The effect of age on childbirth is an important problem, particularly important at this time when marriage is so often postponed until the woman is toward the end of her reproductive span. At this period many women avoid maternity because of the insurmountable hazard which they believe their age adds to labor. This erroneous supposition is the result of uninformed lay opinion, aided by quasi-scientific medical observations.
In an analysis of the effect of age on childbirth, we can rule out of consideration the multiparous woman, for if a woman has once borne a child her age at a subsequent birth little affects the speed and progress of labor. We shall focus our attention on the effect of age upon the first childbirth. How much is labor lengthened, and how much increased risk is there to mother and child?
Almost all observers agree that a first pregnancy after the age of thirty-five, when women are classed as elderly primip-aras, is attended by an increase in length of labor. Today we believe that the difficulty is due to the replacement of some of the easily stretched elastic tissue cells and muscle cells of the uterus and birth canal by less easily stretched connective tissue cells. Even though women are still young at thirty-five, from the standpoint of childbearing their span is more than two-thirds over.
When one compares a large group of women thirty-five or over, giving birth to first children, with a group of women of assorted ages in their first labor, he finds that the more elderly women are penalized an average of one and one-half hours; when they are compared to young women, twenty and younger, the difference is approximately four hours.
In all the studies on elderly primiparas, the maternal and fetal risks were slightly higher than in an average age group, but the increase was so insignificant that no woman is justified in being deterred from motherhood by it. Any woman, even though she is thirty-five or over when undertaking her first pregnancy, can confidently anticipate a very happy outcome if she receives the proper type of obstetrical care.
Youth and Childbearing
Despite the fact that the relatively elderly woman does satisfactorily, there is no way of gainsaying the fact that the best ally of successful childbirth is youth. This phrase should be emblazoned on the walls of high schools and girls’ colleges. It is a message which the medical profession must constantly reiterate to the women of America.
I learned this lesson from a patient several years ago. When I first saw her she was thirty-four and had been twelve years married. She was a department-store buyer and so engrossed in her career that she could never afford the time to start a family. When she suddenly realized age was catching up, she got pregnant very efficiently, and gleefully came to see me. On examination, I found that she had atumor of the uterus many times the size of her early pregnancy, and when, because of complications, the whole uterus had to be removed, leaving her forever childless, she kept sobbing to me in a kind of chant, ‘Why didn’t someone tell me you should have children while young?’
Leaving out of the question all socio-economic considerations (of course in actual practice they can never be left out), the ideal age for a woman to start a family, from the purely obstetrical viewpoint, is between the ages of seventeen and twenty-one.
According to the 1959 report of the National Office of Vital Statistics, in that year the age group of twenty through twenty-four had the greatest number of first births in the United States; the fifteen-through-nineteen five-year sample ran a close second. The figure given under each five-year age span is the number of women within that age bracket who gave birth to their first living child per 1000 estimated female population. We shall list the groups in order of frequency:
How Many Labor Pains Are Required? ‘How many pains make a baby?’ is the facetious form in which the layman phrases a serious scientific query. As can be surmised, there is extraordinary variation. According to one Swiss study, first labors required an average of 135 contractions and muciparous labors, 68.