Japan: the best place to give birth?

Japan is one of my most favourite places to travel. After this morning, I feel a little more in love with the country upon reading an article about the increase in pregnancies among 'older' women. When I first started reading, I expected that the article would turn into a rant about why 'older' women are 'high risk' and need to be managed medically more so than other women. But then I read something that caught my eye: Japan has one of the lowest maternal mortality rates in the world: 6 per 100,000 births (lower than the US, Britain, Finland and Canada).

Why is it so low?

Well, the picture is complicated. Much like other developed countries Japan has a technologised/medicalised approach to pregnancy and birth. Women who are 35 years + are seen as 'older' mothers. Birth choices for women are still circumscribed by the limitations placed upon them by health professionals in hospitals, however, not to the same extent as in other countries like the US.

Surprisingly, use of epidurals is much lower in Japanese hospitals. This is in part due to the more practical reality that there is a shortage of anesthetists. As you might know, the use of epidurals has been linked with an increased risk for caesarean section.

While most Japanese women give birth in hospitals, there is a small proportion of women who give birth in birth centres, called josan-in. These centres are set up like a traditional Japanese home and offer women care by a team of midwives. Centres offer maternity yoga, cooking classes for post-birth diet and nutrition counselling as well as a pool for water births.

What I found most interesting, however, was that this article, whilst couched in the language of 'women over 35 are high risk' blah blah blah, in fact, the piece ended up being about the importance of women over 35 being IN CONTROL of their pregnancies. As one obstetrician notes, the worst thing women can do is let a doctor be in control of their decision making. This is vastly different from what I perceive to be the perception of health professionals in other parts of the developed world. Women ('older' or not) are so often viewed as incapable of making decisions when it comes to birth that in a conservative environment like Japan, it is refreshing to see that obstetricians do not shove tests on women and whilst operating in a medicalised system, see the importance of women doing pregnancy and birth on their own terms.

Kelly Preston: Having a baby at 47

So it appears that Kelly Preston, actress and wife of John Travolta (age 56), is pregnant AT THE AGE OF 47.

Today they have released a statement to People describing the pregnancy as a 'miracle'.

'Miracle', my arse.

Aside from all of the gay rumours circulating lately about JT, everyone with half a brain cell could probably figure out that they have probably been undergoing fertility treatments for quite some time now. As reproductive specialists suggest, it's a rarity for a woman to become pregnant on her own after age 45." According to the Centers for Disease Control and Prevention, in 2008 there were 0.7 births per 1,000 women ages 45 to 49, compared with 9.9 births per 1,000 women ages 44 to 40.

As much as Celine Dion makes my skin crawl, at least the gal has had the guts to be open and honest about her age and the fact that women over 40 don't get pregnant miraculously. I mean, seriously, that's like suggesting storks drop babies on your front porch.

What do you think? Are Kelly and John too old to parents again?

Britain's oldest mum back to work

Welcome back to moral panic Monday.

Elizabeth Adeney, Britain's 'oldest mum' has given birth to her first son at the age of 66 back in May to a phalanx of media scrutiny. Criticised for being too old, a divorcee and for accessing IVF in the Ukraine, Adeney refused to talk to the media noting that she felt young at heart.

Now, poor Adeney is being slammed for returning to work 4 weeks after giving birth. Adeney was spotted being driven to work by a friend, leaving her newborn son Jolyon, with a live-in nanny. As Adeney gave birth by caesarean the Daily Mail further criticises her, speculating that her caesarean scars probably have not been given a chance to heal properly:

"Sue Jacob, adviser to the Royal College of Midwives, said: 'Hormonally women are still very delicate after four weeks and caesarean scars will not have healed properly. Babies still need the consistency of a mother's attention at this point and new mums especially will be exhausted.
'There's no reason why women should not carry on with their careers as soon as they are able. But it's only a select few women who are able to get the support necessary to do this. It isn't what we expect normal, ordinary women to be able to do."

As I said in an earlier post, the issue of having IVF at 66 and being an 'older' mum are actually separate issues. Elizabeth Adeney owns her own company, has a fabulous home and the ability to hire the support that she needs in order to help her be a good mother. I don't see why Adeney having a child at 66 is any different from older men like Larry King having young children well into their 70s. What really bothers me is that Adeney's reported 'desperate' desires for children throughout her life is being used against her. It's like, 'How on Earth could this women conceivably return to work *shock horror* when she wanted a child so badly'? GIve me a flipping break. Celebs return to work 2 minutes after they have babies and most of them use nannies and whomever else they can to help them get through the day as career women, wives/partners and mothers. If Adeney wants to go back to work, why is it anyone's business but her own?

