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Question
“I am considering the issues of having a second child in my late 30's and would love any feedback or advice. All the books I look up or online info are quite stress inducing, frankly. I know that after 35 I am considered "high risk" and this alone scares me as I do not have an OBGYN that I like to discuss this with. I have also read that after more than a 4 year gap between kids the mother's risk of related health issues is much higher. I am not sure how accurate this is?
Some background: I had my first (and only) child at 32 years old through natural home birth, and am 37 now. I am healthy but I have a lot of doctor related anxiety as I grew up in a homeopathic / non-medical sort of environment. Though my husband and I had always thought we wanted more than one child, since we both have siblings and come from fairly large, tight families, we had a very rough go with the first 5 years of our child's life on so many fronts (financial stress, Three deaths in family including my mother, and two close calls, our child has a life threatening disease we continue to deal with and will likely affect our second child, 2 job related moves, and the list goes on, and on, and on) and could not, AT ALL, fathom having another child through all of this.
We sort of decided we would just have one, as time was ticking on by and things were not getting easier.
However, as I have just turned 37 and it appears that most of the above major life stresses are behind us, for now, I am revisiting the decision. I am afraid that I may regret not having another child forever if I don't revisit this decision now that the stresses are behind us, somewhat, though the question of our child's health still looms and as it's a hereditary condition, we could be nailed with it twice... Ugh.
I also worry that as I am older, I have a much greater likelihood of suffering health-wise myself from the pregnancy and birth, as this is often noted in the literature I am finding. That scares me, since I need to be strong for my child. I do not want to compromise my 5-year-old's safety by not being as present or strong given his on-going medical needs.
This is a very though decision and one I know I need to make on my ownn, but any insight from all you wise ones would be welcome.
My husband says he would be happy either way, sticking with our one adorable child or trying for #2. I am the only one conflicted about this decision and I feel that time is running out for me to just make a choice and be at peace with it...
Thanks for any thoughts."
Responses
I had my second child at 40:
“Our children are 6.5 years apart because we too were dealing with illness (parents), finances, and other issues. We too originally planned on 2, eventually decided we could live with 1, but then changed our minds. My partner gave birth to both of our children... the first at age 34 and the second at age 40. No need for a high risk specialist here; same OB managed everything. No health issues other than borderline diabetes, but that was more genetic/expected than an age complication and has resolved post-birth. Both kids were delivered in a hospital, both with minimal intervention. No epidural for the second, who was nearly 10lbs!
Now that our youngest approaches her 3rd birthday, the kids are able to play together independently. It's beautiful. I'm writing from vacation abroad, where they're snuggled together in one bed (we have them in separate rooms at home.) Sure, jealousy can be an issue. But the age difference is nice and I can't recommend it enough. No regrets.”
I had my healthy son at 42:
“Here are 2c from probably a quite different perspective. First I should say I'm relatively comfortable with the conventional medical system (while also recognizing that it sucks at times) partly because I grew up in Canada where the system is overall better. I had my healthy son at 42 by IVF and by Cesarean because I'd had previous uterine surgery. All the medical intervention was very stressful but since I'd resigned myself to it from the start I just went with it, told myself it'd all be over soon, eyes on the prize, etc.
But getting back to your situation: over 35 is highER risk but still not very high, and a lot of the risk is of complications that are usually pretty manageable like high blood pressure, gestational diabetes (which I had but like most managed easily with diet), etc. It does make home birth more dangerous so you might want to consider delivering with a midwife in a hospital. And you will probably need to see you midwife or OB more often - I was at every 2 weeks for quite awhile - which may wear on you.
The question of whether to have another child who might have the same condition as your first is hard to figure since you don't say what it is. I'd suggest talking to your pediatrician and maybe a genetic counselor - your ped or an OB can recommend one; unfortunately I can't because she was at St Vincent's and they're gone - if it's something whose genetics are known.
Mainly, I think you are absolutely right to feel you have to be sure about wanting this before going ahead. You may have to subject yourself to a lot of contact with conventional medicine, testing etc and it will be miserable if you aren't at least wholeheartedly happy about the goal if not the path to it. Kudos for not just rushing in blindly and putting in the work if thinking it through carefully.”
