What I Don’t Know Can Hurt Me

October 12, 2007

“Late Maternal Age,” they call it. It’s a fancy term for OLD MOM.

I was not late of maternal age when I had Wonderbaby. I was not entirely early of maternal age, but still – I didn’t qualify as elderly. Somehow, between the time of her birth and my current pregnancy, I became old.

I don’t mind being old. I much prefer the older me to the younger me, and I intend to go on liking myself even more as I continue along the long and winding road of time. But I’m still don’t like the euphemism that is “Late Maternal Age.” I don’t like it because it’s code, because it’s troubling code. It doesn’t refer to my maturity, or to the wisdom that time has conferred upon me as a mother – it refers to the long list of negative factors bearing upon the odds of success of this pregnancy.

Because I am now over 35 years of age, I have an increased risk of miscarriage. I have a markedly increased risk of carrying a child with fetal abnormalites. There is an increased risk of Spina Bifida and Down’s Syndrome and Trisomy and all those other terrible disorders whose names we prefer not to speak. Because I am now over 35 years of age, the doctor puts pamphlets about Chorionic Villus Sampling and Amniocentesis into my hands and refers me to genetics counsellors.

Because I am now over 35 years of age, my doctor tells me that I must consider seriously tests that will tell me the odds of this being a “problemed” pregnancy. Tests that will give me information that might lead me to consider terminating the pregnancy.

Before I was pregnant with Wonderbaby, I underwent genetic testing and genetic counselling, because my nephew’s disorder, the one that will kill him, is hereditary, passed along the female line of the family. I swore at the time that no matter what the tests revealed, I would proceed with starting a family.

When I was pregnant with Wonderbaby, my doctor offered to conduct amniocentesis, because I was already in my thirties, and because there was a history of genetic difficulties on both my husband’s and my own side of the family. She said, because there is a risk of miscarriage, I only recommend this if the results would effect whether or not you would continue the pregnancy. I was going to continue the pregnancy no matter what, I told her. The results of an amnio test wouldn’t change that.

She said the same thing to me this morning, although she added that, because of my age, the odds of miscarriage due to amnio are now precisely the same as the odds of the test results showing Down’s Syndrome. It’s a worthwhile risk, she said, if knowing the results of the test are important to you. What she meant: if a certain result would lead you to consider terminating the pregnancy.

I told her that I didn’t know. I told her that I didn’t know. I don’t know. I just don’t know.

That I don’t know – that I don’t have the conviction of the last pregnancy, that I don’t have the faith of the last pregnancy, that I don’t know what I’d do – is hurting me. It’s hurting my heart.

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    { 81 comments }

    Julie Pippert October 12, 2007 at 1:04 pm

    Oh (HUGS). Big ones of support and understanding.

    Julie
    Using My Words

    Julie Pippert October 12, 2007 at 1:08 pm

    If it helps, we ultimately decided to proceed the same the second time as the first (no testing, for the same reasons as you). The only difference was the caveat: if the level 2 ultrasound looked fine and sent off no red flags. We felt this was less risky and invasive. The u/s looked fine so we decided to carry on in blissful ignorance. And all was well. (We also have two genetic risks in the family.)

    Now you understand what a baby and child are, now you know what is at stake. You know what mother love is, how it feels to watch your heart walk around outside your body.

    How you feel is so understandable, and I think a lot of us relate.

    Whatever it is, whatever you do…it will be okay.

    I wish I knew all the right things to say or better words, but this is what I’ve got.

    Take care.

    Julie
    Using My Words

    ewe are here October 12, 2007 at 1:17 pm

    Perhaps you don’t know this time, and the conviction isn’t as strong that you would proceed with the pregnancy no matter what, because of WonderBaby. Any decisions in this arena (where such decisions are required) would not only effect you, but would effect her and her life and the amount of attention and resources she would continue to receive from you and your husband. So, in a way, there’s more at stake.

    Sending you warm thoughts… these things are never easy to sort through.

    Sarah, Goon Squad Sarah October 12, 2007 at 1:35 pm

    Hang in there. Why do people always try to scare us when we are pregnant?

    Don’t they know we are already afraid?

