advanced maternal age” pregnancies, there was a lot of negative information out there regarding how long it would take and the increased risks of genetic problems, etc. I’m happy to share news that it can also happen really fast without any complications!

happy 8 month old

A happy 8 month old

We are going to start trying for our second sometime after Tyler’s 1st birthday. Even after knowing how easy it was for me the first time, I still worry about the second. I know you should wait at least 18 months between pregnancies (that’s what I read) but because of my age, I think we will try sooner.

Share your thoughts – we’d love to hear from you

Stephanie’s Story of Birth on Two Continents

Stephanie's exercising

Exercising while pregnant in Europe


Stephanie shares her unique story of motherhood. Stephanie is not only an advanced maternal age mother of two, but also a reverend and a doula in Austin, Texas. Founder Sharon had the pleasure of meeting her in person.  

I gave birth to my children at age 36 and 38, and it wasn’t until halfway through my second pregnancy that I experienced a health professional treating me differently because of my “advanced maternal age.”  This is because I did not go the traditional OB route of care.  I chose to birth my babies at home, under the care of a midwife.

 

My first pregnancy and birth happened while I was living in the Netherlands, where my husband and I were pursuing master’s degrees.  The Dutch generally have a very different view of birth than Americans.  They see birth as a normal event.  Painful? Yes.  Inherently dangerous? No.  In the Netherlands, student OBs must first train with midwives to learn about normal birth before they go on to study its possible complications.  Midwives attend most births there (since most births are uncomplicated), and the parents-to-be have the choice of giving birth in the hospital or at home (about 20% of Dutch births are home births).

midwife at home

Stephanie’s dutch midwife weighing her baby

I was all set to give birth in a Dutch hospital, until I realized, at about month 8 of my pregnancy, that I would be a lot more comfortable at home.  I knew I didn’t want to use drugs for pain relief, and, after getting loads of encouragement both from my midwives and from my prenatal yoga class, I had become more and more confident in my body’s ability to give birth.  I continued to walk and ride my bicycle right up until I went into labor. 

In short, I had adopted the Dutch view of pregnancy and birth as normal.  

However, I was sensible enough to realize that I my family back in the States had not been on the same journey that my husband and I had, so we chose not to tell them about our change of plans.  My dear mother arrived about a week before my due date, and we had every intention of sitting down over dinner the evening of her arrival and talking her through our homebirth plan.  Only…my water broke on our walk back from the grocery store.  I had no contractions at first, so we calmly informed my mother of our intention of staying put and called the midwife.  My mother was totally supportive, as I knew she would be.  The midwife came by and advised me to go to bed and get some sleep—contractions would likely start in the night, and there would be plenty of time for activity tomorrow.  She did not do a vaginal exam, because she did not want to risk infection.
In fact, during my entire pregnancy, I had not had any vaginal exams.  Nor did I ever pee in a cup.  I had never set foot on a scale, either.   At every appointment, the midwives had checked my blood pressure, palpated my belly, and checked the baby’s heart using a hand-held doppler.  

Twice they pricked my finger, to check for gestational diabetes, and something else I can’t remember.  That was it.[/pullquote]

So, after the midwife left, we all settled in to bed.  I was having a few mild contractions, similar to menstrual cramps.  My husband was reading aloud to me, when all of a sudden it was like someone hit a switch.  I jumped up out of bed with contractions that were very intense and maybe a minute apart.  After about 20 minutes of this, I insisted that my husband call the midwife and insist that she come over right away.  She came, checked my cervix and found that I was 9cm dilated!  I’ve never seen anyone move so fast!  From the start of those crazy contractions to finish, my labor was 3 hours.
People will sometimes say that I am lucky to have had such a fast labor, but I’m not so sure.  I have almost no memory of it, only sensory impressions.  I somehow managed not to panic.
I credit that to the very high level of confidence I had in the birth process, as well as the calm and capable people—my husband and mother, my midwife and her assistant—who surrounded me and supported me.   After my daughter was born, the midwife and her assistant cleaned up, tucked us all in bed, and left.  To me, this is one of the best parts of home birth: sleeping in your own bed afterward.  The next day (and for a week afterward), a postpartum doula came to care for us.  The midwives came and checked on me a couple of times, as well.  
None of this cost me a dime.  My insurance (which ran me about 50 bucks a month) covered everything, including the postpartum doula.