Moral panic Monday: Britain's 'oldest mum' at 66

In case you missed it, everyone in the world seems to have their knickers in a knot over the pregnancy of Elizabeth Adeney, 66, now claiming the dubious honour of Britain's 'oldest mum'. Following on from many years of failed IVF attempts, Adeney fell pregnant after treatment at a Ukrainian fertility clinic. Most UK doctors refuse treatment to women of her age and also it is much cheaper to go elsewhere for IVF. Nevertheless, whether you agree with her decision or not, it is hard to deny that this poor woman is being unfairly castigated for choosing to become a mother at what is considered to be a socially inappropriate age. While on some level, I tend to agree that being nearly 67 when you have a newborn is morally ambiguous when you think about whether you will be around long enough to see the child into their teen years, at the same time I am appalled by the personal attacks on this woman's character, her ability to raise a healthy child and her position as a 'divorcee' in recent days. Has anyone forgotten about all of the famous men in their late 60s who have fathered children, receiving only pats on the back and knowing winks by other men for partnering with a woman nearly half their age?

Case in point: talk show host, Larry King. King, who became a father for the fifth time at the age of 65 in 1999 received only praise for having a 39year old (7th) wife and a baby on the way. Last year at the age of 73, he was praised for being a 'better father' to his two young sons, aged 7 and 8 in Ok!:

"Larry King enjoys being a dad at the ripe old age of 73. He loves to take his young sons, Chance, 8, and Cannon, 7, to Dodger games, which is something his older sons, aged 47 and 40, didn’t enjoy enough. “I’m a better father this time,” he tells intern Brandi Tape at The Quaker Smart Heart Café breakfast. “I have more time to spend with them, and I guess I care more.”

Argh. This makes me so angry. With regard to Adeney, who is expected to give birth by caesarean next week, one fertility doctor has said:

"I do not treat women older than 63,' he said. 'I don't want the child to be left without a mother before they reach 20."

If any of you saw Today this morning in Australia, Herald Sun columnist Andrew Bolt (whom I hate, by the way) had the nerve to say that Adeney was an unfit mother because she was divorced and because she was not providing the child with a father figure. This woman is the manager of a factory and earns a decent living.

I think the issues are being confused. Whether Elizabeth Adeney can be a 'good' mother is completely separate to whether it is appropriate for women over 65 to be able to access IVF. Older men seem to be able to get away with fatherhood late in life with no concern over the very real prospect that some of these men will not be alive to see their children finish high school. Women, on the other hand, are seen as 'past their use by date' once they reach a certain age and I think the threat of an 'older', 'single' and clearly financially secure woman choosing to have a child is what is really at the core of this moral panic about IVF.

IVF: pregnancy waiting to happen

Gotta love a little media spin. 2 article about IVF on the same day using the same stats with very different arguments:

Headline: Celebrities give false hope to IVF mums
In this story, the Daily Telegraph claims that only 2% of women over 45 become pregnant successfully through IVF.

"Despite the increase in success rates in women over 40, the majority (over 40) who come for IVF treatment go away without a baby," he said.

Headline: IVF boost for women in their 40s
In this article, women in their 40s have apparently 'doubled' their success rate with IVF over the last 2 years. One doctor is quoted as saying the success rate now amounted to, "a realistic chance" for older women, particularly those aged 40 or 41."

Of course, both articles conclude that IVF is not an 'insurance policy' for women who wait too long. *sigh*

Sources: http://www.news.com.au/dailytelegraph/story/0,22049,24359180-5005941,00.html
http://tinyurl.com/5tjojh

Mothers over 40

If you recall, in October, I wrote about 'Statistics That Piss Me Off'. In particular, it was statement about fertility, that well, pissed me off:

"Fertility Society of Australia spokeswoman Anne Clark warned that the decision to defer motherhood could have serious implications for national population growth: "This is not good news, because fertility levels change for women in their mid-30s and for men after 40, so you are going to have a lot of people pushing it to have more than two children."