    Madame M. October 12, 2007 at 1:42 pm

    It’s a series of tough decisions and I don’t envy your position– but in a way I guess it’s a very real reminder of just how overwhelming it can be to be a parent. Best of luck to you.

    Liz October 12, 2007 at 1:48 pm

    With me, he term they used was “Advanced Maternal Age” I had my first at the age of 37.

    I refused the amnnio, with the same caveat as Julie, as long as the level II didnt fly the red flags in our faces. I wanted to go the path of least invasion (and risk).

    I had a healthy boy at 38, and now, on the cusp of 40, I’m hoping I’m not done yet.

    JenK October 12, 2007 at 1:57 pm

    I’m delurking to comment because I went through something similar with my first baby. I ended up doing the amnio even though I was only 24 because several red flags came up.

    I didn’t have it because it would decide whether to continue my pregnancy or not. I did it so that I could be prepared for any results. If you have a chance to be prepared for a possibly difficult situation, why wouldn’t you want to be? If you knew in advance that you were having a baby with Down’s Syndrome, you could do research. You could find out everything that you need to know to help your child, instead of being handed a baby that you had no idea how to care for.

    Just for the delurking record: I love your blog and congratulations on your pregnancy. I might as well get it all out now since I’ll probably end up back in lurking status. Heh.

    Former Dyspeptic October 12, 2007 at 2:01 pm

    Why do we resort to speaking in code? Why can’t we say what we mean and mean what we say without resorting to verbal gymnastics?

    The risks seem to be weighing heavy on you. That’s understandable. I liked what Julie said in an earlier response to your post.

    Try not to feel pigeonholed by other people and “late maternal age.” We can’t turn back chronology — no matter how we may try via the latest cosmetic surgery (if one is into that sort of thing). I think that you will always have a youthful spirit and that’s what counts.

    You are a mother and desire another child who will be wanted, treasured and loved. That is the important thing in the equation. Vicissitudes are part of life and occur with the chances that we take.

    verybadcat October 12, 2007 at 2:01 pm

    I’ve never been pregnant or had a kid, so who the hell am I to tell you what to do?

    What I will say is that I think that if you can make the space in your mind and heart only big enough for your and your husband’s opinions- if you can drown out all the other noise, you’ll know/hear/feel your answer.

    My Mom was almost of “advanced maternal age” when she had me, and was well into it when she had my sister. You’ve never seen two healthier girls. We kick ass. ;-)

    Mimi aka pz5wjj October 12, 2007 at 2:03 pm

    I was in the same position as you. I was “Late Maternal Age” for my 2nd and my doctor told me not even to test for anything unless I’d do something about it. I had no tests done… and my neice is medically fragile as well, but we don’t know what she’s got or if it’s hereditary or not… And my husband’s brother died of Spinal Muscular Atrophy — we’d both have to be carriers it’s an autosomal recessive genetic disease.

    I opted for no tests. And, aside from only having 1 kidney, he’s fine! I did have Gest. Diabetes which is more common in older pregnancies as well.

    It’s not fair having to make all these decisions with your hormones going wild. Good luck!

    Don Mills Diva October 12, 2007 at 2:04 pm

    HUGS.

    You have every right not to know. You have Wonderbaby now and only you and your husband know what is best for your family.

    I was 35 when I got pregnant with Graham and 36 when I delivered. Before then I truly never thought of myself as an “older” mother. I still don’t really.

    Doctors are paid to inform about ALL risks. In all likelihood your baby will be perfectly healthy.

    The City Gal October 12, 2007 at 2:06 pm

    It’s tough. I was a teenager when the doctors told me that I am a carrier of a blood disease. For about 15 years now, everytime I see my doctor, she asks if I am planning to have a baby, and if that’s the case, I should consider amnio.

    Would I want to know if my baby will die in a few years after birth? or would I just love my baby the way he/she is going to be?

    I also know that I will plan to have a family when I am around 35 or so. Which means, amnio could result in miscarriage.

    It’s a tough decision.

    Kyla October 12, 2007 at 2:15 pm

    Cath, this comment is not in regards to terminating or not terminating or testing or not testing or any round about way of my voicing an opinion on that aspect at all. This is just me saying, my girl, my sweet girl, has been the best gift of my life, regardless of her faulty genetic make-up. An amnio can’t measure love…but it is in you, even if you don’t have faith in it right now.

