Mommy Maturity

REBECCA LEE IS A MOM — AGAIN. She gave birth to her now 14-month-old daughter, Jennifer, when she was 41, an age when many mothers are fretting about curfews and hormones not diapers and baby-proofing.

But Lee, who lives in Spokane with her husband, 7-year-old son and baby daughter, is part of a growing group of women having babies well into their third, fourth and even fifth decades.

And Lee is loving the experience.

“For us, a fun night is renting a family movie,” Lee says. “Your priorities shift as you get older. Our priorities have shifted; it changes your view of parenting. This is it. This is what it’s all about for us.”

Just last month, a New York woman made headlines after giving birth to twins, days shy of her 57th birthday. Aleta St. James used donor eggs to create the pregnancy. And a 59-year-old Georgia woman is scheduled to deliver twins next month, three decades after having her tubes tied.

Those are extreme examples, of course. But the latest reports from the Census Bureau show that birth rates for women in their 30s and 40s are on the rise. Birth rates for women aged 35-39 climbed 6 percent in 2003 and rates for women aged 40-44 rose 5 percent. Birth rates for women aged 40-44 have more than doubled since 1981.

The American College of Obstetricians and Gynecologists has noted the trend, publishing a health and lifestyle pregnancy magazine for women 35 and over. Plum magazine will debut in doctors’ offices in the next couple of months.

But becoming a mom gets increasingly tricky with each passing year.

“If everybody tried to get pregnant when they were 15, everybody would (succeed),” says Dr. Edwin Robins, Spokane’s only doctor specializing in treating infertility.

“Basically, starting at about age 25, reproductive ability starts to decline … I think 38 is getting to be a serious time … It drops and then it just drops faster all the time, sort of like a hyperbolic curve.”

Lee and her husband, George, did have a little trouble conceiving their first child. Rebecca Lee was 34 then, but just as they began preliminary fertility tests she learned she was pregnant. The second time around was more difficult, though.

“We tried insemination five times,” she says. “We tried the good old-fashioned way. We stood on our heads together and separately. We did the basal thermometer. We did ovulation predictor kits.”

In the end, it took four rounds of in vitro fertilization for Lee to have a successful pregnancy. Unlike many women her age, Lee was able to use her own egg to create the embryo.

During the lengthy and expensive process (each round of IVF cost about $10,000, plus medications), Lee says a woman who knew of her situation accused her of being selfish.

“‘You already have a baby,’” Lee says the woman told her. “She didn’t have children and what I was thinking in my mind was, ‘I already know how fabulous they are. I already have an amazing, incredible little boy.’”

Leanne Zilar, 45, and her husband, Christopher, had a total of four children from previous marriages. But the Spokane couple also wanted to create a family together.

After two rounds of IVF, Leanne gave birth to twin boys — Ariel Jean and Gabriel Lee — at the age of 43. She used eggs from a 22-year-old donor.

“It took me about 20 minutes to get over being sad that it wasn’t going to be our eggs,” she says. “We just feel so incredibly blessed this woman was willing to donate her eggs for us to have these kids.”

Zilar says she’s a different mom this time.

“I’m much more tired, absolutely,” she says. “(But) I’m also much more patient and I enjoy it a lot more. I enjoy all of the little things I get to watch them do. They climb and jump off of things. I know they’re going to live … I am much more relaxed this go-around.

“I’m happy it’s turned out this way. It’s bonded my family like nothing else has.”

Being older not only makes it more difficult to conceive a child, it also increases the risks for moms and babies.

“The big issue is the increased risk of chromosomal abnormalities,” says Dr. Judy Marvin, an obstetrician-gynecologist with Northwest OB-GYN in Spokane.

That’s why pregnant women over 35 are offered detailed screenings to assess risks for Down syndrome, cystic fibrosis and other diseases. (Zilar didn’t have to undergo the tests since she used eggs from a young donor.)

Older women may also be at greater risk of pregnancy-induced hypertension and diabetes than younger moms-to-be. And older women tend to have a higher rate of Cesarean sections.

As women age, it also becomes more likely they will have multiple births — even without medical intervention to boost fertility. That’s because older ovaries need to work even harder to pump out eggs, increasing the odds they will release more than one.

But, most importantly, women in their late 30s and 40s need to know that while they may be able to get pregnant, it may be impossible for them to use their own eggs, says Melanie Mikkelson, a clinical social worker at Dr. Robins’ infertility clinic.

Often, media reports about women in their 40s and 50s giving birth fail to mention that the woman used donor eggs, Mikkelson says.

“It does really frustrate me,” she says. “These celebrities don’t come out and say they’ve used a donor egg.”

As reproductive technology becomes increasingly advanced, it raises a host of questions, most notably: How old is too old to have a baby?

Some infertility clinics around the country have begun setting age guidelines, Mikkelson says. For example, in some clinics, couples are ineligible for treatment if their combined ages total more than 100.

Arthur Caplan would like to see medical groups create some standards when it comes to age and reproduction.

Caplan, chairman of the University of Pennsylvania’s Department of Medical Ethics, recently wrote a column for MSNBC.com criticizing St. James, the single mom who had twins at 56.

He admits it’s tough to question the decisions of St. James and others without sounding like a “moral busybody.”

He thinks using the parents’ combined ages as a rule of thumb, which is what many adoption agencies do, makes sense.

“At least somebody’s going to be there to be a parent,” Caplan said by phone.

But Caplan is doubtful that the medical community or politicians will regulate the practice, since it raises so many thorny issues.

Nevertheless, he writes:

“Society needs to be sure that as we stand in amazement watching medicine circumvent nature’s reproductive limits, nothing is done to put the best interests of the children that are created at risk.”