In case you have been living in a hole, Nicole Kidman is pregnant. She will actually give birth when she is 41. Whereas the Australian media has been all about flogging mothers over 35 for being selfish and risking their health for no reason, in the last two days, almost every story about 'older' mothers is praiseworthy. For example:

NSW Midwives Association, Hannah Dahlen, said yesterday women should not be deterred.
"Older mothers are more likely to be educated and financially secure, more settled in themselves and more prepared to make the sacrifices required to be a mother," she said. "They are better able to negotiate care for their child, their children often do better in school, and it has also been shown in some studies that women who have babies in their 40s live longer."

Apparently, because Nicole Kidman 'looks' fit and healthy and wants a child so badly, apparently she is immune to any of the 'risks' associated with pregnancy over 40.

Sources: http://www.smh.com.au/news/health/the-risks--and-rewards--when-motherhood-begins-at-40/2008/01/08/1199554655649.html

Older mums a 'risky' trend: a problem of biology or society?

Seriously (how many posts have I started with a *sigh* and a 'seriously' lately?) why do American obstetricians make it so difficult for women to be pregnant and give birth safely these days?

Women who are 'young' (in teens/20s) are consistently represented as welfare queens and 'bad' mothers. Celebrities are increasingly the only representation of motherhood accessible to everyday women in popular culture. And now, as always, 'older' mothers are copping flak for selfishly wanting to fall pregnant and actual give birth vaginally when they are over 40. I find this particular issue incredibly disturbing. According to the Los Angeles Times, pregnancies to women over 40 has increased threefold in California as a result of middle-class women's access to fertility treatments. In the words of one fertility specialist:

"Women begin to have fertility problems about 10 to 15 years before they experience menopause, Rodi said. The average age of menopause is 50 to 52, but it can range from 40 to 60. Women have no way of knowing for sure at what point in the spectrum they'll fall"

I'm not denying the statistical risks associated with later childbearing. A range of studies have shown that certain complications are more likely to arise when women give birth later in life. However, I find it particularly offensive that all of these articles being fired off in the media about 'older' mothers are generally not related to the welfare or well-being of 'older' mothers pre and postnatally. Rather, these articles position women over 40 as taking a gamble on bodies that, according to biomedicine, are no longer reproductively valuable. The whole industry (and yes, it is an industry) of infertility is reliant upon women who are told that as soon as they hit the age of 35, the egg factory will be invariably shutting up shop. As the quote above suggests, women must be aware of their fertility from the moment they begin to menstruate and are encouraged to have children early in life so as to circumvent any unforeseen 'problems' later on, as a sort of reproductive 'insurance' policy. The overriding message is that if you wait too long, you can find yourself with a 'barren womb' and it is nobody's fault but your own.

I think it's interesting that nowhere in the LA Times article does anyone specifically address (as I have said many times before) the specific cultural/economic/historical shifts that have provided women with positive opportunities to be active in the public, to have fulfilling careers and to not be resigned to the domestic if they don't want to be. As I have found in my own research with pregnant women over 40, these women have spent half of their lifetimes establishing their own identities, independence and a career. By the time they are 40, having a child seems right despite the associated 'risks'. Why fault women for finally making themselves happy? I thought we had evolved past the women-as-baby-making-machines metaphor that has so deeply embedded itself in American biomedical directives. In fact, the reason why women are 'waiting' so much longer as the media suggests is implicitly tied to working. New Canadian research shows women over 40 are often more likely to forego maternity leave because they have made huge investments in their professional lives; many of these women do not even take the majority of the materity leave to which they are entitled because they are so fearful of the real consequences of taking time off and losing a corporate edge.

Adrienne ten Cate, a senior researcher with Human Resources and Skills Development Canada, has found that the more educated, well-compensated and high-ranking the woman, the less maternity leave she takes. "There's a U-curve, where women in low-level positions can't afford to take time off," she says, "and women at the high end return early for fear of forgoing promotions, wage increases and other opportunities."

Perhaps if the culture of working changed and women were not at the nexus of the work/life balance, delayed childbearing would not be such an issue. The truth is most workplaces are still extremely unsupportive of motherhood and women have to constantly negotiate the demands of motherhood and working without an infrastructure for support. Billable hours, long working days and women performing 'like men' are staid features of the American workplace.