    And that being said, whatever you decide, however you decide it, whatever you do or do not find out, we are standing beside you.

    slouching mom October 12, 2007 at 2:15 pm

    Ahh. This reminds me so of Dutch’s post of a week ago.

    Such tough, thorny questions.

    Sometimes I think that we know too much in the year 2007, that we have too many options.

    The Hotfessional October 12, 2007 at 2:15 pm

    {{{{Hugs}}}}

    You didn’t really ask for advice, and I wouldn’t presume to give any since this isn’t somehting I’ve faced – so just know that there’s hugs from here.

    Phoenix October 12, 2007 at 2:25 pm

    I can’t say anything helpful…I have no kids. I guess I’d say don’t make the descision until you know if it matters to you to know. Also, remember that test can be wrong. Considering WB is under two, shouldn’t the risk go down?

    Sides you’re not old. :)

    Good luck with whatever you choose to do.

    DaniGirl October 12, 2007 at 2:32 pm

    Argh, why are they still laying on this “advanced maternal age” crap?

    I’m 38. This is my third (okay, well fifth) pregnancy, and I’ve had three miscarriages – one of which where Trisomy 18 was suspected and one false-positive for Down syndrome that sent us to the genetic counsellors — and STILL my OB assured me that age is NOT an accurate predictor of genetic abnormalities. The IPS screening, however, is… which is why when my IPS results came back at some gorgeously high figure against chromosonal and neural tube issues, I blissfully changed to a midwife and won’t consider more invasive testing.

    All this rant to say that from the obsessive research I’ve done, maternal age *does* affect your ability to conceive, but it doesn’t automatically mean your risk levels for birth defects, genetic problems or miscarriage are elevated.

    (But it sure does tire you out faster. Then again, that might have something to do with chasing the 3 and 5 year old around, too.)

    Janet October 12, 2007 at 2:33 pm

    I know I worried more about the “What Ifs” with each child I carried. There are so many tests offered these days that it’s difficult to know where to draw the line. We did the most testing with Elyse, as I suffered a miscarriage before her and I was a full six years older than when I had my first baby. Still, it’s such a personal and decision. I wish you luck and peace with making yours.

    pkzcass October 12, 2007 at 2:35 pm

    I don’t have any advice to give you, but can only tell you my own experience. My husband’s cousin had a child with trisomy 18. Very, very RARE, but horrible nonetheless. I saw this poor child and the incredible suffering of his parents and knew that I, personally, couldn’t handle something like that. So I got the CVS test for both of my children. I was 32 for my first son and 35 when my second son was born. For ME, having had the test gave me a level of comfort I could have not had otherwise. I worried enough about every little thing while pregnant; I was just glad I didn’t have to worry about genetic defects. As for miscarriage, I really think that if you go to a good doctor who only does these procedures, then you’re chances of miscarrying are very slim indeed. My OB referred me to a highly experienced doctor who did these tests all day, every day. My doc had the utmost confidence in him and, therefore, I did too.

    Also, I believe that during my pregnancies, level 2 ultrasounds were in their infancy and are much more revealing these days. My sister in law is 35 and having a baby in February. I believe they are only going with the level 2 ultrasound. I would probably be fairly comfortable with that option now.

    Whatever you decide, I’m hoping for the best for you.

    Robbin October 12, 2007 at 2:50 pm

    I had my son at 40. I turned down all invasive tests. I had the quad-screen maternal blood tests and the ultrasound screenings ONLY. I was warned they would come out with elevated risk “because of my age”.

    I had better results than most 25-year-olds.

    In my case, the risk of miscarriage was higher than my chance of conceiving again. I was not going to take that risk.

    My son is a happy, wonderful, perfectly normal 2-year-old now.

    jen October 12, 2007 at 2:53 pm

    Bad,
    I went through all of this – I even tested positive on some of the tests. I know how you are feeling. And am here if you ever want to talk about it.

    Oh, and I prefer rustic to aged. but that’s just me. We are rustic.

    mothergoosemouse October 12, 2007 at 2:57 pm

    Have not read through the comments, but it’s not that cut and dried.

    I encourage you to look into the screening tests – either the quad screen (blood test) or the nuchal translucency (ultrasound measurement) or both. Those will give you a more individual view of your risk.