Shortly after we returned to the U.S., I became pregnant again.  I knew that after enjoying such supportive, nurturing and hands-off care, I would not be able to use an OB and give birth in a hospital here.  I found a wonderful midwife (whom my insurance actually covered!) and prepared for my son’s peaceful birth at home.  I was surprised at the number of interventions my midwife here used prenatally, including urine tests at every visit, glucose screening, and at least one vaginal exam, but I went along.  She also sent me for a 20-week ultrasound at another office.

This was where I encountered my one and only experience of being treated differently as AMA. 

Because I was over 35, they told me at the front desk that I would need to undergo genetic counseling for all the things that could possibly be wrong with my baby before they even did the ultrasound exam.  I found this completely ludicrous.  How could they have any idea about my baby’s health without even looking?  I asked whether I could decline this, and the clerk grudgingly handed me a waiver to sign. Everything was, in fact, normal, and 21 weeks later I gave birth to my 9lb 4oz baby boy, at home, after another superfast birth—which I was at least prepared for this time!  
Baby Dory

Baby Dory

 

Sharing Our Perspectives: Emily’s Feedback

Emily is a 52-year-old woman who is pregnant for the first time and used donor egg IVF to conceive. She wrote us recently and we are hoping to hear more of her story. Her baby is due in August 2014.

Sharon:  How did you react to getting the Advanced Maternal Age stamp on your medical chart (or having that label applied to you) What did it mean to you–if anything?

Emily:  I expected this, as I started trying in my 40s. Now, 5 months pregnant for the first time at age 52 via donor eggs, the old age factor is par for the course.

Sharon: Do you identify yourself as an “Older Mom”? If yes, what does that mean to you? If not, tell us about that!

Emily: It’s exciting, but also scary. I have told very few people, only a few friends. I still have not told my own mother, as I fear her reaction will contain no small amount of negativity. I do not want to have to defend my position. At the same time I am somewhat embarrassed to be so old and pregnant. Publicly I will be proud, but I do feel isolated. Thankfully I have a very supportive partner.

Share your thoughts – we’d love to hear from you

Meeting the Doulas

We have been advising women to strongly consider having a doula or birth coach present at their childbirth and to look for help for a postpartum doula when baby comes and more help is needed. Doulas provide personal and customized help to couples and support to attain their birth plans and beyond. My own experience of having a doula with me during childbirth (twice) was so important in getting the experiences that my husband and I wanted with the best possible healthy outcomes. We provide guidance to women in how to choose a doula.

I had the pleasure of talking with doulas who are members of the Central Texas Doula Association on December 3, 2013 in Austin. Each of the doulas has helped women who are age 35 or better in their work and were interested in the focus of our nonprofit.

Central Texas Doula AssociationNotes from the meeting are shared below, which show the understanding and support that doulas have for women and their partners during this important time in their lives.

“Founder Sharon Munroe of the Advanced Maternal Age project shared with us today. She became a mom for the first time at age 40, then fostered to adopt at age 42, then had second baby at age 44; she has experienced first hand the deleterious effects of modern medical care on the psyche of the advanced maternal age (AMA) mom. She is a market researcher by training.

The words commonly used to describe an AMA mom can be depressing. “Elderly primigravida”, you could be referred to the new specialty of “geriatric obstetrics”. In her experience, the OB automatically assumes the AMA is a high risk patient, when sometimes there are NO risks at all, mom may even be in great shape. Many moms come away feeling more distressed and scared due to more tests, that “warnings” may be standing orders, but it may be the norm for that particular practice, they just don’t know any better.

She wants everyone to know YOU CAN HAVE A HEALTHY BABY AT AGE 35 OR OLDER, and believes that the more women who defy the odds and tell their stories the better.

Her website includes info on how to choose: a doula, midwife, OB and is intended to be reassuring, reinforcing that women have multiple choices/multiple paths in prenatal and birthing care. She feels she is seeing a trend to using midwives, more about getting what they want in birth and to be treated as a woman, not just a patient. She also acknowledged that if fertility was an issue, those women tend to lean more to hospital/obstetric care and often have a significant amount of fear and sometimes loss issues.

Her desire is that we channel our AMA moms to the website and then after the birth (sometimes years later) have them tell their story.”

