a special place in a special time

As you are over 40 there are some risk for you in pregnancy. These include a greater risk of Down's syndrome, greater medical intervention, and, depending on your pre-pregnancy fitness and health, your body may feel the physical effects of pregnancy more than a teenager might. However, this does not automatically mean that you will have a tougher pregnancy or delivery, solely based on your age.

When over 40, you can not be refused a home birth. If the professionals caring for you feel that there is a medical or practical reason why you should not consider it, they will discuss it with you. The decision should not be based on your age, but on Factors concerning you and your baby's well being. If you are an older first time mother, and feel you could benefit from staying in hospital to gain confidence and new skills, thar will be your decision. Usually, the staff caring for you will discuss this and the conclusion will be worked our between you. Also, having not a caesarean is still possible when over 40. Age is nor an important part of the equation when deciding on a Cesarean. The decision whether or not to have a Cesarean will be based on medical issues . That's not to say you will not end up having one, but if you do then age should not be the major determining factor.

You can have prenatal screening (usually based on blood tests or the nuchal thickness measurement of the baby) to establish your risk. You can then decide whether to have "invasive" tests such as amniocentesis or CVS (chorion villus sampling). These do carry a risk of miscarriage, but they will tell you if your baby has Down's Syndrome or another chromosomal abnormality. If this were the case, you would then have the option to continue your pregnancy or, where this option legally exists, to terminate your pregnancy.

The only increased risk for your baby because of your age is of trisomy; this is where the baby has an extra chromosome. The commonest trisomy is Down's (chromosome 21); much less common are Edward's syndrome (trisomy 18) and Patau's (trisomy 13). The last two are invariably lethal for the baby. There is no evidence of other abnormalities; for example, cleft palate, spina bifida, and heart defects are no more common than if you were 20 years old.

Most people are still very fit in their 40s. However, you do have a higher risk of chronic conditions such as raised blood pressure, diabetes, heart and kidney conditions, and thrombosis (see below). It is important for these to be identified and treated before you get pregnant, so a general check-up with your doctor before trying for a baby is a good idea.

The risks of getting deep vein thrombosis (DVT) and pulmonary embolus are much higher in the over 40s, and even higher just after delivery, particularly if you have a Cesarean. After delivery, to combat this risk, you will be kept well hydrated, the doctors and midwives will advise you to get up and walk around as soon as possible, and you may need to wear compression stockings on your legs. Many women will be given small doses of heparin or similar drugs, as an injection , for a few days after the birth until fully mobile.

Women over 40 generally cope very well emotionally with pregnancy, possibly because they have had the time to develop supportive networks, are more established in a job, and may have been with a partner for a long time. Of course, this is not necessarily true for all over 40s. After the baby is born, you will be more tired than if you were 20 years younger, although you are likely to have family and friends to help our and be realistic when it comes to going back to work!

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