Pregnancy is a time when common sense all too often flies out the window, chased by a culture that is out of balance concerning birth. Nowhere is a woman’s connection or loss of connection to her inner guidance more evident than during pregnancy. Suddenly, her body is no longer her own. Her entire extended family feels that it is pregnant, and all of them give her advice about what to eat, what to wear, and what to do. I was amazed by how total strangers would approach me when I was pregnant, pat my belly, and offer suggestions. Friends seem to think it their duty to tell pregnant women the worst stories they can think of about cesarean sections, labor pain, and poor outcomes. (This is another example of our dominator culture — glorifying pain and destruction over the life-enhancing qualities potentially available through pregnancy and birth.)
I felt blessed to be an obstetrician because I was spared hearing all these horror stories. (Perhaps people figured that I had been “socialized” by having already learned these horrible stories firsthand!) War stories about the rigors of birth are often passed down from generation to generation. Mothers not uncommonly tell their daughters that “now you’ll see how I suffered with you.”
At some very deep level, we are all awed by pregnant women and their power. But instead of emphasizing a woman’s awe-inspiring birth power, in classic patriarchal reversal our culture attends to the fear that that power brings up. Pregnant women are emotionally more porous and more in touch with their intuition than usual, and they are therefore more vulnerable. They pick up on all the collective societal fear of them.
Media images of pregnant women suddenly falling to the ground during pregnancy and shrieking things like, “Oh, John, the baby!” reinforce in our psyches the notion that pregnancy is a time of great danger and unpredictability instead of a normal process. They reinforce the misconception that pregnancy, like our female body, is a disaster waiting to happen. In every hospital I’ve ever worked in, pregnant women who come into the emergency room are rushed to the labor and delivery floor as quickly as possible, even if they’ve come in for some other problem. In Boston, the ER crew once sent up a woman in mid-pregnancy who had a broken leg!
This emergency mindset is especially damaging to women who are having babies in their thirties or forties. Most, if not all, pregnant women over the age of thirty are taught by our culture that they are much more at risk for complications than if they were in their twenties. This perception of increased risk is not necessarily true and depends on the individual woman’s health. I remember the first pregnant woman I ever met who was over thirty. It was in the prenatal clinic at the Mary Hitchcock Hospital during my second year of medical school, and I thought that she was very unusual and very brave to be having her first baby at such an advanced age—age thirty-two. Looking back, I realize that this woman was at the very beginning of a trend that began in the 1970s and has continued unabated through the present—delaying childbearing until later. (As an evolutionary side note, my now twenty-something daughters both feel that marrying much before the age of thirty is awfully young.)
Women having their first babies after the age of thirty-five were once referred to as “elderly primigravidas.” Happily, that term has been dropped. Though the term “geriatric” obstetrics is still used occasionally, it should be eliminated, as it sets up all kinds of negativity. Whether or not a woman is more at risk in her thirties must be completely individualized. A forty-year-old in excellent health who has a planned pregnancy is apt to do much better than a twenty-five-year-old who smokes two packs and quaffs a gallon of Diet Coke per day. Too often the medical profession “hexes” women who become pregnant in their thirties and forties by lumping them into statistically high-risk categories that are not necessarily applicable.
Older women who are pregnant, as well as infertility patients who become pregnant, have a much higher risk of a C-section. In some places, a woman older than forty will be told that she is very apt to have a cesarean because hers is a “premium pregnancy” (as opposed to a pregnancy in the mother’s twenties, whose success doesn’t “matter” as much because “you can always have another—you have time”). Premium pregnancy means that because the mother is presumed to be or is more anxious (or is made to be anxious by her culture and her doctor), we should treat her differently. This is a reflection of the health care team’s own unfinished emotional work. And this is the thinking that has led to our current all-time high rate of cesarean birth—which is now about 33 percent, Goldin1 despite the fact that the World Health Organization says that a 5- to 10-percent rate is optimal and that recent research shows that anything over 15 percent does more harm than good. Chamberlain2
The rate of births by C-section keeps going up every year, and over the past decade, it’s increased by more than 50 percent. Way back in 1965, for example, the rate was only 4.5 percent! China3 At least in part, these sky-high rates may be linked to doctors’ fears of being sued. In 2003, more than three quarters of all American obstetricians were sued at least once, with a median award of $2.3 million for medical negligence in childbirth. As a result, many doctors are more likely to opt for performing a C-section at the first sign of a complication. Rosenberg4 Even so, C-sections are far from benign procedures and our collective trust in them is mind-boggling!
In fact, age doesn’t predict anything when it comes to labor and birth. Chronological age (age in years) and biological age (age of one’s tissues) aren’t necessarily related. One of my friends had her first baby at forty-one. The first stage of her labor lasted only three hours—very short by any standard. And if her hips hadn’t been so narrow, she’d have delivered in a total of four hours. Healthy women who are well supported in labor usually do beautifully, regardless of age.
One of the nicest things about women having their first babies in their late thirties and early forties is that by then, these women have established themselves in the outside world of work and career. When they do have babies, they take the time to enjoy them. They already know what it’s like “out there.” They realize the limitations of the corporate world and are willing to put aside its “benefits” to reassess their lives through the lens of parenting. Many have had time to get in touch with their bodies over the years and are more comfortable with themselves than they were in their twenties. In my mind, such women are actually low risk.
Learn More — Additional Resources
- Women’s Bodies, Women’s Wisdom by Christiane Northrup, M.D., Bantam, revised 2010.
- Claudia Goldin and Lawrence Katz, “The Power of the Pill: Oral Contraceptives and Women’s Career and Marriage Decisions,” Journal of Political Economy, vol. 110, no. 4 (August 2002), pp. 730-70; available online.
- David Chamberlain, The Mind of Your Newborn Baby (Berkeley, CA: North Atlantic Books, 1998); see also www.birthpsychology.com.
- I met a woman OB/GYN physician from China who told me she had performed twenty thousand abortions in her career. In China, only one child per couple is allowed—sometimes not even one. Abortion is commonly used for birth control. If a couple has more than one child, the parents may lose a job or be subject to other sanctions. As a result, Chinese couples now selectively abort female fetuses, and now an entire generation of young men do not have enough women their age for wives—a fact that, although tragic, seems a cruel kind of justice.
- Carroll Smith-Rosenberg, Disorderly Conduct: Visions of Gender in Victorian America (New York: Oxford University Press, 1986).