Motherhood on your timeline: Navigating pregnancy after 35

More women than ever are choosing to have children later in life.

In the United States alone, 19 percent of all pregnancies and 11 percent of first-time pregnancies are in women age 35 and older. 

However, this hasn’t always been the case. At one point, “geriatric pregnancies,” as they used to be called, were heavily stigmatized. But now, as many women opt to focus on career, finances and personal goals before starting a family, that stigma is fading.

Hartaj Powell, MD, medical director of obstetrics and gynecology at Holy Cross Health, who had her first pregnancy at 35 years old, understands firsthand this societal shift and the multitude of factors that go into the decision to enter motherhood at a later age.

“There are social, economic and financial drivers, but it really comes down to life choices and opportunity. Women are spending more time in school, building their careers. And they have the opportunity—with advancements in reproductive technologies and highly effective birth control—to decide how and when they want to start a family,” says Dr. Powell. “For me, I felt more ready, professionally, financially and personally.”

After age 35, it may be difficult for some women to become pregnant. At birth, a woman is born with all the eggs she’ll have in her lifetime and, as she gets older, the quantity and quality of those eggs decrease.

“Age—and especially the age of the eggs—still has a significant impact on outcomes and risk,” says Dr. Powell. “When I talk to patients, it’s about understanding the limits of technology and optimizing by planning early.”

Thanks to ever-evolving modern medicine, in vitro fertilization and egg freezing have expanded the options available to women who wish to start a family. These options can, in some cases, allow a woman who couldn’t conceive naturally to become a mother. However, Dr. Powell emphasizes that technology cannot completely override biology.

After age 35, it may be difficult for some women to become pregnant. At birth, a woman is born with all the eggs she’ll have in her lifetime and, as she gets older, the quantity and quality of those eggs decrease.

While having a baby after age 35 has its benefits, it’s also important for expecting moms to be aware of the increased risk for:

• Gestational diabetes
• Hypertensive disorders such as preeclampsia
• Stillbirth
• Premature or pre-term delivery
• Low birth weight
• Possibility that the baby will need a neonatal ICU admission
• Labor dystocia, or an abnormal progression of labor
• C-section
• Postpartum hemorrhage

“The key thing to remember is that most women will still have a normal, healthy pregnancy and outcome for the baby,” says Dr. Powell. “High risk doesn’t mean that something bad is going to happen. It simply means we monitor closely and provide additional support to optimize outcomes.”

At Holy Cross Health, patients experience a team-based approach that includes obstetricians, midwives, doulas, prenatal care groups and specialized maternity services. The goal is to provide personalized support throughout pregnancy, from nutrition and wellness to labor and delivery.

For women considering motherhood after age 35, Dr. Powell offers a reassuring message: age is only part of the story.

“High risk doesn’t mean that something bad is going to happen. It simply means we monitor closely and provide additional support to optimize outcomes.” – Hartaj Powell, MD

“Age matters, but it is not going to define your outcome,” says Dr. Powell. “There is some risk associated with having a pregnancy later in life, but most women will have a healthy, normal pregnancy.”

The most important things are to understand your risks, optimize your health and partner with a care team that supports you every step of the way.

Visit our Maternity and Birth Care webpage for more information on maternity services at Holy Cross Health.

Watch Hartaj Powell, MD, speak on this topic in our Beyond the Stethoscope series.