Over the past 40 years, the number of women giving birth at age 35 or older has increased significantly, both in the United States and globally. In the U.S., this trend began in the mid-1970s and continues today. In 2018, about 18% of women giving birth were over 35, compared to just 8% in 1990. What’s even more striking is that this number is steadily rising. In contrast, birth rates among teenagers and those in their twenties have reached record lows.
The trend toward later parenthood is not limited to the U.S. Many high-income countries are seeing a similar shift. In 2013, about 20% of births in England and Wales were to women aged 35 or older, compared to only 6% in 1980. So, what’s behind this global movement of delayed parenthood, and what does it mean for women who want to have children later in life?
One thing I want to point out is that pregnancies to women over 35 are often referred to as geriatric pregnancies by the medical community. Frankly, I hate this term. It’s rude, outdated, and demeaning. Referring to healthy, vibrant women in their 30s and 40s as “geriatric” is not only insulting, but it also reinforces unnecessary fear around aging and childbirth. These women are not fragile—they are often among the healthiest, most prepared, and empowered mothers I work with. It’s time we retire this term for good.
Why Are Women Delaying Parenthood?
There’s no single answer as to why women are waiting longer to have children, but there are several contributing factors, including:
- Higher Education Levels: More women today are pursuing advanced degrees, and it’s taking longer to complete their education. By the time they feel settled in their careers, many are well into their 30s.
- Careers in Male-Dominated Fields: Women are increasingly entering and excelling in historically male-dominated professions. These jobs may not be as understanding or supportive of motherhood, making balancing career advancement and family planning harder.
- Cultural Shifts: In today’s world, more women feel that they’re not ready for the responsibilities of parenthood until later in life. This feeling of not being “ready” can be influenced by societal pressure to have everything “perfect”—the right job, house, and partner—before having children.
- Workplace Policies and Lack of Support: Unfortunately, many workplaces still don’t offer adequate maternity leave, flexible hours, or affordable childcare. This lack of support can make it difficult for women to balance careers and family life, leading to a delay in starting a family.
- Economic Uncertainty: Financial instability, concerns about the housing market, or even unemployment can cause women to delay parenthood. It’s hard to think about having children when you’re not sure how you’ll afford to support them.
- Medical Reasons: Some women delay parenthood for medical reasons. They may want to focus on their health or resolve any medical issues before starting a family.
- Relationship Factors: Not everyone meets the right partner at a young age, and finding someone they want to start a family with can take time. Interestingly, research shows that having a stable partner is linked to women choosing to have children later in life.
These are just a few reasons why women choose to wait. Parenthood is one of the biggest life decisions, and there’s no one-size-fits-all timeline.
Fertility After 35: What You Need to Know
While it’s common to hear about fertility declining with age, many women don’t realize just how early it starts. Fertility begins to decline slowly in the early 30s and then more rapidly after age 35. This means that when many women feel ready to start a family, they may already face some challenges in getting pregnant.
For women, fertility is largely determined by the quantity and quality of their eggs. Unlike sperm, which are produced continuously, eggs are finite. You’re born with all the eggs you’ll ever have, and as you age, the number of viable eggs decreases. In addition, the quality of those eggs diminishes over time. This decline in egg quality can make it harder to conceive and increase the risk of miscarriage or genetic conditions like Down syndrome.
But that doesn’t mean having a baby at 35 or older is impossible! Many women successfully conceive and give birth after age 35, either naturally or with the help of fertility treatments. However, it’s important to understand the realities of fertility at this age.
- Chances of Getting Pregnant: According to studies, 74% of women under 31 who are trying to conceive will get pregnant within a year. This number drops to 62% for those aged 31-34 and 54% for those aged 35 and older. While these numbers may sound concerning, they show that many women over 35 can still get pregnant, though it may take longer.
- The Role of Assisted Reproductive Technology (ART): With advances in ART, many women over 35 can conceive with the help of fertility treatments like in vitro fertilization (IVF). About 2% of all babies born in the U.S. each year are conceived using ART. This option can be a game-changer for women who are struggling with fertility.
- Maximizing Fertility at Any Age: Charting your menstrual cycle and tracking your fertility signs (like waking temperature and cervical fluid) can help you identify your most fertile days and maximize your chances of getting pregnant. There are also apps and devices available that can help with fertility tracking.
What Are the Risks of Pregnancy After 35?