    Furthermore, the risk of M/C is based across the whole spectrum of facilities performing amniocentesis – from the big teaching hospitals to the rural clinics. It skews the risk toward the end of the spectrum where you’re not.

    Plus, ultrasound technology has improved, even in the last few years. They’re able to see so much more now than before, without resorting to invasive tests.

    That said, they are obligated to cover their asses. Please don’t let that ass-covering freak you out any more than necessary.

    xoxoxo

    Karen October 12, 2007 at 2:57 pm

    you know Western medicine treats 35 like the magic number, but it’s really just their cut off number for how to decide how should considers these tests. You have many, many reasons to be hopeful – for example one Wonderbaby – and I hope in the midst of all these choices you can feel hopeful, at least some of the time.

    Karen MEG October 12, 2007 at 2:58 pm

    It is a tough decision, and I agree, likely because you already have Wonderbaby so anything going forward affects not only you and your partner.
    I was just under that magic “35″ when I had baby #1, so not necessarily recommended to have an amnio automatically. Funny how that is, you’ve got to remember that number 35 is based on statistics too, so just because you’re over 35 doesn’t mean that you specifically, will all of a sudden “need” one – it’s all about mitigating risk. Since we had problems conceiving, I opted not to have any tests, although DH at the time was leaning toward it.
    So when I got pregnant at 38, the risk went “up”. We had gone further down the fertility journey so we decided to take it one step at a time and only have an amnio if the IPS and ultrasound showed significant risk. Thank goodness my tests came back great, so we opted out again. We are lucky to have two lovely, healthy children.
    It’s such a private, personal decision. I wish you well in your choice – I know you’ll make the right one for you and your family.

    kgirl October 12, 2007 at 3:02 pm

    Good gravy, you need a new doctor. The risks of many of the tests greatly outweigh the ‘risk’ of having turned 35. And amnio because of genetic difficulties in the family? What family doesn’t have some wonky genes? Where is the positive, helpful, strengthening messages you should be getting?

    Ok, they’ll have to come from us. You are strong. You are healthy. Your baby will not be NOT strong and healthy just because you are 35. GRRR.

    Karen Rani October 12, 2007 at 3:03 pm

    We went through the “triple test” decision with both kids too and its definitely a tough one.

    We chose not to but I think my decision might be different now and here’s why: It might be good to know so you can prepare yourselves with knowledge should baby have issues. This decision will not lead you to the decision of termination regardless of results, so why not find out to put your mind at ease with whatever may happen: good or challenging.

    (I’m not saying good or bad, because I don’t believe there is a ‘bad’ when it comes to the birth of a child)

    I guess you might want to weigh your decision on the risk of the test – I don’t know what that risk is, but I hope whatever you do decide brings you peace.

    You are one of the most intelligent mothers I know, and your heart is bigger than Canada – I know you will make the right decision for you and your family. Best of luck, Catherine.
    xoxo

    Her Bad Mother October 12, 2007 at 3:47 pm

    Kgirl – she’s an awesome doctor, really; we just have pretty frank discussions because I pester her to spell everything out, good bad and ugly. And because there’s been down’s syndrome, and duchenne’s, and other genetic ‘bads’ within close circle of family (close enough that I’ve had to go through genetic counselling once already) it had to be put on the table once again.

    I will be doing the intergrated process screening, which includes nuchal translucency measurement, before I make final decisions. But whereas last time, I was very clear on where I stood, this time I’m not, and I find that disconcerting.

    xo all of you. really.

    Anonymous October 12, 2007 at 3:47 pm

    I understand the uncertainty of doing the tests. I chose not to have the tests but I did have a lot of sonograms. I felt any major issues would be found in a sonogram so I could prepare myself if I needed to. However, I also felt no matter the result I would continue with the pregnancy. My son is perfect.

    Her Bad Mother October 12, 2007 at 3:56 pm

    And, Kyla – I know, I know. I’ve thought of you, and my dear Red, and my sister, and the miraculous children that you all have brought into the world, and that makes such difference. It also makes me feel all the more troubled that today, I can’t say, as I did last time, “no matter what.” But it makes a difference, a big one.

