What to expect when you're expecting (24 page)

But as much as medical science can do to help you have a safe pregnancy and a healthy baby, it’s nothing compared to what you can do yourself through exercise, diet, and quality prenatal care. Just being older doesn’t necessarily put you in a high-risk category, but an accumulation of many individual risks can. Eliminate or minimize as many risk factors as you can, and you’ll be able to take years off your pregnancy profile—making your chances of delivering a healthy baby virtually as good as those of a younger mother. Maybe even better.

So relax, enjoy your pregnancy, and be reassured. There’s never been a better time to be over 35 and expecting a baby.

“I’m only 31, but my husband is over 50. Could his age affect our baby?”

Throughout most of history, it was believed that a father’s responsibility in the reproductive process was limited to fertilization. Only during the twentieth century (too late to help those queens who lost their heads for failing to produce a male heir. was it discovered that a father’s sperm holds the deciding genetic vote in determining his child’s gender. And only in the last few decades have researchers begun to suspect that an older father’s sperm might contribute to an increased risk of miscarriage or birth defects. Like the older mother’s eggs, the older father’s spermatocytes (undeveloped sperm) have had longer exposure to environmental hazards and might conceivably contain altered or damaged genes or chromosomes. In fact, researchers found that regardless of the mother’s age, a couple’s risk of miscarriage increases as the dad’s age increases. It also appears that there is an increase in the incidence of Down syndrome when the father is over 50 or 55 (regardless of how old the mother is), though the association is weaker than in the case of maternal age.

Uninsured, Mama?

Having a baby these days can definitely be an expensive proposition—and that’s before you even purchase onesie number one. Still, no expectant mother needs to go through pregnancy and childbirth without the prenatal care she and her baby need, even if she’s uninsured. If you can’t afford to pick up health insurance now, here are some other ways to find that care at a price you can afford:

Check online or in the phone book. Search under “Clinics” or “Health Care Centers.” Most communities provide health services through organizations such as Planned Parenthood and at women’s health centers. Many of these can provide some free care, and most will offer care on a sliding pay-what-you-can basis.

Turn to the government. If your income is low enough, you may qualify for Medicaid. Through this program, you’ll be entitled to prenatal care. If you don’t qualify for Medicaid, there are low-cost health insurance programs (that will cover your pregnancy as well as your child’s health care after delivery) offered through the government. Ask at any clinic or call (877) KIDS-NOW or (877) 543-7669. If affording nutritious food is an issue—or will be once you’re feeding another mouth—contact WIC (Women, Infants, and Children), a government program that provides pregnant and nursing mothers with food and nutrition counseling. For information, contact WIC,
www.fns.usda.gov/wic
; (703) 305-2746.

Call your local hospital. Some hospitals provide a certain amount of free or low-cost obstetrical care to women who need it. Childbirth classes may also be available at little or no cost to women who can’t afford to pay full price for them.

As a last resort (and this really should be the very last resort), try the ER. If you experience a pregnancy problem or go into labor before you’ve been able to secure a practitioner, head to the ER of the nearest hospital immediately.

Still, the evidence remains inconclusive, mostly because the research involving older dads is still in its infancy. Despite what seems to be a small yet growing body of evidence to implicate paternal age as a factor in birth defects and miscarriages, genetic counselors do not recommend amniocentesis on
the basis of a father’s age alone. The screening tests that are now offered routinely to every mother-to-be, regardless of her age, should put your mind at ease. If your screening tests turn out normal, you can relax about your husband’s age without having to go through amniocentesis.

“I keep wondering if I might have a genetic problem and not know it. Should I get genetic counseling?”

Just about everyone carries at least one gene for a genetic disorder. But fortunately, because most disorders require a matched pair of genes, one from mom and one from dad, they’re not likely to show up in their children. One or both parents can be tested for some of these disorders before or during pregnancy—but such testing usually makes sense only if there is a better-than-average possibility that both parents are carriers of a particular disorder. The clue is often ethnic or geographic. For example, testing for cystic fibrosis is offered for all couples but it is especially important for Caucasians of European descent, because about 1 in 25 are carriers of the condition. Jewish couples whose ancestors came from Eastern Europe should be tested for Tay-Sachs, Canavan disease, and possibly for other disorders. Tay-Sachs has also been noted in other ethnic groups, including Louisiana Cajuns and French Canadians, so getting tested is something to consider if your family has these roots. Similarly, black couples should be tested for the sickle cell anemia trait, and those of Mediterranean and Asian descent for thalassemia (a hereditary form of anemia). In most cases, testing is recommended for one parent; testing the second parent becomes necessary only if the first tests positive.

Pregnancy and the Single Mother

Are you a single mom-to-be? Just because you don’t have a partner doesn’t mean you have to go it alone during pregnancy—and you shouldn’t try. The kind of support you’ll need can come from sources other than a partner. A good friend or a relative you feel close to and comfortable with can step in to hold your hand, emotionally and physically, throughout pregnancy. That person can, in many ways, play the partner role during the nine months and beyond—accompanying you to prenatal visits and childbirth education classes, lending an ear (and a shoulder) when you need to talk about your concerns and fears as well as your excited anticipation, helping you get both your home and life ready for the new arrival, and acting as coach, supporter, and advocate during labor and delivery. And since no one will know better what you’re going through than another single mom, you might also consider joining (or starting) a support group for single mothers, or find an online support group (check out the single mom’s message board at whattoexpect.com).

Diseases that can be passed on via a single gene from one carrier parent (hemophilia, for example) or by one affected parent (Huntington’s disease) have usually turned up in the family before, though it may not be common knowledge. That’s why it’s important to keep family health history records and to try to dig up as many health details from your parents, grandparents, and other close relatives as you can when you’re
pregnant (or are trying to conceive).

Most expectant parents, happily, are at such low risk for transmitting genetic problems that they don’t need to see a genetic counselor. In many cases, a prenatal practitioner will discuss with a couple the most common genetic issues, referring to a genetic counselor or a maternal-fetal medicine specialist those with a need for more expertise:

Couples whose blood tests show they are carriers of a genetic disorder that they might pass on to their children.

Parents who have already had one or more children with genetic birth defects.

Couples who have experienced three or more consecutive miscarriages.