In 2012, I received the biggest shock of my life when I learned I was pregnant. Prior to starting a rigorous new fitness routine in preparation for a trip to Costa Rica, I had recently taken a blood test to ensure I was not. A week later, before I even had a chance to adjust to the news, I miscarried. As devastating as my miscarriage was, I was fortunate to conceive again just weeks later. I went into my third pregnancy with renewed hope but this time, my prenatal care was very different. Though I was already a mother with two uneventful births under my belt, my recent miscarriage and status of being pregnant over age 35 put doctors on high alert.
I was immediately labeled high-risk. Even though the frequency of my appointments increased, the quality of my care diminished. It seemed as if every week I was scheduled for another test or an appointment with a specialist. I grew tired of being prodded, poked, and constantly badgered about all of the potential risks associated with pregnancy after 35. I felt great and I did not see the necessity of continuing to schedule additional tests when all signs indicated both the baby and I were healthy.
As soon as I opted to forego optional tests, my doctor’s demeanor changed. She became cold and impatient, as if my visits were an inconvenience. The first time she used scare tactics to pressure me into optional testing, saying my baby would die if I refused, I started researching new doctors. When she told me I would need a cesarean section, despite having two healthy vaginal births in the past, I canceled my next appointment. I did not know where I would receive prenatal care, I just knew I did not trust her to deliver my baby.
Optional prenatal testing
Optional prenatal testing is made available to women over 35 to help doctors screen for birth defects and allow patients to make informed healthcare decisions. These tests are often administered by specialists in conjunction with regularly scheduled prenatal appointments, at an additional cost. These are not mandatory and it is illegal to intimidate a patient into consenting to optional testing, or discriminating against a patient who declines.
Section 1557 of the Affordable Care Act (ACA) was the first law enacted to prohibit discrimination in the administration of health care services based on race, color, national origin, sex, age, or disability. Any healthcare facility that receives federal funds is covered under this mandate.
According to the Center for Disease Control (CDC), the number of pregnancies in women age 35 to 39 continues to rise. Though some doctors have stepped away from labeling the age of 35 and over an “advanced maternal age” due to antiquated data, many doctors continue to perpetuate the stereotype. But what matters most is not chronological age, it is the presence of pre-existing conditions and overall health.
While there is a marked increase of infertility and the chance of miscarriage as women age, maternal age alone is not a risk factor. There is no agreement among healthcare providers on the best method of care for women who are over 35, near the end of their pregnancy, and likely to have a successful birth.
A 2016 study on the experiences of pregnant women 35 and over revealed women feel healthcare providers are more focused on the clinical aspects and risks of the birth than providing them with helpful information that makes them feel prepared and supports their emotional well-being.
Experiencing age discrimination: Pregnant at 35
In the last few years, women have taken to the web to share traumatic birth stories attributed to age discrimination, hoping it will help other expecting mothers. Organizations like the International Cesarean Awareness Network (ICAN) post personal accounts of pregnancy discrimination on their Facebook page. Their mission is to inform women of their right to be active partners in their birth experience and prevent unnecessary cesareans. In 2014, cesarean rates for women 35 and older were between 38.5 and 57 percent, while cesarean rates for women under 35 peaked at 33 percent.
Higher c-section rates for women over 35 can be attributed to doctors that are overly cautious, or that wish to avoid prolonged labor with older patients whose cervixes are slower to dilate, rather than due to medical necessity. Studies have proven that doctors are often quick to introduce medical intervention with women 35 and older.
After failing to secure a doula or a doctor willing to accept me as a new patient due to my “high-risk” status during my third trimester, I lucked upon some helpful information about patient rights while suffering false labor pains at my chosen birth hospital. A nurse informed me I could utilize the doctor on call when I went into labor, instead of having them contact my doctor on record. I felt an immediate sense of relief.
Preparing for birth
There was still one problem—I learned I was breech. Fortunately, I visited a prenatal chiropractor who was able to flip my baby in one session. I started going for long walks and seeing an acupuncturist that gifted me with deep and restorative naps during the day. I turned chaos into zen by deciding to honor my body and reclaim my right to make healthcare decisions that were right for me and my baby.
I went on to have the epidural-free vaginal birth I wanted, with a doctor who had great bedside manner. I experienced minimal pain, rested in the hospital overnight with my healthy baby, and was released the next day—as was customary for me. The decisions I made may not be appropriate for everyone but it is important to understand you must be your own advocate when facing a healthcare system that discriminates against women, especially when they are pregnant and over 35.
Historically, systemic issues have allowed discrimination against women. Women have been charged higher healthcare premiums, restricted from access and prevented from receiving adequate care because women’s health research is largely ignored. Having the birth experience you want over the age of 35 is entirely possible, but it starts with being aware of how a doctor’s bias can negatively impact your level of care.