 

Considering Foster Parenting

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

Q: My husband and I had our daughter when I was 39 and now that she’s three years old, we’d like to add to our family. Having been through a pregnancy and now raising a daughter who is genetically related to us makes us open to expanding our family by being foster parents and potentially adopting. What should are the steps for fostering?

Response from Sharon Munroe, founder/executive director:

Family photo

Sharon, Jasmine (at her third birthday) and Grandma Barbara.

A:  There are choices for adding to a family through foster care, domestic and international adoption. Here are the steps we took to add to our family through foster care:

  1. My husband and wanted to learn more about fostering and adopting and went to an orientation with our state agency “CPS” in January 2010.
  2. In March of that year we were selected to begin training in Texas’ PRIDE Program with the hope of being certified as a foster and adoptive home and being able to care for a child. (Many similar training and placement programs exist in our city and across the country, including those with private agencies.)
  3. In that six-week period, we had lots of homework, including paperwork to complete, home and fire inspections, a first aid and CPR training class and of course, a home study. Early in the process, we also had the mandatory criminal background checks.
  4. A Home study is next. During that visit, we talked with a social worker about a variety of topics including our own childhoods, and our values and plans for the placement. Importantly, we were asked about our support network and how our families, friends and neighbors would react to a foster placement and adoption of a child.
  5. Once we were certified as a foster and adoptive family we waited fora call. The waiting was hard.
  6. We received a call from our local child protective services office and received our foster daughter and paperwork.

(She was eligible for adoption 1.5 years later and we adopted her at age 2. She is shown celebrating her third birthday in the photo.)

You can learn more, and find out if foster or foster-to-adopt is the right way to build or expand your family at the State of Texas website, or your state’s Child Protective Services website.

We’d love to see your question! Write Us with Your Question!

On Parenting Styles

This is the column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

 Q: Getting ready for my first child to be born, I’ve heard about many styles of parenting. How do pediatricians feel about these styles?

Dr. Kibler

Dr. Elise Kibler, Capital Pediatric Group, Austin

Response from Elise Kibler, M.D., Capital Pediatric Group

A:  Parenting styles can vary significantly.  There are a number of different parenting styles.  In my opinion, parents need to be flexible with their parenting style.  Children of different ages and maturity levels will need different parenting styles.  Different situations over the course of a day may call on different parenting styles as well.

Attachment parenting encourages parental proximity to the child, consistent caregiving by parents, and protective parenting style which meets the basic needs of the child.  Parents usually sleep in the same room as the child as well.  This is a good style to support when the child is young and fully dependent on the parent.

 

Another parenting style is authoritative parenting.  With this style of parenting, parents respond to concerns and questions from their children.  They are also willing to adjust plans based on the needs and wishes of their child.  Parents do have rules that their children are expected to follow, but parents are flexible and adjust to the situation at hand.  Discipline involves supporting their children when they are making good decisions rather than being overly negative.  This parenting style encourages independence and is appropriate for children beyond infancy.
 
A third style of parenting is authoritarian parenting.  In this style, the child is expected to follow strict rules established by the parents.  This set of rules is set by the parents and non-negotiable.  Failure to follow the rules results in punishment.  This style of parenting plays a role in certain situations, but requires a high level of maturity on the part of the child to comply.  Certain rules require an authoritarian style of parenting such as “don’t open the door for strangers”, “no drugs or alcohol”, and “no hitting or biting”.  Parents need to pick their battles.  When authoritarian style of parenting is used constantly or restricts a child’s ability to make their own decisions it can lead to insecurity and anxiety.
 
Permissive parenting involves letting the child do whatever they want without regard to the needs or wants of other people.  These parents are still responsive to their child and play the role of a “friend” more than an authoritative figure.  This may serve a role from time to time such as on birthdays and special occasions.  My children periodically have a “special day” where they can pick what they want to do and where they want to go.  Although the child has a sense of total control, it is important to allow options that are feasible and desirable for the parent as well.  For instance, if the child wants to go to a place that is not safe or too far away the parent will ask the child to pick another option? Giving the child a sense of control periodically can be very healthy for a child and allows them to cope with situations such as getting shots at their check-up where they lost control.
 

