Waiting on motherhood
WQueen Elizabeth II was 37, she gave birth to her fourth child. The queen’s 37-year-old granddaughter-in-law, Meghan Markle, announced this month that she’s pregnant with her first.
What a difference two generations make.
The Duchess of Sussex is the latest celebrity poster woman for two clashing realities. One is that the ability to bear children declines so rapidly that age 35 is the threshold for “advanced maternal age.” At that point, both woman and baby face significantly higher risks of complications.
The other reality is that women are delaying childbearing anyway.
The latest federal data showing that women are having fewer babies and at later ages was released recently. Over the past decade, women in rural areas and small towns have bolstered this trend, although it is most pronounced in metropolitan counties.
At the same time, birth rates have been falling for women in their 20s and climbing for women in their
30s and 40s. Last year, 42 percent of the nation’s 3.8 million births were to women in their 30s, according to federal data.
This shift is seen in all Western countries. It is not driven by some environmental or political catastrophe like in “The Handmaid’s Tale.” Mostly, it’s because women can postpone motherhood in favor of education and careers.
Still, the shift has inspired strident reactions. Many infertility specialists think women choose to ignore, or don’t believe, that by age 35 they have only 3 percent of the eggs they were born with, and the supply and genetic quality go downhill fast after that. The experts blame the media for feeding willful ignorance by glorifying women such as Markle.
“The media portrayal of a youthful but older woman, able to schedule her reproductive needs and balance family and job, has fueled the myth that ‘you can have it all,’ rarely characterizing the perils inherent to advanced-age reproduction,” Mark V. Sauer, chief of reproductive endocrinology at Columbia University Medical Center, wrote in the journal Fertility and Sterility.
Women, meanwhile, rankle at medical terminology that they feel shames them for having biological clocks.
Laura Kenney, writing in Self magazine, decried the “litany of quasi-ageist terms knocked-up over-35s are blasted with: There was ‘advanced maternal age,’ ‘geriatric pregnancy’ and the fact that I was considered ‘high-risk.’ ”
How much of a dive does fertility take after 35? That can be hard to tease out, since married couples’ friskiness also tends to decrease with age. A classic French study got around this by following women who were inseminated up to 12 times because their husbands were sterile. A little more than half of the women older than 35 got pregnant, compared with three-quarters of
PREGNANCY
out of hand. Eventually, they run out of room and wind up with narrow walkways and only a tiny place to sit amid what looks like trash to most people but is treasure to them.
Some hoarders grab good deals on furniture they plan to fix someday but never do. “I am a rescuer of things,” one woman told Arbore. “I save them.” Some hoarders have a similar attitude toward animals.
“What do you see?” Arbore often asks hoarders. “I see Christmastime,” one woman told him as she surveyed the piles of debris in her room. “My cats are really flourishing,” another said, even though Arbore saw sickly animals along with some smelly, dead ones.
The cause of hoarding is unknown. Arbore sees elements of addiction and compulsion. The condition may also run in families. Many hoarders reject offers of treatment. “When you try to help guide them,” he said, “there is so much resistance.”
Arbore said hoarding needs more study. There is currently no evidence-based treatment. While hoarders may seem obsessive, they do not respond well to treatments for obsessive-compulsive disorder, and antidepressants have mixed results. Just clearing out their stuff for them doesn’t work. Most end up filling the space again because they’re more comfortable amid clutter.
He said one study found that about 70 percent of hoarders responded to cognitive behavioral therapy, a type of talk therapy that helps patients change their thinking patterns, when combined with skills training that strengthens decisionmaking and organization along with motivational interviewing.