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29 April 2014

UK: RCOG president talks sense on delayed fertility

The shift towards older motherhood is irreversible and it is pointless to warn women to have their children by the age of 35 or risk their babies suffering a range of medical problems, says Dr David Richmond, Britain's top maternity doctor.

Dr David Richmond’s relaxed view of the growing number of women delaying motherhood until their late 30s or early 40s contrasts sharply with the acute concern expressed in recent years by senior doctors, including the government’s chief medical officer, the Guardian reports.

“I think it [the trend] is irreversible because of increasing equality in the social, professional, financial [and] corporate environment we live in. If you put a man in that situation, they would do exactly the same. I completely respect that position.

“Older women becoming mothers is a trend that’s here to stay, I believe,” Richmond said.

The average age of motherhood across all age ranges has been creeping up, and now stands at 29.8 years in England and Wales. The average age of fatherhood has also been rising.

“All I can do is say, ‘Hang on, we’re the ones at the receiving end and these are the problems that we then face,’ and that’s a challenge,” Richmond added. Many women hold off starting a family until their mid-30s or later because they want to feel secure professionally and financially before taking maternity leave, said the doctor, who is the president of the Royal College of Obstetricians and Gynaecologists.

The most recent Office for National Statistics data shows that the number of live births in England and Wales to women aged 40 or over has risen more than fourfold from 6,519 in 1982 to 29,994 in 2012 – out of the 700,000 babies born that year. Similarly, the number of babies born to women over the age of 50 has more than doubled in four years from 69 in 2008 to 154 in 2012.

Later maternity can reduce a woman’s chances of conception and involve a greater risk of miscarriage, a more complicated labour, and medical intervention at the birth. However, most women who leave it late know the risks they are running, the doctor believes.

“I would have thought that that message [about the potential risks] is out there. I think those who are delaying their pregnancies are by and large well aware of what’s happening. Those who delay, both men and women, are probably well aware of what’s happening. I think it’s a conscious decision,” Richmond said.

Asked about obstetricians previously telling women in strong terms that they should have their family before their fertility started to decline in their mid-30s, he said: “Education might help arrest the trend, [but] informing them of the facts, that can only help a little. I think society’s changed. I don’t think [health] professionals can influence that societal change.”

Richmond’s pragmatic, understanding attitude contrasts with the stance of the college he heads, the Guardian reports. Its statement on maternal age in recent times has emphasised that “there is an urgent need for better public information on the issues surrounding later maternity” and that “later maternal age is an emerging public health issue”. It also stressed that while women should be supported in their life choices, “both women and society need to be aware of the possible problems that older mothers may encounter”.

Richmond was also unconcerned by the extra costs often involved in the treatment of older mothers. The continuing trend of older motherhood “is going to be a financial burden and a healthcare burden. But the number of women over 40 having babies is a fraction of the whole, so it’s probably an inconsequential financial burden,” he said.

A commentary by Lynsey Hanley, visiting fellow in cultural studies at Liverpool John Moores University, in the Guardian congratulates Dr Richmond for being ‘both a good sociologist and a great feminist’. Hanley argues:

‘Educated women are armed to the ears with information; it’s the last thing they lack. Understanding the medical risks involved in leaving parenthood till later is weighed alongside having horizons widened, not purely in career and financial terms, but also in terms of travel, greater general mobility, relationships and cultural pursuits. Significantly, Richmond didn’t address the fact that the age at which you have your first child has a pronounced, and growing, class aspect. The geographer Danny Dorling points out that the last time the average age of motherhood was so high was when large numbers of young women were in domestic service, a trend altered only by the second world war. My grandmother, in service until 1939, then working in factories throughout the war, had her only child when she was nearly 34. My mum, neither born into service nor educated beyond 16, had me at 23.

‘Dorling’s research shows that women who haven’t been to university, living in areas where few people have higher qualifications, have children at pretty much the age their own mothers did. Where once women in, for instance, parts of south Wales and Surrey would have started families at broadly the same age, there is now a 10- or even 15-year gap between different areas so that now, he writes, “working-class grandmothers can be of a similar age to upper middle-class mothers”’.

Hanley concludes: ‘Rather than lamenting the choices of women who now have control over a fundamental aspect of their lives, Richmond has rightly acknowledged – and, in so doing, celebrated – the fact that they are not about to relinquish it on the basis of a degree of risk they feel we can handle.’

Top maternity doctor: increasing age of first motherhood is irreversible. Guardian, 27 April 2014

At last, a doctor who respects older mothers. By Lynsey Hanley. Guardian, 28 April 2014

Also read:

Analysis: What’s the problem with older mothers? Reproductive Review, 3 February 2014

UK: National conception statistics confirm trend towards older motherhood. Reproductive Review, 25 February 2014