MIDLIFE CHILDBEARING Strategies for Informed Decisionmaking

More and more women in the United States are choosing to delay mother-hood until their 30s or even 40s. Yet traditional medical advice warns against midlife pregnancy, predicting a variety of adverse reproductive outcomes associated with advanced maternal age. Assignment to a high-risk category may result in heightened feelings of concern about pregnancy complications among midlife mothers. Because it is possible that increased emotionality during pregnancy may itself give rise to various childbearing complications, some middle-aged women may become victims of iatrogenic stress during pregnancy. This article first examines critically the medical literature describing the relationship between maternal age and pregnancy outcomes and finds little support for the medical pessimism. Next, the article describes the literature that explores the links between heightened emotionality during pregnancy and various negative outcomes and suggests that, despite serious methodological flaws, there is some evidence that fear-induced stress during pregnancy may place certain middle-aged women at higher risk for complications. Finally, strategies for improved decisionmaking and for enhancing the pregnancy experience of midlife women are proposed.