Pregnancy Over 35

Pregnancy is generally a time of joy and anticipation for growing families. And this is true no matter your age. Due to changes in the workplace and society as well as advances in reproductive technology,  American women are delaying childbearing. Making women wary about having a baby is not helpful, but informing them is. Women planning a pregnancy over 35, also called advanced maternal age (AMA), are at increased risk for several issues in pregnancy such as gestational diabetes, high blood pressure, preterm birth, cesarean section, and pregnancy loss.  Fortunately, most women over 35 have healthy babies!  A cornerstone of Thrive is to treat women as individuals instead of statistics. So, let’s move on to how you can optimize your health in pregnancy regardless of your age.

Being as healthy as possible prior to conception is crucial

At Thrive, we offer comprehensive pre-conception visits that focus on creating a personalized plan for you to optimize fertility and health before pregnancy. We recommend specific supplements and nutrition based on your health and lifestyle. It is preferable that you start with a normal weight (BMI<30), avoid environmental toxins, minimize caffeine consumption, exercise regularly, and avoid nicotine, marijuana, and alcohol use both prior to and after conception. It also might be smart to check a couple labs depending on your current health status. Contact us today for a preconception visit. https://thrivemidwives.com/contact/

If you are already pregnant and 35 or older?

  1. Due to the progressive aging of a woman’s eggs, the risk of miscarriage increases as they grow older. Watch for concerns such as spotting (blood), abdominal pain, pink/brown vaginal discharge, or menstrual-like cramping. If you experience any of these symptoms, notify your provider promptly.
  2. Consider whether noninvasive prenatal testing—a simple maternal blood test taken between 10-13 weeks—is something you want done. Maternal age increases the risk of having a pregnancy affected by a chromosomal issue, such as Down Syndrome.  
  3. Get a level 2 ultrasound at 20 weeks, which is more detailed than a conventional ultrasound. Extra attention is paid to your baby’s heart, brain, and bony structures.
  4. Gain the recommended weight in pregnancy based on your pre-pregnancy weight. Unfortunately about 48% of American women gain too much, putting them at increased risk for complications in pregnancy. Focus on healthy fats, lean proteins (including fish twice a week), bountiful vegetables, dark, leafy greens, and minimal sugar. 
  5. Get 20-30 minutes of brisk exercise most days of the week. It will help you navigate your weight gain, increase physical comfort, and give you strength for your labor and birth.
  6. Women over 35 have slightly higher rates of gestational diabetes and high blood pressure than younger mothers. Screening for both is important! If you have had a prior pregnancy affected by one of these issues, discuss this with your midwife either prior to conception or during your first trimester. You can take evidence-based steps to reduce these risks.
  7. Many providers increasingly offer weekly fetal monitoring beginning at 38-39 weeks pregnancy over 35.  This is due to the slight increase in stillbirth after 39 weeks. This recommendation is stronger if it is your first baby, you are African-American, or have a BMI >30. While this approach might decrease the rates of stillbirth by identifying babies who are showing signs of compromise, the actual advantages are still being debated. “[There] are no large randomized trials that have examined the efficacy of routine antepartum testing in women age 35 and older, there remains no consensus on the management of late pregnancy for these women.” (UTD 2018)
  8. More providers also offer an induction of labor at 39-40wks to prevent the small, increased risk of stillbirth due to pregnancy over 35. According to a study, 1 in 1000 healthy women under 35 will have a stillbirth between 39-40 weeks, compared to 1.4 out of 1000 women between 35-39 years old, and 2 per 1000 women 40 and older. (EBB, 2018). It is not until women get to 41 to 42 weeks that those risks increase more significantly. 

Evidence Informed Resources

https://evidencebasedbirth.com/advanced-maternal-age/

https://www.ontariomidwives.ca/sites/default/files/2017-10/In-due-time-pregnancy-beyond-40-English.pdf

Take home message about pregnancy over 35

While this can be taxing to wade through, it is crucial that women understand the evidence around recommendations they are receiving from care providers. Labeling women as “high risk” without first looking thoroughly at the individual’s health and medical history, as well as lifestyle.  At Thrive, we believe that women over 35 can optimize their health before and during pregnancy, thereby decreasing their risks and having a birth on their own terms.

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Families Thrive Midwives

I loved the ease and convenience of using Thrive’s telehealth option. My daughter and I had developed a nasty case of thrush and with three kids and a busy schedule, I had no time to travel to an appointment to get it taken care of. Not to mention, it was a Saturday! In about 10 minutes, Kari had asked me the necessary questions, diagnosed the problem and had a prescription sent to my local pharmacy. It could not possibly have been easier. Thrive definitely has a patient for life!

−Catherine

As a doula practicing for 20 years, I can attest that the physical, emotional, informational and midwifery care that Kari provides is truly phenomenal. She cares so deeply about the families that she serves, which is evident in the countless births I have attended with her. From the moment you meet Kari, her knowledge about and trust in normal birth is infectious. On top of all of that she has an amazing sense of humor! As a doula, it is a joy to watch her hold space for all of the fortunate families that have entrusted her with their care.

−Jessie, doula

When I think about who I trust to deliver my baby, my mind automatically says, Kari. In 2015 I delivered my first son in a local hospital, and the tender care and attention I received from Kari during labor, delivery and post postpartum, I knew I wouldn’t be able to find in anyone else. The amount of respect you have between the boundaries of culture and medicine manifests itself in your practice, as I witnessed it during my first delivery. You place your patients wants and needs before yours. You are there any time of the day or night via phone, email or text message. During the hard times of struggle and when my life caused me stress, I turned to you to help me get back on track to improve or maintain my health. When I was going through my miscarriage, I trusted in your expertise and wisdom. Even though I was far away from home when it occurred, you made me feel comforted as I knew you were just one call away. When I think of you Kari, it brings tears to my eyes to have known such a wonderful person and knowing my family trust you whole heartily. What I can say about you is endless. Thank you for all you do.

−Mai

I have known and practiced with Kari for a long time, and trust her implicitly to provide top-notch care for her patients. She stays current in evolving research regarding women’s health and demonstrates a growing knowledge base regarding use of supplements and herbal therapies. Kari is also really innovative in providing care in low resource settings, such as international health.

−Robyn, MD

Kari’s care is exceptional! Not only does she provide stellar whole woman care, she listens and truly forms a bond with each of her clients. Never feel like a number or meet an impersonal provider again. Kari takes the time to get to know you and your family’s health needs and provides you with the tools and knowledge to make well-informed and practical health choices. Thank you, Kari, for being my advocate!

−Suzanne

Kari provides a one-of-a-kind blend of compassion, attention to detail and well researched medical knowledge. She believes strongly that pregnancy and birth is a natural process for most women, recommending both natural remedies and evidence-based Western medicine when it was indicated.

−Melisa

I am so impressed by how Kari keeps up with current research. You can rest assured that the care you get at Thrive will be rooted in the latest evidence and tailored to your needs. Kari is a strong communicator and will be your advocate. I will gladly refer families seeking home birth, gynecological care, and intrauterine insemination to Thrive Midwives.

−Emily, nurse-midwife

Kari is extremely knowledgeable, her clinical judgment and decision making are spot on, she is easy to talk to, and has a comforting and peaceful presence.

−Christy

Kari offers the perfect balance of medical knowledge and personal care, while also trusting a woman’s body and addressing overall wellbeing. She believes that women’s bodies know what they’re doing. She helps you believe that, too.

−Maggie