According to some OB/GYNS in New York, 36 is young:
“I'm not sure this answers your questions, but according to my OB/GYN, I am "young" at 36 to be having a 2nd child. NY city sees lots of older moms giving birth - I have a friend who delivered baby #1 at age 45. So, I have to imagine that age 37, though it has added risks over being 25, is still very normal and common.”
I had my second daughter at 38:
“I really sympathize with your situation, having had a rough go of number 2 as well, though I have not had to deal with a life-threatening disease. But I did have a very rough, medically-challenging first pregnancy followed by severe postpartum anxiety. And, I could not, for many years, think of having another. I was 33 when my first daughter was born. After about 3.5 years, I decided I finally felt more competent and steady in motherhood and was not done having kids. So, we went for a second, and I gave birth to my second daughter at the age of 38. I have to say I do not regret one moment of it. I am so, so happy we had her. That said, I have a couple of thoughts about your situation:
1. Sounds like you have been through a lot. And, if you are not benefiting from it already, I would recommend seeing a therapist to manage some of the inevitable mood effects that can come from some of what you have been through as well as the anxiety about making this choice. My husband and I actually both had a few sessions with my therapist (whom I highly recommend - Deborah Draving, 212-206-9252) to decide about going for number two.
2. 37 is no longer that old to have a baby and, with the right medical care, you can get the answers to your questions and feel comfortable going forward. I absolutely loved my high-risk OB, whom I went to for both pregnancies, even though only my first was complicated. Before getting pregnant a second time, I met with him and talked through how we would handle any medical issues that could arise during my second, including the possibility of keeping me on zoloft, which I take for anxiety, and which I find a life saver. His name is Chad Klauser, and while I would not say he has a holistic approach, he is an extremely friendly, calm doctor from Mississippi who is so calming amid all the anxiety related to having kids in NYC. He is very low intervention, was super supportive of a non-medicated birth, etc and he has an awesome practice of doctors who are experienced dealing with all of the medical and emotional aspects of getting pregnant and giving birth. They also have two midwives in the practice who do not do deliveries, but who do appointments. One time when I was meeting with a midwife, I wanted to pop in and ask a question of one of the doctors, but I cou;dn't, because three of them were in meeting with a patient who just had a miscarriage. That's how caring they are. Dr. Klauser also answers my emails the day I send them and told me he wouldn't worry about my anxiety until I was emailing him "several times a day," they are completely accessible, kind, and competent and they have access to good genetic counselors who could talk through the potential hereditary illness issues you mention. They are also some of the most advanced docs in NYC for maternal fetal medicine.”
Successful pregnancies at 37 and 41:
“I had my first child at 37 and my second at 41 (both without fertility assistance), so you seem quite young to me! My children are almost exactly 4 years apart and we, like you, did not feel ready to even consider a second for a LONG time. My husband and I also had many of the same misgivings as you. However, our first does not have an hereditary illness, so I cannot address the additional concern that might bring. But every pregnancy and child is a gamble.....
In any case, now that we have two, we cannot even imagine WHY we ever hesitated. Seeing your children play together and knowing that they have each other brings us incalculable joy and comfort.
37 is not very old and your odds are good for a healthy pregnancy. As long as you and your husband are healthy and fit, I would encourage you to try! Having two young children while you are in your 40s is not a breeze, but I do believe that children keep you young. I think you should go for it.”
Pregnant at 38:
"I think it's very normal to give birth later in life these days. I asked at Methodist and they said the majority of their patients are in their 30's so just imagine!. I'm 38 and about to give birth to my 2nd and most of my friends and also family had and are having kids in their late 30's through their early 40's. I didn't think twice about it. I feel great physically I just occasionally think about how old I'll be when my daughter is grown up.
As for all the other things you're dealing with and worrying about, it might make sense to see a therapist for a session or two or also go speak with a genetic counselor who can give you more statistics."
On giving birth at 39:
“You know, it seems to me that the medical literature hasn't really caught up with realities on the ground when it comes to the age at which women are giving birth. Reading about it, the idea of getting pregnant after 35 can seem terrifying, but in reality many many women are making this choice these days. I gave birth the day before my 39th birthday, and my doctor (just a regular OB, not a high risk specialist or anything) was not the slightest bit fazed by my age, which she said was not at all unusual in her practice. The only concrete difference in how she approached over-35 pregnancies was related to Downs syndrome risk. Because this genetic abnormality does become more prevalent with age, my doctor was more proactive in terms of recommending blood tests and/or amniocentesis for older mothers. I did end up having an amnio to rule out Downs, but otherwise I had an ordinary and uneventful pregnancy, a normal (in other words, excruciating and unending and amazing) labor and delivery, and a bright, healthy little girl.