    Mimi October 12, 2007 at 4:04 pm

    If I’m being perfectly frank, this is why I’m considering stopping at one child: she’s so perfect and wonderful and I don’t know what I would do … Kyla’s comment really got me, but the older I get, the more scared I am, and am I big enough to say it doesn’t matter? That I’m okay with having to make a decision and to live with the consequences of those decisions?

    I thought I would be braver after the first pregnancy, the first baby. I’m not. I’m much more scared.

    Anonymous October 12, 2007 at 4:55 pm

    I did the tests, not to help decide whether or not to keep a baby, but to take one more thing off the list of things to worry about. If the less invasive tests look normal, you can concentrate on worrying about him/her going to the wrong university.

    xoxo
    ps are you 35 or *closer to 40*?

    rachel October 12, 2007 at 4:59 pm

    You are so very brave. There is value , real epistemological and human value, in your sharing your knowledge that absolutes aren’t always possible, even where our culture tells us they most need to be. Your nuance and complications and hesitations are inspiring to me.

    meno October 12, 2007 at 6:04 pm

    When i was pregnant, they called it “Advanced Maternal Age” and i was 33. That made me feel like a dinosaur.

    I have no advice for you, only support for whatever you choose.

    GeekLady October 12, 2007 at 7:00 pm

    This is, I think, the downside of having a female OB – because they’re also women these issues are much closer and I think it makes it that much harder for them to be objective.

    Your doctor may just be offering what she would want in your shoes.

    motherbumper October 12, 2007 at 7:22 pm

    I’ll support you no matter what, and there will be many others who will do the same.

    Mommy-Like Days October 12, 2007 at 7:22 pm

    Wow–but you have all that amazing morning sickness, which has been a reassuring sign, no? (and lots of fun besides :( )
    Almost everyone I know (including me) was more scared the second time around then the first–that’s normal, and not predictive/indicative of problems.

    Karen October 12, 2007 at 7:25 pm

    My 4th baby was born when I was 40. I didn’t test. He was my 4th, why test? I knew what I was doing….

    My youngest, my baby, has Down syndrome.

    I am SO glad I didn’t test, because like you, I didn’t know. I didn’t know what I would have done. I still don’t know.

    It’s okay that you don’t know. You are so human, so fragile, so beautifully resiliant, so perfect, and whatever you do will be the right thing. Whatever that is.

    Motherhood Uncensored October 12, 2007 at 7:42 pm

    I have no idea either. I’d like to say I wouldn’t care.

    But I think I would.

    Granny October 12, 2007 at 7:57 pm

    Those tests weren’t available when I was having my kids so I don’t know what I would have done. (I have an idea but it’s all hypothetical).

    I do know that I support my friends in their decisions and will keep you in my thoughts.

    Ann

    Mom101 October 12, 2007 at 9:17 pm

    LATE maternal age? That’s just fucking wrong. At least here (with our shitty medical system) they call it “advanced” maternal age so it’s not like we entirely missed the boat or anything.

    Now considering I was over 35 for both it was par for the course for me to do all the testing. The amnio is SO not a big deal if you have a competent doctor and we can talk more about this if you want. The risk is teeny and the stats are overinflated because they don’t take into account 100% of docs who use ultrasounds to guide the needle.

    FWIW, my OB (the love of my life) reco’d that we get the amnio no matter what – not because you need to make hard decisions now, good lord. But because whatever the result you want to have the info you need to be able to deal with it.

    Remember, if there’s a 2% chance of rain you probably don’t go out with an umbrella.

    flutter October 12, 2007 at 9:24 pm

    I am sorry you hurt and I can’t begin to imagine how it feels. But I am here and holding your hand.

    Mrs. Chicky October 12, 2007 at 9:34 pm

    I just got the same talk. I said the same thing. I don’t know, I don’t know. I’ve been thinking about ever since, so I’m feeling you on this.

    Sticky eggs. Extra chromosomes. Advanced age. If three is the magic number then what does that make 35?

    Email if you need to chat.

    Damselfly October 12, 2007 at 10:23 pm

    Aw, I totally relate. I had Fly after 35 and had too many genetic counseling appointments to count and was pressured to do the amnio. (I declined.)

    I know you’re torn, and I would be too — I wonder, though, if the difference with the second baby is that I would know I already have a child, so if the second baby didn’t make it, I’d still have my child? I’d still be a mom?

