Advanced Maternal Age

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The aim of the study

Researchers conducted a study to clarify what factors form the basis for delay childbearing, what thoughts, views, and fears of women accompanied such process and investigated the level of consciousness in a decision-making and risk understanding.

Literature review on existing trends

Benzies et al. (2006) made a research on the factors that are essential for the motherhood timing decision. This study was conducted in Canada. The authors underlined that crucial components of the decision-making process were confidence in the strength of the relationship with the partner, independence, and health issues in particular risk of infertility and inability of its treatment. Motherhood is perceived as a part of the strictly followed life plan, where education and career are the previous stages. Moreover, the researchers argued that delayed childbearing became a trend in society, and younger motherhood is criticized due to inability to guarantee dignified and prosperous life to the children. Taking into consideration the existing obstetric and neonatal risks, health professionals should provide more detailed information to women for their understanding of the potential subsequences of late motherhood.

The emphasis on the carrier building is also put in the study by McIntosh et al. (2012) whereas “the pressures of motherhood resulted in women’s careers becoming secondary to the family unit, and that in order to allow time for childcare women required occupations with flexible hours” (p. 346).

The issue of the advanced maternal age is accompanied by the critical question of the increased risks. Cooke, Mills, and Lavender (2012) argued that the data received on existing medical risks was rather controversial and needed further development and investigation. But the common thing for the most studies is the position described by Goodwin, Montoro, and Muderspach (2010). The authors pointed that antepartum and intrapartum complications are presented in this obstetric group. They highlighted that the time to conceive increases due to ovulatory dysfunction and fecundity decreases with advancing maternal age.

As it is pointed in the analyzed article, media bring uncertainty and create a stereotype that women choose to delay having children driven by ambitions and desire to get financial independence and make a successful career. Such position is supported by Browning (2007) and Carolan and Nelson (2007).

In contrast to these studies, Cooke, Mills, and Lavender (2012) were the first researchers in the United Kingdom who raised the question of in-depth understanding the experiences and opinions of women aged 35 and over on the factors that influence their decision to have a child at this age. They drew a significant conclusion claiming that “delayed childbearing is rarely a conscious choice; timing is influenced by a complex interplay of factors outside of women’s control” (p. 31).

Cooke, Mills, and Lavender (2012) put an emphasis on three main themes based on analyzed women experiences that were background for the decision-making on timing of childbearing:

- the chapters of life;

- information integrity on delayed childbearing and risk knowledge;

- control question for the decision to have a child.

Research design and methods

The authors of a chosen article conducted phenomenological qualitative study. Phenomenology is a “study of the shared meaning of a phenomenon for several individuals” (McCaslin & Scott 2003, p.449). In the analyzed case, it is the issue of experiences concerning delayed childbearing. Eighteen women at advanced maternal age (35 years and older) were organized in three groups: not pregnant, without children; pregnant with the first child receiving fertility treatment. All supporting data including demographic figures were collected using a questionnaire. Regarding the data collection and analysis methods, semi-structured, audio-recorded, and transcribed verbatim interviews using one-to-one model were conducted. The thematic analysis was made applying a hermeneutic approach and was conducted using above mentioned three global themes: chapters of life, control and information possession. Limitation of non-participation of multiparous women predetermined the impossibility of universal generalizations creating. Moreover, it is pointed that the transferability of obtained results to other cultures can be limited. It is a reason for further in-depth investigation which will provide more substantial and incontrovertible evidence.

Ethical issues

Cooke, Mills, and Lavender (2012) had ethical approval from Tameside and Glossop Research Ethics Committee. All women participating in the research gave their informed consent, and they were given enough time for taking the decision whether to take part in the interview or not. Moreover, understanding that the study concerns sensitive personal information about private life of the participants, names were changed to pseudonyms and obtained information was properly secured.

Research findings

The researchers analyzed the experiences and thoughts of 18 childless or pregnant women aged 35 and over. The starting point for the study was the fact that the authors doubt whether women have a choice and consciously decide when to have children. The authors analyzed the phenomenon “within control or beyond control” (Cooke, Mills & Lavender 2012, p.33). Women deny the fact that the career ambitions and education play a major role in deciding on the time of childbearing. Career and education are regarded to be a part of contemporary life where women are no longer perceived as the keepers of the hearth and mothers above all and are equal members of a professional society.  Moreover, the chapters of life and lack of knowledge about possible risks relating to advanced maternal age played a significant role. During the interview, women put an emphasis on the complexity of these issues and underlined that if they had had the appropriate life circumstances including reliable partner, adequate financial basis, good health and educational information, they would have made another decision on pregnancy – positive one.

The most significant conclusion based on the results of obtained data is that women, in most cases, do not choose consciously to have a baby so late. The complex of factors related to stable partnership and financial state, health issues and fertility influences the readiness and ability to have a child.  Women are sure that they can conceive at any time they would wish, there are no or little risks related to advanced maternal age. These findings are crucial and alarming, because it is obvious that the propaganda conducting through media and the materials presented in the existing literature reduces the level of anxiety among women.

Discussion

The authors of the article proposed a new concept that is not enough presented and investigated in the literature in particular “the phenomenon arising from the data that women do not have ultimate choice or control over the timing of childbearing” (Cooke, Mills & Lavender 2012, p.37).

The study is a significant first step to investigate the issue of advanced maternal age and delaying childbearing in the context of consciousness level of making this choice.

The fact that the majority of women surveyed did not think seriously about the possible risks for their health and the future child, the ability to conceive at advance maternal age is noticeable. Thus, it must be a serious concern for the medical professionals especially nurses and the great task to provide women at childbearing age with all the necessary information about advantages and obstetric risks connected with timing of childbearing.  Benzies (2008) support this view arguing that women should understand all medical risks that could influence on the decision about trying to conceive earlier.

This study should be a signal to review the prevailing opinion that the woman deliberately postpones childbearing until later and stress the background of complex of interrelated factors.  It is necessary for clinicians and nurses to understand this fact and to intensify their efforts on providing young women at maternal age with sufficient information and more sensitive care.  

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