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Motherhood demographics shift as more women wait

LARGO —Vicki Berk and Maud Hoffman got the same reactions when people found out they wanted to become mothers for the first time in their 40s.

"Are you nuts?" Berk, 53, recalled hearing from some. "You're kidding me," Hoffman, 47, was told a few times.

The two friends were neither nuts nor kidding. In fact, they're in growing company.

Across Florida and the United States, more women are bucking the odds, accepting the risks and — in many cases — absorbing high costs to have children at an age when some peers are welcoming grandchildren. The number of women 45 and older giving birth in Florida is small, but it has more than doubled in the last decade.

Many, like Berk, have been helped by fertility treatments, while others, like Hoffman, have overcome long odds against spontaneous pregnancy so close to menopause.

"The demographics of pregnancy have changed drastically," said Dr. Robert Yelverton, chief medical officer of Women's Care Florida, a Tampa-based network of more than 100 obstetricians. "But it's a trend we as obstetricians worry about because getting pregnant and having a child at later ages carries increased risk."

Those may include pregnancy complications such as maternal diabetes and dangerously high blood pressure, pre-term births and birth defects such as Down syndrome.

Berk and Hoffman are among the small but growing number of women who roll the dice and beat the house.

Berk had son Micah when she was 49, and daughter Peri last year at 52. Hoffman had son Cody when she was 43 and daughter Matilda when she was 46. All four pregnancies were without complications; all four children were born healthy.

And though both women endured their share of concerned comments during their pregnancies, each also found support from their husbands, friends and family.

"Most people would say, 'that's wonderful' " when they heard the news, Berk said.

• • •

The number of babies born to women 45 and older in Florida increased from 200 in 2000 to 437 in 2008. Nationally, the number grew from 4,604 in 2000 to 7,666 in 2008. These increases have come while the overall national birth rate has fallen nearly 2 percent.

Why is this happening? According to a new report from the Pew Research Center, women are marrying later in life, they're better educated and are likelier to have careers that may prompt them to delay pregnancy.

What has not changed, however is the fact that the older you get, the more difficult it is to get pregnant. According to the American Society for Reproductive Medicine, a woman's risk of infertility — defined as failing to get pregnant after a year of trying — climbs from 30 percent at ages 35-39 to 64 percent at 40-44, and keeps climbing to menopause.

Medical technology, however, is changing the odds, at least to a limited degree. Dr. Catherine Lynch, interim chair of obstetrics and gynecology at the University of South Florida, attributes much of the increase in births to women 45 and older to in vitro fertilization, a procedure in which eggs — either the mother's own or a donor's — are fertilized in a lab, then implanted.

"In that group, it's highly unlikely that they're spontaneous pregnancies," Lynch said.

"As IVF treatments became more well known over the last 10 to 15 years, it may have given women a sense of less urgency with their ticking time clock," Lynch said.

"You're dealing with a work force in which there's a lot more women who are continuing on with their careers and trying to figure out when to figure in a child."

IVF treatments, however, are expensive, can be physically taxing and are no guarantee of pregnancy. Around 30 percent of IVF treatments result in live-birth deliveries, according to the U.S. Centers for Disease Control and Prevention.

• • •

The odds of conception get longer, and the health risks to mother and baby go up, each year a woman waits to get pregnant.

Babies conceived from older eggs have higher risk of Down syndrome or other chromosomal abnormalities. For a 40-year-old woman who is pregnant with her own egg, the odds of having a baby with Down syndrome are 1 in 100. At age 45, the odds climb to 1 in 30. By age 49, the chances are 1 in 10.

Women 45 and older also are likelier to have very low birthweight babies, defined as less than 3 pounds, 4 ounces.

Women over 40 are likelier than their younger sisters to have chronic conditions like diabetes, high blood pressure and obesity. All can lead to complications including gestational diabetes — producing larger-than-average babies — preterm births or miscarriages.

Yelverton says older women contemplating pregnancy should seek preconception counseling, in which a doctor reviews medical history and current health to gauge what to expect.

