Sister Lilian’s Pregnancy & Birth Companion. Lilian Paramor

the capsule of the female egg is not strong enough. This is not picked up easily but is one cause of ova disintegrating before they are fertilised. It may be well worth your while to see a homeopath before opting for an expensive fertility procedure.

      GENETIC CONSIDERATIONS

      Many prospective parents worry about whether their unborn child will be normal. The more anxious you are by nature, the more difficult you will find it to put this into perspective. Remember that most babies are born ‘normal’. The value of not stressing unduly about this in pregnancy is great. Rather deal constructively with anxiety.

      If you are aware of hereditary problems in your family, it is advisable to seek advice from a genetic counsellor before starting a family. Much heartache can be avoided in this way. Expectant couples who are at risk of giving birth to a baby with a genetic problem would be well advised to undergo appropriate tests (see Testing in pregnancy, which will put their minds at rest, assist them in a possible decision to terminate the pregnancy or give them time to prepare for the extra challenges of parenting a special-needs baby.

      I advise every expectant parent to read The Antenatal Testing Handbook: The Complete Guide to Testing in Pregnancy by Vivienne Parry and others for an excellent overview of the tests available. It addresses the questions relating to genetics that are uppermost in the minds of many before conception and during pregnancy.

      The best age to have a baby

      I doubt whether there is such a thing as a best age to start a family. There are advantages and disadvantages to different ages and circumstances, and it remains a very personal decision. Those who have difficulty conceiving envy others the relative luxury of being in a position to consider such a question. I hope this Companion will help you decide what is best for you.

      For as long as women have had babies, they have had babies in their late thirties or forties – usually ‘laatlammetjies’ – many due to the lack or failure of contraception. Today it is frequently a conscious choice to start a family much later in life. The reasons for this development are many and varied:

      •significant contraceptive advances made in the second half of the twentieth century;

      •a range of career options for women;

      •older single women are no longer seen to be ‘on the shelf’;

      •divorce and remarriage with a desire for children from the new union;

      •some women (and their partners) wish to enjoy their younger lives unencumbered by the demands of parenthood;

      •many wish for greater financial and emotional security before embarking on the responsibility of parenthood;

      •an apparent general decline in fertility of both women and men and an increase in menstrual cycle disturbances;

      •women who choose not to marry but desire to have a child tend to do so in their thirties or forties rather than at a younger age.

      Having a baby after the age of 35 is not massively more risky than having a child at a younger age. Risk does not suddenly emerge but each year might make one or other factor more significant. There might also be some risk from an older father’s side, although this is very difficult to research accurately.

      There are certain benefits to having babies at an older age and these might even be favourable to both mother and baby. Research bears out that higher standards of education and improved socioeconomic status are linked to healthier pregnancies and babies in older mothers. Good maternal health and lifestyle are far more important than chronological age.

      A common concern is genetic defects. Just as the ageing eggs might result in more miscarriages, this might also contribute to the slowly increasing risk of genetic abnormalities in babies born to women over the age of 35. The most common condition is Down’s syndrome. Whereas at the age of thirty the risk of Down’s syndrome is about one in 885, it increases to about one in 365 for a 35-year-old and one in 110 at forty. Although it causes great anxiety for those who face it, this is less than a one per cent risk. The risk is definite but not huge. While it does increase steadily with advancing age, most women over 35 have completely normal babies.

      Health generally declines as you get older and conditions like diabetes and high blood pressure in pregnancy affect more women after the age of 35 (see Pregnancy complications. Other circulatory problems like varicose veins and blood clots are also slightly more likely (see Moans and groans in pregnancy. Babies born to older mothers are often smaller due to such health problems. This can make their start in life more difficult, but with good pregnancy care and the mother doing all she can to live healthily before and during pregnancy, these problems can be minimised and are usually easily treatable.

      Many women who choose motherhood later in life are health conscious and have followed wise eating and exercise patterns for many years. They understand the need for a balanced life, although some are extremely ambitious and may neglect the need for rest and relaxation. Moderation, simplicity and wisdom are key ways to enhance the chances of a healthy pregnancy, birth and baby. Physical strength and stamina may have declined a little by the age of 35 or beyond, but if you take care and live healthily, this need not be of great concern.

      Emotionally you are more mature and better able to deal with the ups and downs of parenting when you are slightly older. Your relationship is cemented in the confidence and caring that time brings so that the inevitable stresses of the baby phase are less likely to rock the boat. The desire for a baby is usually very strong later in life. Moms and dads who are able and willing to prioritise this phase are less upset by demands on their personal space and time. Although you are used to your routine and your own space, Baby is usually a very welcome addition to the family. Patience is a virtue that is required and is usually present in older parents.

      Earlier financial concern is often over or substantially less when parents are older, removing one huge stress factor from the parenting equation. Money problems can lead to a whole array of insecurities and tensions which further complicate parenting. Babies and children are quick to notice undue stress in the home and this can make them unhappy, leading to a vicious cycle of ever-increasing tension. It’s not that a child costs so much; rather, the cost of living is the problem if you have not yet built up and consolidated your resources. This is particularly true if you do not have much support from your extended family.

      You become so used to the independence of adult life that being on 24-hour call and having to respond to a baby’s often unpredictable patterns and needs might be quite challenging for older parents, especially if they are very ordered and goal-oriented. The playfulness that young parents are still in touch with can be a valuable parenting skill, making the task lighter, but older moms and dads can recultivate this.

      Having a baby later in life may herald a change in friendships if your peers don’t have babies although, as more women choose this option, this is rapidly disappearing as a potential problem. By the time the children have grown up, you might feel there is less time left to enjoy what life offers, but most say that the extended time before starting a family satisfied that need.

      Your relationship

      We all know that babies don’t save marriages, yet it is amazing how often couples in an ailing relationship pin their hopes for family happiness on having a child. Sharing children can be good as you will often laugh about mannerisms and delightful personality traits peculiar to your child in the knowledge that only you, the father and mother, really understand and love your child that intensely. A child will not, however, heal a deep rift.

      Perhaps our expectations of marriage or love partnerships are unrealistic, but just as we hone the qualities needed for our careers and practise them, we should do the same for this time-consuming and very important aspect of our lives. I believe the tools of the partnership trade are:

      •respect for the individuality of the other;

      •time invested in making your partner feel good;

      •regular