    Tracey October 12, 2007 at 10:55 pm

    Hmmm. I feel for you. I do. I haven’t had a change of feelings from one pregnancy to the next,but I can imagine how distressing it must be to not be as convinced of what you will do.

    I chose to never have any testing done on any of my 3 pregnancies. We do have some abnormalities in our families, but not MD, so I can’t compare to that. But I knew that I couldn’t abort, no matter what they found. To me, it was always a baby, never a fetus. I also knew that I could never forgive myself if I spontaneously aborted after an amnio. Whether the child had been “normal” or genetically different…

    Just listen to your heart. Put yourself into those positions in your mind and heart, and picture saying the words… If there’s any doubt in your mind, then you need to reconsider.

    Good luck. These kinds of decisions while floating in pregnancy hormones, morning sickness and a toddler are all-encompassing and horrible.

    Cathy October 12, 2007 at 11:17 pm

    Same thing happened to me.

    I had my first baby when I was 33.

    My second, however, was due right around the time I was to turn 35.

    Luckily, my second ob was much more laidback and low-key than my first. He listed my options, but not in a scary way.

    We decided against any testing — A.) Because we already had had one healthy baby and felt the odds were in our favor and B.) We wouldn’t have terminated.

    I know some parents choose to have the testing because IF something were wrong, they want to be prepared. I totally get that.

    I feel sure you’ll make the decision that is right for you. It is tough, having babies when we’re oh so “elderly” and duly warned. *sigh*

    crazymumma October 12, 2007 at 11:24 pm

    ok. so you are here. and here you are. I don’t know how many ‘older’ mothers are out there…echo?

    You need to breath into this. Relax.

    I had littlegirl at 39. And it was BIGirl who they were concerned about. so. what can I say. every pregnancy is different.

    Only you can decide whether or not you go for amnio. And any other testing.And I understand how it hurts your heart and makes you wring your hands.

    But, you will get through it. And on to the next challenge that the universe throws your way.

    Laural Dawn October 13, 2007 at 8:37 am

    I kind of get where you are coming from here. (the testing not the age part).
    With my son I just didn’t want to be tested. It was like I would never worry about that stuff. I had no idea what it was really like having a baby and couldn’t process what I would do if there was a disability.
    This time around it’s ALL different. I have been anxious about everything since conception. And, like you I’m stuck on the testing.
    Do I want to know?
    It’s just so different. All of it. My body is reacting different and my mind is. I’m paranoid about things that I wouldn’t have considered before. I am making decisions that never crossed my mind last time.
    For what it’s worth – if I had to choose between not knowing or doing a test that could cause miscarriage I think I would forego the test. I’m not saying you should.
    It’s a tough call.
    But … hang in there. I’m determined that thinking positive is at least helping me maintain my sanity.
    PS Just so you know, I hit 14 weeks yesterday and nausea morphed into heartburn mid-week – there’s hope.

    Alley Cat October 13, 2007 at 9:16 am

    A friend of mine recently went through a pregnancy where new technology enabled the doctors to worry her to tears for the whole nine months. Her baby is perfectly fine. I think doctors might be somewhat motivated to legally protect themselves a when they scare their patients with all the bad possibilities.

    Antique Mommy October 13, 2007 at 9:35 am

    I was almost 44 when I had my first and only baby – a baby we were not ever supposed to be able to conceive. I chose to have the amnio because if there was something wrong, I wanted the rest of the pregnancy to emotionally come to terms with it, not because I would terminate the pregnancy.

    Amnio is risky, but I totally trusted the skill of my doctor. He is a neonatal specialist, not just the run of the mill OB, he is the doc that all the other doctors send their patients to for amnio. He warned me of the risks, but said he hadn’t lost one yet (in 20+ years). After I had the amnio, I was able to relax and enjoy being pregnant.

    As someone who lived with all those depressing “old-pregnant-lady” stats, I encourage you to ignore them and force yourself to be positive and thrilled to be carrying this baby – it will be good for you and for your baby.

    Wishing you joy HBM.

    Antique Mommy October 13, 2007 at 10:00 am

    I wrote neonatalist – I mean perinatalogist. Big difference when it comes to amnio.

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