So my advice based on my own experience would be not to read too much of the fear-mongering stuff about being an older mother, and instead focus on the other questions raised by the idea of having another child. If you decide a second child is the right choice for your family, don't let your age hold you back (heck, we're considering a second child now, and you sound young compared to me!). One other point that may be helpful in keeping the risks in perspective: Yes, some problems do become more likely for an older mother, but in general the risk is still pretty low. Just as a hypothetical, say a certain complication generally occurs in 1 in 10,000 pregnant women, but after age 35 it shows up more often, 1 in 1000 times. If you read about this complication, you're likely to see something scary like "X horrible condition is 10 times more likely in older mothers! Oh no!" Which is true, but it's still really, really unlikely. The things you read don't generally emphasize that for 999 out of those 1000 older mothers, everything turns out fine.
Pregnancy later in life can be hard, but with no regrets:
“Cut to my 40th birthday, a few margaritas, some fumbled communication and Bam! Pregnant with number 2. At 40. Not exactly what I had in mind. I would have wanted to be 38 or MAYBE 39!! But alas, I thought it was meant to be. My pregnancy was a little harder (Lots of morning sickness…because I was older? Or because it was a girl? Who knows.) But I had an AMAZING home birth. In like 2 hours. Easy-peasy. And to answer another question you have not even asked: Is it weird or too much that the kids are 5 years apart? NO. It is awesome. Instead of having a toddler running around while I had a newborn I had a 5 year old who could talk and express his feelings and help (and sleep!) and be an amazing big brother.
DO NOT let anyone or any book or any blog tell you that being older is an issue. (Unless you have health issues that you know of that are more difficult with age.) Your body is a temple. It can do some incredible things. PLUS, you have already done it once! So all those things that stressed you out or seemed unknown or unknowable are in the bag! Been there done that. I was a less stressed mother to my baby, to my husband, to MY mother, to myself. I was more calm and relaxed in all aspects of birth and motherhood. I LOVE it! I am so happy she came to us. And now, I do not know what is happening, but she is 2 and I see pregnant women and I think…"oh, I want another one." Hahahaha.
Not happening. But still, I do not regret it at all.
The thing I cannot answer for you is the health issue with your child. That is a tough one. Just be true to yourself. IF you do have another one, do it because YOU and your spouse/partner want to. Not because you think you should or you wonder if you will regret it or you wonder if your child needs a sibling. Just follow you heart.
P.S. I can name 9 close friends, not just acquaintances, who had babies over the age of 40 (some well over) and are healthy and happy – both moms and kids!”
I had my first and only child at 44, but do wish my son had a sibling:
“I, too, had my first and only child at 44. I was a bit nervous throughout my pregnancy, but much more so after the fact, with all the reading I did and the experience of labor and an unanticipated C-section. I became amazed at the fact that there are so many normal births because there seemed so many opportunities for things to go wrong! Because of my advanced age I had some of the embryos frozen in anticipation of wanting to someday go for a second child, but because of my anxiety around some of the things mentioned in this thread (my own aging and potential illness notwithstanding) I opted NOT to try again.
I do wish my son had a sibling (he's now 7 and a really active and social kid), but feel blessed with the amazing miracle of life that my body was able to produce at that age!”
I gave birth at 37 and 39:
“My first child was born when I just turned 37 and the second at 39 (1 month shy of 40th bday). Also had one unplanned pregnancy at 23 which I terminated. With my first child I got pregnant pretty easily (we "pulled the goalie" but weren't watching the calendar and actively trying). With the second it took a little longer but I think that was also because I didn't really understand my cycle or the ovulation kits. (I know, kind of lame).
Both children were delivered vaginally with epidurals, but with #1 it was a super-long labor and the baby had a rough road coming out -- but made it! Second kid was much smoother.