Uninvolved parents are not responsive to their children, do not provide limitations, and are basically absent in their child’s life.  This style of parenting plays no role in a healthy parent-child relationship.

 
We’d love to see your question. Write Us!

Sharing Our Perspectives: Vicki’s Feedback

Vicki from Pennsylvania found us online and a felt compelled to write us with her story filled with wisdom. She is 66 and her youngest daughter is now 21.  

My first child was born when I was 29. He was a healthy 8 lb. baby and I was probably a little in awe of this tiny bit of humanity. I went back to work immediately, primarily because I was able to take my son back to work with me. My husband was a veteran who was completing his bachelors degree and was able to take the baby in the afternoons.

Then in 1981 we decided to have another child. Our son was 6 years old when his sister was born. We were sure that our family was complete. When our daughter was 9 years old, and I was 44, I found that I was pregnant with a third child.

This was totally unplanned and happened despite every precaution we had taken to prevent a pregnancy. In fact I was scheduled for tubal ligation surgery in June – a month after I found out I was pregnant.

I was stunned and embarrassed. Here I was with a 16 and 10 year old and I am expecting another baby at 44. I was immediately advised by both my PCP and my Obstetrician that I was a “high risk” mother. Other than a fibroid tumor that seemed to have attached itself to the growing fetus, I didn’t have any problems with the pregnancy.

The birth of our 3rd child, a girl was relatively easy. After completing a full day of work, I came home to start dinner, but my water broke within the first half hour of getting in the door. Our little girl came 6 hours after my water broke.

Emotionally, my concerns were about how I was going to have enough energy to keep up with a baby. The blessing in it all is that I had a very supportive family, and lots of help from both my mother and mother-in-law.

My experience with this late life baby has been awesome. She has grown into a thoroughly capable competent young woman. I believe I was a more relaxed mother with her, and I think that being older allowed me to engage in more thoughtful parenting practices than I used with my two older children.

Newborn Tests

We have begun a new column where our readers can write in with their questions. We’ll field the questions to one or more experts in the subject and post the responses typically within 2 weeks. Write Us with Your Question!

 Q: What newborn care is given typically at the time of birth and what are the tests and checks done on a healthy newborn during our hospital stay?

Dr. Kibler

Dr. Elise Kibler, Capital Pediatric Group, Austin

Response from Elise Kibler, M.D., Capital Pediatric Group

A:  When a baby is born, the healthcare providers should allow time for immediate skin-to-skin between mother and baby.  Skin-to-skin time is the best way to warm and comfort a baby, encourage bonding, and stimulate milk production.  They should assist the new mother in establishing a good latch and supporting breast feeding.

Two injections are given to the baby shortly after birth – the vitamin K and Hepatitis B vaccine.  The vitamin K prevents bleeding in the newborn period.  The Hepatitis B vaccine prevents a liver infection that can affect newborns.

When at the hospital, the infant has its breathing and temperature monitored by the nurses periodically and is checked daily be the pediatrician.  A pediatrician will look at the baby from head to toe.  We check to make sure the eyes developed well, soft spots are open and in good position, check the heart and lungs, and also look at the hips to ensure that the ball and socket joint developed well.  We also look for rashes, tongue-tie which can affect a latch, and other congenital abnormalities.

During the second day of life, hospital staff will check the newborn’s hearing.  This is required by state law.  It will not be done at a home birth and is usually not done in a birthing center.  If that is the case, it should be arranged later by the child’s pediatrician.

During the second day of life, the hospital staff will also check the newborn’s jaundice level.  Jaundice is caused by the buildup of bilirubin which is a protein in the blood stream.  It is typically flushed out by the liver once the child’s gut matures and starts eating and stooling at full speed which is usually starting on the 5th day of life.  The level of jaundice should be checked by the hospital before the baby leaves and then followed up by the pediatrician between one and three days after discharge (depending on the level).  Getting outdoors helps clear this jaundice and can be beneficial in allowing the newborn to make vitamin D as well.  Ask your pediatrician more about vitamin D and the best way to make sure your child will get enough.

A heel prick to obtain blood sample will also be done on the newborn.  This is called the newborn screen or metabolic screen test.  It tests for 30 different congenital and metabolic abnormalities that are important to pick up in the newborn period.  It is done on the second day of life and repeated when the baby is two weeks old.

We’d love to see your question. Write Us!