While many women have healthy pregnancies after age 35, there are some risks to be aware of. As we age, the risks of complications increase. Here are a few key risks to keep in mind:
- Genetic Conditions: The risk of having a baby with a genetic condition, like Down syndrome, increases with age. For example, at age 25, the risk of having a baby with Down syndrome is about 1 in 1,340. By age 35, that risk rises to 1 in 353; by age 40, it’s 1 in 85. However, this risk can be mitigated using donor eggs from a younger person.
- Miscarriage: The risk of miscarriage also increases with age, from around 10-11% for women under 35 to 17% for those aged 35-39 and up to 33% for those aged 40-44. This is primarily due to the decline in egg quality as we age.
- Stillbirth: Older maternal age is linked to an increased risk of stillbirth, though this risk has decreased in recent decades thanks to advances in maternity care. Studies show that women aged 35-39 have a stillbirth rate of 0.22%, while those aged 40 and older have a rate of 0.30%.
- Other Complications: In addition to the risk of miscarriage and stillbirth, women aged 35 and older may also be at a higher risk for pregnancy complications like pre-eclampsia, gestational diabetes, and placental issues. These risks increase gradually with age, and while they are higher, they are still relatively low for most women.
Does Midwifery-Led Care Offer Benefits for Older Pregnant Women?
Absolutely, midwifery-led care offers significant benefits for older pregnant women, particularly those 35 and older. This model of care is centered around the belief that childbirth is a natural process, which can reduce unnecessary medical interventions often associated with older pregnancies. Studies show that midwifery-led care is linked to lower rates of interventions, including Cesarean sections and inductions, which are frequently overused in the U.S., especially in older women.
Research from the Birthplace in England study, which examined nearly 80,000 births, found that older pregnant women who opted for midwifery-led care experienced fewer medical interventions. This included lower rates of Cesarean sections, labor augmentation, and the use of epidurals compared to those in obstetric-led care. For example, first-time mothers aged 35 to 39 had significantly lower rates of labor augmentation (use of Pitocin) when in a midwifery-led setting. Not only were interventions reduced, but both mother and baby outcomes were just as good—if not better—than those seen in traditional obstetric units.
Also, midwifery-led care often occurs in the home or birth center environments, which offer a more relaxed, homelike setting. This can be especially appealing for older pregnant women who may want to avoid the high-intervention culture of hospital births. Research shows that planned home births with a trained midwife can be just as safe for older mothers as hospital births, provided the pregnancy is low-risk.
The benefits of midwifery-led care aren’t just physical. This care model also supports emotional well-being through personalized, continuous support, which can be crucial for older parents who may face additional stress due to societal pressures or medical labeling, like the outdated term ‘geriatric pregnancy.’ Midwives spend more time with their clients, providing reassurance and fostering a trusting relationship, which can make a huge difference in the birthing experience.
I know I am showing my bias here, but midwifery-led care is an empowering, supportive option for older pregnant women. It provides a balanced approach that combines the safety of evidence-based care with the personalized support needed for a positive birth experience.
Assisted Reproductive Technology: A Path to Parenthood
For those who struggle to conceive naturally, ART offers hope. Technologies like IVF, intrauterine insemination (IUI), and donor egg programs have helped countless women become parents later in life.
- IVF: This procedure involves retrieving eggs from the ovaries, fertilizing them with sperm in a lab, and then transferring the resulting embryos into the uterus. IVF success rates decline with age, but for women over 35, it can still be a viable option.
- Donor Eggs: For some women, using donor eggs from a younger person can increase the chances of a healthy pregnancy. This is especially helpful for women who experience declining egg quality due to age.
What About Cesarean Sections?
One of the most glaring issues in maternity care in the U.S. is the remarkably high cesarean section (C-section) rate. Currently, about 32% of all births in the U.S. result in a C-section, which is significantly higher than the 15% rate recommended by the World Health Organization (WHO) as optimal for the health of both mothers and babies. When we compare this to other developed countries, the disparity is striking. For example, in Sweden, the C-section rate is around 17%, and in the Netherlands, it’s closer to 15%, both far below the U.S. rate.
What’s even more concerning is that despite this high rate of surgical births, the U.S. doesn’t have better health outcomes for mothers and babies—in fact, our outcomes are often worse. The maternal mortality rate in the U.S. is 24 deaths per 100,000 live births, a rate more than double that of most other high-income countries like Germany (7 per 100,000) or Canada (8 per 100,000). For infant mortality, the U.S. fares no better, with 5.4 deaths per 1,000 live births, compared to 3.7 in Norway and 2.9 in Japan. This raises an important question: why are so many C-sections being performed when the outcomes don’t justify them?