Sources: http://www.latimes.com/news/local/la-me-oldmoms3dec03,0,6600732.story?coll=la-home-local
http://www.latimes.com/news/local/la-me-banks4dec04,1,4364409.column?coll=la-util-news-local&ctrack=1&cset=true
http://www.financialpost.com/magazine/story.html?id=130063

Inconceivable dilemma: Helena Bonham Carter and the myth of the 'older' mother

Actress Helena Bonham Carter discusses her struggles with infertility in the Sydney Morning Herald, a topic of conversation that most celebrity mothers tend to keep under wraps lest they damage their image of 'good' motherhood. Let's face it. Women who are infertile or who have difficulty falling pregnant are positioned culturally as 'failures' and in particular, 'older' women (especially over 40) are constantly represented as being 'selfish' for bringing a child into the world in a uterus nearing its use-by date.

For instance, in an article about pre-conception diets for 'older' mothers today, the author uses similarly negative language to explain how women of a certain age can better their chances of becoming mothers:

"Women are most fertile between 17 and 25. Over the age of 35, one woman in three will have trouble getting pregnant. It's not always the woman's fault – in 40 per cent of cases the finger can be pointed at the male. There are various reason why a woman finds it harder to conceive in these later years – there may be a structural problem with the reproductive organs, like blocked fallopian tubes, or a disease of the uterus like fibroids or endometriosis. Most cases, though, are due to a failure of ovulation – eggs just don't ripen and release when they're supposed to. This is usually because of a hormonal imbalance – at an older age, the body isn't producing enough sex hormones at the right time and in the right amounts to ovulate successfully."

As you can see from the words I've highlighted, the language of failure is invoked in talking about certain women's inability to fall pregnant. This is almost always tied to insufficient biology; as a woman ages her reproductive capacities are seen to degenerate. She is no longer valued as a 'producer' as the quote above suggests. This is in spite of the fact that 40% of causes of infertility are due to issues with the woman and 40% of causes are due to issues with a male. Yet, in an article of this nature, men's problematic reproductive capacities are never discussed. The quality of a woman's eggs are always the most important site for criticism.

Helena Bonham Carter,currently 8 months pregnant with her second child, utilised Clomid to jump start her fertility after trying for many months without a pregnancy at the age of 41. She says:

"I had a terrible reaction to it," she says. "Many people think it is the only thing that's going to make them ovulate but as it turned out I was ovulating anyway. It stressed me out beyond belief. Hormonally, I was all over the shop and I got really low emotionally. Lots of people don't have that reaction but on the internet I found a Clomid club, with people who react to the stuff discussing it online."

Fortunately, Carter fell pregnant before she had to take the next excruciating steps into IVF. I find it interesting that a number of countries including the Netherlands are trying to enforce preconception care particularly because so many 'older' women are having babies. This is seen as a way to stem the birth of babies with genetic 'defects'. Although there is good research suggesting a healthy lifestyle is beneficial in pregnancy for a number of reasons, the idea that 'older' women can only produce 'damaged' good lest they eat x number of servings of green vegetables, cut out all caffeine and lose heaps of weight is problematic. As I've said before, government have complained for ages that too many 'young' women in their late teens and early twenties are having babies out of wedlock and are too irresponsible to look after children. Yet, now that women are having babies when they are ready, they are threatened with the prospect of birthing deficient children and for being castigated as selfish for holding off on motherhood.

Sources: http://www.abc.net.au/health/thepulse/stories/2007/11/08/2085199.htm

http://www.smh.com.au/news/parenting/i-would-have-tried-anything/2007/11/06/1194329229763.html?page=3

Helena Bonham Carter pregnant at 41: Miracle or Media Malarky?

This headline from the Telegraph intrigues me:

'Helena Bonham Carter pregnant again at 41'

Yes, indeed HBC is pregnant with her second child..but the 'again at 41' part is the kicker. Do people really think that women's ovaries shrivel up and die when they age past 35 or something? The word 'again' reads like getting pregnant at 41 is a miracle akin to the immaculate conception. 'Again at 41' as though women are selfish for choosing to bring children into the world when they are past a certain age. 'Again at 41' as if to say 'Silly woman! Everyone knows that women over 40 are past their use-by date!'

Despite all the mumbo jumbo about pregnancy risk in 'older' women, the truth is the number of women getting pregnant over 40 has doubled.

Source:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/10/nbonham110.xml