Re: the terms "high risk pregnancy" and "advanced maternal age" -- I wouldn't get too hung up on these terms. At first I asked my doc why I was high risk and she said, "it's just an arbitrary age thing that the insurance companies do. It could be 34 or 36. There is nothing else about your pregnancy or health that is high risk."
Basically if you are 35 or older the amnio and some other things are covered. Also, I had 11 or so blood tests to check for being carrier of certain diseases as well. Nothing came up.
One last thing about age: there are always 25 year olds that have trouble getting pregnant and 35 year olds that don't. And of course the other way around.
Best to you in your decision making process.”
Pregnant at 38 and 42:
“I can certainly relate although I do not have a child with medical needs. I had my first child at 38 y.o. and my 2nd at 42. When I turned 35, and got engaged (within a day of each other), I went to a high risk doctor just to see if he thought I should have any worries and he practically laughed me out of his office, saying he seen a woman in his office earlier that day who was 42 and pregnant with twins! After my first child, my husband and I had pretty much decided we were done having kids b/c it was really hard and we both work F/T in Manhattan and we thought we felt fulfilled with just one. My husband felt pretty strongly about it and I was ok with that although I always wondered if I would regret it someday and did a lot of reading about only children (I am one of 4). When my daughter was approaching 3 and life started to get a little easier with her, my husband brought up the idea of having another child. Because I had come to terms with having an only child, this threw me for a loop! I gave it a lot of thought and we decided to go ahead and try for #2. My kids are now 4 yrs, 2 mos apart and it's a great spread. My daughter was very independent and social before we had #2 so that made the transition a little easier than what I've observed in families with kids who are 2 yrs apart. While I would never say that it's easy to have a baby at 42, and I can certainly see advantages in having babies when you are 18 (energy!), I am so glad that we did it. My 2nd child is definitely not as easy as the first, but as he approaches 3, he seems to be getting easier, too.
In terms of feeling you are "not being there" for the older one, that is likely to be the hardest part of this whole thing. I had 2 horrible pregnancies with nausea and severe back pain. With the 2nd child, I was virtually home-bound for the last 3 months so my husband took over all outside parenting duties. It was very hard on our marriage and hard for my daughter to accept that mommy wasn't coming to whatever it was that was happening. It really broke my heart but, now, in retrospect, if you ask my husband about any good that came out of that, he would say that the relationship he has with my daughter really solidified during that time.”
On being pregnant in your forties:
“I can understand your anxiety, especially if your reading a lot about the subject without an experienced person to bounce it off of. I had my second, after waiting 5 plus years, at the age of 41. That all being said- being pregnant at an older age than the first time, and with the responsibilities that come with already having one child, was a bit harder but the great thing was, because I have a first I now had this fantastic group of fellow parents who were super excited for us and pitched in and offered help at every step.
So, call on your circle. Let another parent pick up your child from school when you're not feeling up to it. Have that list of people you know you can count on if you need it. For pregnancy and after the birth. Our second is now 1 and a half and a total handful. She runs me ragged some days, but she always makes me laugh and she loves that big sister of hers, and vice versa. We are so glad we went ahead and did it."
Giving birth at 41:
“I had my daughter at 41, six years after my son. Understanding that my chances of getting pregnant at 40 were a crap shoot, I let fate determine--and got pregnant immediately!
Every day I am thankful for our decision to try for a second (I felt pretty "one and done" for the first five years of my son's life). My daughter brings us such pure, deep joy, and I am so excited to see how our family's story unfolds.
I say go with your gut; it will always steer you. And put the books away!
Giving birth at 39 and 42:
“I had my first child at age 39, with a midwife. I am pregnant again, at age 42, with my second son. Other than the uterus being a bit more "supple" at an earlier age, so it's easier for the little one to move down, all of my research has indicated that there is no such thing as being high risk just because you are older. You may be more susceptible to pre-existing conditions because of age, like high blood pressure or diabetes, and that would make you high risk. But if you do not have those issues, then in my opinion, and the opinion of many midwives, birthing educators and even OBs that I've spoken to, there is very little difference, as long as you are monitored properly for birth weight issues, etc (but not overmonitored).
I actually hate that just being over 35 makes you high risk--it makes no sense to me, and leaves you open to much more needless intervention. I am not a doctor, this is just my own personal experience and research. My mother had me at age 47, at a time when C-Sections were unheard of just because of age, so she didn't have one. And my sister had a VBAC at age 38.”