Medical advances have made it easier to detect abnormalities like Down syndrome in the fetus, he notes. But nothing has been done to reduce their frequency.

• • •

As a Pinellas schoolteacher, Vicki Berk spent her days surrounded by children. Yet she never considered having her own until she was in her 40s.

"And when the urge hit me, I couldn't get rid of it," she said.

She knew the odds weren't good, so she went to a fertility specialist, and soon found her best option was IVF.

At age 48, she became pregnant with Micah. And a few years later, she conceived Peri. In all, Berk underwent six IVF treatments with her own eggs, at about $10,000 each, to have her two children.

Berk says both pregnancies went smoothly. "I exercised, ate right, worked every day," she said.

And she delivered both babies naturally. "I had her in nine minutes," she said, pointing to a picture of daughter Peri.

Berk still works for the school district, teaching at Lighthouse of Pinellas. She said she and her husband, Wes Niedecken, 52, face the same challenges as other parents — balancing the needs of their jobs (Niedecken owns his own business) with those of their children. They're just doing it later in life.

But, she smiles, "We treasure every moment."

• • •

Maud Hoffman said she and her second husband, Mike, 50, figured it was probably too late for her to have children in her 40s. "So, when I got pregnant (at age 42), it was a surprise," she said.

Hoffman said her doctor strongly urged her to undergo fetal testing. But she declined.

"We figured if we were meant to have a special-needs child, so be it," she said.

Hoffman said doctors did detect some possible abnormalities in the heart and kidneys during an ultrasound. But when she gave birth to Cody in 2005, he had no such problems.

Two years later, when she became pregnant again, she declined testing, and again, some of the same possible abnormalities were suspected. Yet, in February 2008, Matilda was born a healthy child.

Hoffman and Berk figured they had a number of things going for them. They were both in good health, of normal weight, with no chronic conditions. They stayed active during their pregnancies, watched what they ate, and enjoyed the support of family and friends.

• • •

Berk and Hoffman once met at the studio where Hoffman worked as a licensed massage therapist. But their friendship really began when they crossed paths near their Largo homes, each pushing their young sons in strollers.

"We felt it was fate," Berk said.

"I think it's great. We both have had similar experiences," Hoffman said.

The two got together with their children last week at a park, just a short distance from the school where their sons will start kindergarten together this fall.

Asked about the advantages of parenting young children at their age, both women said they have more patience now than when they were younger. And their families both are financially stable.

As for the disadvantages? Hoffman paused to think about it. "My vision's not as sharp," she quipped, as she temporarily lost sight of Cody before he popped up from behind some bushes.

Berk acknowledged some uncomfortable moments. "I'll get stopped at the mall and someone will say 'those are adorable grandchildren.' But I've learned to shrug that off."

Neither spends much time thinking about how old they'll be when their children finish high school, or get married. Will they have the energy to keep up with their kids? And what about grandchildren?

"We joke that I'll be the oldest kindergarten mom," Berk said. "But I try not to think about that."

Instead, she says she enjoys what she has now. "Honestly, I never expected to have them. I'm probably happier now than I've ever been."

Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

By the numbers | Older moms

437
Number of women 45 and up who had children in Florida in 2008, a 119 percent increase over 2000.

7,666
Number of women that age who had children in the U.S. in 2008, a 67 percent increase over 2000.

29.9
Success rate of in vitro fertilization treatments in
the United States.

8%
Likelihood of infertility for a woman aged 30-34.

69%
Likelihood of infertility for a woman aged 45-49.

1 in 2,000

Incidence of Down syndrome in the child of a 20-year-old woman.

1 in 10
Incidence of Down syndrome in child of a 49-year-old woman.

70
Age of Omkari Panwar of India, believed to be the oldest ever to give birth through IVF. She gave birth to twins in 2008.

57
Age of Ruth Kistler of Portland, Ore., believed to be the oldest ever to have a natural pregnancy. She gave birth to a daughter in 1956, before IVF was invented.

Sources: Federal and state health statistics, National Down Syndrome Society

Motherhood demographics shift as more women wait 05/07/10 [Last modified: Monday, May 10, 2010 12:50pm]

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