Hubby wants more kids, but…
Dear Dr Mitchell,My husband and I have two beautiful children, a girl, nine years and a boy, seven years. My husband has always wanted three children and thinks that we should really have another child.
Both my children were vaginal births. I didn’t have any complications of any kind during pregnancy or childbirth, but for some reason I’m a bit sceptical, even nervous, when I think about pregnancy at this age. I am aware of some of the complications I could develop if I decide to do this.
Kindly advise from a medical perspective, and also your honest opinion.
The fact that you have had two uncomplicated pregnancies and vaginal deliveries should put you at low risk for complications in a subsequent pregnancy. You did not state your age, but older women over 35 are considered to be at an increased risk for complications in pregnancy.
Your ability to become pregnant and your egg quality starts to decline once you reach 35, and is definitely significantly reduced at age 40 and beyond. The risk for chromosomal abnormalities such as Down’s Syndrome is also increased. There is also an increased risk of a pregnancy loss in early pregnancy in older women due to chromosomal and other abnormalities.
Women of advanced age are also at an increased risk for diabetes mellitus and high blood pressure during pregnancy. This contributes to an increased risk for complications in both mother and foetus. There is an increased risk of premature deliveries in women who have poorly controlled diabetes mellitus and hypertension. This results in the increased risk for admission to the intensive care unit for the neonate because of immature lungs and significant respiratory problems.
It is important as you get older to control your weight by exercising and eating properly. This will help to reduce your risk of developing diabetes mellitus and high blood pressure in the pregnancy.
Women are now choosing to have babies at an older age and the outcome has been good because of the access to good health care. With the advancement in technology and the increased opportunity for screening in early pregnancy, chromosomal abnormalities and congenital defects can be detected early and managed appropriately to reduce complication during the pregnancy.
If pregnancy does not occur naturally, then options such as invitro fertilisation is widely available. Donor eggs and donor sperm can also be used to achieve a successful pregnancy if there are problems with poor quality eggs and sperm in older couples. Using a surrogate is also an option for older women who have significant medical problems.
It is important that you plan the pregnancy properly and ensure that you control any medical conditions that you have before pregnancy to improve your outcome. Daily folic acid supplements before pregnancy and throughout the first trimester will decrease your risk of birth defects in the brain and spinal cord.
If your husband wants a third child, I think that you should definitely explore the option. Consult your doctor who will do a complete physical examination including a mammogram if you are over 40, and a Pap smear. This will help to reduce your risk of complications once you become pregnant.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