Piling on to the previous advice:
"Just to pile on here, I think you'll find a ton of people on this list who had their second (or first) child at (or well after) age 37, and that things went fine. Myself, I had my first child just after I turned 35 and my second just shy of 40, a gap of four and a half years. Each time, no problems at all with getting pregnant, the pregnancy itself or delivery, for which I'm grateful.
(Although as others said, I was much more tired and bovine the second time, being four years older with a pre-schooler at home.) None of my caregivers ever regarded me as high risk or ever really mentioned my age at all. I know medical stats can be scary, but to pass along a phrase I once read from a doctor -- statistics don't tell you what's going to happen to YOU. I like the recommendation of the previous poster to talk to a doctor who can interpret the statistics meaningfully for you.
That said, you have a lot of other concerns that I didn't have, particularly a child with a serious illness that's hereditary. That would definitely give me pause. I don't think I can possibly know what I would do in that situation until I was actually in it, but I certainly think your concern about being able to be strong for your son's medical needs is very valid."
39 with a home birth:
“If you want a second child go for it! If you were happy at home the first time then I would say try for it at home again. Many home birth midwives have official hospital backup relationships if you do need to transfer for some reason. I am 39 and just had my second at home. I had my first in a hospital at 36 and ended up with an unplanned cesarean. So this was an HBAC (home birth after cesarean) and one of the most amazing experiences of my life.”
On having a natural birth at 43 - find people who don't make you feel like you should be scared:
"I had never been pregnant before, got pregnant at 43 naturally and delivered naturally with no drugs and no complications. Although family, friends and the fertility community and medical community might call me "high risk" as was over 35, midwives definitely did not consider me high risk. and, looked at me a little funny when i asked them if i was. I was considering homebirth but decided to go with birthing center and as my baby was two weeks late, ended up in a hospital. It was fine and all was well. If i did it again, i would do the birthing center at Roosevelt but that's another conversation.
Bottom line--i was told by Columbia Fertility people (who are lovely btw if you go that route) that i was something to the effect of sub-fertile based on my age alone. Well. We know that's not true as my daughter is 14 months now. I wasn't ovulating every month and I also had a polyp. I had the polyp removed and was pregnant two months later but my point is, find people who don't make you feel like you should be scared. Know the risks and your options and consult the general medical community where you need to (which i did and worked with naturopath, general doc and ob) but gravitate away from those that will tell you there's a danger as there wasn't for me and most others i know who conceived and gave birth in their forties. I had a natural pregnancy, natural labor and she is great and so am I. I did a lot of work with supplements, acupuncture etc to get there and stay there (for my own sense of calm) but she's here and she's awesome. All of my sister-in-laws had c-sections and my mom was in her 20s when she gave birth and i think used drugs for most. So, what i was doing and the age i was doing it at was foreign and scary to all of them. No one was worried about the c-section which i think is scary but they were worried about me doing things naturally. And, i will say that friends that i have who had babies in their late 20s and early 30s had a lot more issues with conceiving and pregnancy than i did. I also lead a very healthy lifestyle so i'm not sure how that affected all. But, I had to watch my sugar a little more just for my own peace of mind as i was older. and, i just took good care of myself."
Test for abnormalities:
“My husband and I are both carriers of the same seriously crappy genetic disease. As we were already having fertility struggles, we opted to do IVF with PGD (pre-implantation genetic testing, in which each embryo is tested for said disease, and only those that do not have it--that are either carriers or unaffected--are transferred). We did this for our first IVF cycle, although the issue with PGD, at this point in its development, is that it involves taking a cell from an organism that is so small that it doesn't really have any to spare. As can happen, our tested embryos ended up not progressing as far as they might have, had they not each had a cell removed, and none of the ones transferred implanted. For our second and third cycles, we decided not to do the PGD, which involved taking on some risk--any child we conceive has a 1-in-4 chance of having this disease. When I got pregnant on cycle #3, I had a CVS (chorionic villus sampling)--which can be done earlier than an amnio--at 10 weeks, and that revealed to us that our daughter was unaffected by the disorder my husband and I both carry. Just to give you a perspective on another couple's approach to conception with the possibility of hereditary illness.”
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