More people over 45 are getting pregnant — and abortion laws aren’t ready for the complications

As CNN anchor Don Lemon recently absurdly suggested, the idea that women have a “prime number” is decidedly absurd, ageist and sexist, but nevertheless, biological It is undeniable that academic decks are stacked differently. are categorized as “Aging Motherhood” However, in recent years, advances in fertility treatments have provided more opportunities than ever before to conceive and bear children.48-year-old celebrities in recent weeks da brat and Hilary Swank The Montefiore Medical Center ran a campaign last year featuring brain cancer survivors who welcomed their youngest child. At the age of 57.

But the reality of pregnancy and childbirth after age 40, 45 and even 50 is complicated, especially in the post-Dobbs era.

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First, good news. In the United States, the fertility rate for women under the age of 30 has plummeted over the past 30 years, but has exploded in the opposite direction.census report 132% increase in births among women over 40 This clearly demonstrates that safe and healthy pregnancies are possible even at an age that was once considered highly precarious. Additionally, having children over the age of 40 Reduce cognitive decline and prolong life To mothers, children may enjoy better health and higher education.

Concerns about fetal abnormalities—often among older people with children—also need to be contextualized. This is because many women who become pregnant at an older age may not be using eggs of their age.

“When we meet with the media or celebrities, they’re not going to say, ‘I used an egg donor,’ because that’s private.” illuminate fertility“But some women believe, ‘I’m 46, I’m 47, I’m healthy, and I can have a baby with my own eggs.’ There is no risk of Down syndrome or chromosomal problems when using eggs, compared to a 45-year-old woman using her own eggs. is related to the age of

Still, getting pregnant in the peri-menopausal period remains an undeniable challenge. Estrogen levels decline with age, making it less likely that you will conceive naturally.Parents said, “At 45… the chances of getting pregnant 3% or 4% or less. “ Using donor eggs dramatically improves the chances of conception, up to 60%but multiple attempts may be required for a successful conception, after which there is always the risk of miscarriage.

On the other hand, the cost of donor eggs, insemination, and related procedures can be astronomical. For many people, at least part of the cost will come out of their own pocket. Fertility Foundation Resolve reports: Only 20 states have passed fertility insurance coverage laws, only 14 people cover IVF. Unexpected network costs can result in lost time and wages due to travel and appointments.

Even in the best of circumstances, a pregnant person’s health risks vary at a particular age. This is because general health conditions vary after a certain age.significantly higher Pregnant women over the age of 40. Dr. David N. Hackney“You’re at a higher risk of developing gestational diabetes,” said an associate professor in the Department of Reproductive Biology at Case Western Reserve. risk of stillbirth Go up. Increased risk of caesarean section. “

“We tend to accumulate diseases as we age, and over time we tend to develop diabetes, gain weight and have higher rates of hypertension. It’s always difficult to tell the true age difference. However, in the best studies that have tried to control for these confounders, there appear to be some true core risk increases associated only with age: 40 to 45 years; stillbirth risk Perhaps the most clear in the data, and certainly the most concerning. ”

The risk of stillbirth, like other forms of loss, is a concern on many levels. There is obvious physical pain and emotional grief from the experience.And there is the confused and often strict enforcement of abortion restrictions that seriously endanger the lives of those experiencing complications during pregnancy. 10% and 20% of all pregnancies end in miscarriageAnd while those using donor eggs are more likely to conceive to term, according to a 2019 study in the BMJ: Women over the age of 45 have a 53% miscarriage rate.

Coping with miscarriage and deciding what to do with a nonviable fetus requires supportive and skilled medical management.Patients often require D&C [dilation and curettage] A procedure or prescription drug that removes the contents of the uterus. As Dr. Sarah Prager told NPR last year, “The problem is that treating an abortion is exactly the same as treating a miscarriage.”

“Roughly half of the country now has a basic ban on abortion,” he said. Gynecological Surgeon Dr. Julia Arnold VanRooyen“Most of these states have language about saving a mother’s life. Emergency room doctors and the OB-GYNs caring for these patients are stranded not knowing what will happen if they intervene.

She continued, “Spontaneous abortion is very common, especially in older women. In half the country, abortion is basically prohibited. [the patients] If they’re bleeding, or if they’re slightly infected but not quite septic, the doctor caring for them will quickly say, “Can you?” can’t you? Should I consult a hospital lawyer?” Even if they were in place, it would still cause delays in care that never would have happened before. Despite having no sex, they are getting sicker, bleeding more, and getting more infections before they can get a simple life-saving D&C.”

When we see illustrious celebrities of a certain age proudly showing off their baby bumps, or medical centers celebrating cancer survivors of AARP ages holding babies, this is a common and straightforward occurrence. It’s easy to start believing that even though amazing progress has enabled more people than ever to realize their dreams of starting or growing a family, conception and childbirth are age-defying. The fact is that it becomes a more difficult business with That doesn’t necessarily take someone’s dreams off the table. “We support and encourage any way you can build a family.”

But the truth of this dream for older women is that it almost certainly cannot come true without intervention. There are punitive and ignorant reproductive laws that can pose serious and even life-threatening dangers.

“I can’t imagine going through all of those risks and costs to have a child and knowingly making the decision to do it in a Southern state,” said Dr. Arnold Van Rouen. “It seems like a big flaw in your plan. A woman who has the means and can actually go anywhere has to choose a place like New York or Massachusetts. Or still?” You have to pick a place where abortion care is solid.It’s part of health care, and you may need it.”

Abortion restrictions are a problem for every pregnant or childbearing woman in America, but they are especially troubling for those over 45 who are facing pregnancy. Be willing to have tough conversations about those factors and worst-case scenarios.

“If you’re contemplating pregnancy, know who your OB-GYN will be,” says Dr. Hackney. “See and talk to your OB-GYN. Physicians are often different than fertility specialists, and I ask them what the current state law is and say, ‘What if I have a miscarriage? What would you do if you had a deficiency or a genetic disease? What would you do if your water bag broke when I was 18 weeks? What would you do now?” I think it’s lacking, but do you trust him? And will he be brave?”