In older mothers, the trend toward C-sections is even more pronounced. Many doctors cite age-related risks as a reason for recommending C-sections. Yet, as I always tell my clients, I’m much more concerned with their overall health than their age. I have supported countless women in their late 30s and 40s who had healthy vaginal births, often faring better than some of my younger clients who may not be as physically healthy. I attribute this success to emotional maturity and desire, which are not seen in many younger women. Again, in my opinion, age is not the most important data point when determining risk—it’s the mother’s overall health.
The over-reliance on C-sections in the U.S. seems to be driven more by the system’s structure than actual medical necessity. Factors such as convenience, fear of liability, and hospital policies that place time limits on labor all contribute to pushing C-section rates higher. Unfortunately, the evidence shows that this doesn’t improve safety outcomes for mothers or babies. In fact, mothers who undergo a C-section face increased risks of infection, longer recovery times, and complications in future pregnancies.
It’s essential for women—especially older mothers—not to feel pressured into having a C-section just because of their age. Healthier outcomes are more likely from personalized care and informed decision-making, not blanket policies based on outdated ideas about age and birth.
Making an Informed Decision
Deciding to have a child at 35 or older is a deeply personal choice, and it should be made with a full understanding of the risks and benefits. For many, the decision is shaped by career goals, personal readiness, and financial stability. It’s important to weigh these factors alongside the realities of fertility and the risks associated with pregnancy at an older age.
If you’re considering having a baby after age 35, discussing your health, lifestyle, and potential risks with a healthcare provider is crucial. They can help assess your situation and provide guidance on maximizing your chances of a healthy pregnancy. However, as I have discussed above, there are many biases on this subject, so do your own research as well. No one knows you and what you are capable of as well as you! Whether you’re opting for natural conception or exploring assisted reproductive technology, understanding your options will help you feel empowered in your journey to parenthood.
Below are a whole bunch of statistics on this subject (because you know how I love data 😊😍):
Taking Care of Your Health: Tips for a Healthy Pregnancy After 35
While it’s true that pregnancy at 35 or older can come with additional risks, there are many steps you can take to increase your chances of having a healthy pregnancy and birth. Here are some tips to help you navigate pregnancy in your mid-30s and beyond:
- Get Regular Checkups: Schedule a preconception visit with your healthcare provider before trying to conceive. They’ll assess your overall health, review any medications you’re taking, and recommend any lifestyle changes that may improve your fertility or pregnancy health.
- Eat a Balanced Diet: Eating a nutrient-rich diet is essential for supporting fertility and a healthy pregnancy. Focus on whole foods like fruits, vegetables, lean proteins, and whole grains. Be sure to include foods rich in folate, iron, and calcium to support you and your baby’s health.
- Exercise Regularly: Staying active during pregnancy can help improve your energy levels, reduce stress, and promote healthy weight gain. Aim for low-impact exercises like walking, swimming, or prenatal yoga. Always check with your healthcare provider before starting or continuing any exercise routine.
- Avoid Harmful Substances: Smoking, excessive alcohol consumption, and recreational drug use can all negatively impact fertility and increase the risk of complications during pregnancy. Cutting out these habits as early as possible is important if you’re trying to conceive.
- Manage Stress: Pregnancy’s emotional and physical demands can be challenging, especially for older parents. Consider incorporating stress-reducing techniques like meditation, deep breathing exercises, or prenatal massages into your routine to help you stay calm and focused.
- Consider Prenatal Testing: Talk to your healthcare provider about prenatal screening or diagnostic tests if you’re concerned about genetic conditions or complications risks. These tests can provide important information about your baby’s health and help you make informed decisions throughout pregnancy.
- Get Support: Don’t underestimate the importance of having a strong support system during pregnancy and postpartum. Whether it’s your partner, family, friends, or a midwife or doula, surround yourself with women who can offer emotional and practical support when needed.
The Bottom Line
There’s no doubt that the trend of having babies later in life is growing—and with it, a shift in what we understand about fertility, pregnancy risks, and the impact of age on childbirth. While it’s true that pregnancy at 35 and older may come with additional risks, it’s also true that many women have healthy pregnancies and births well into their late 30s and 40s. Advances in reproductive technology, prenatal care, and maternal health have made it possible for more women to become parents later in life.
At the end of the day, the decision to start or grow your family at any age is a deeply personal one. Working closely with your healthcare provider to understand the risks, explore your options, and make the best choices for you and your baby is important. Whether you choose to pursue a natural conception or explore fertility treatments, the most important thing is that you feel supported and informed throughout your journey to parenthood.
So if you’re 35 or older and considering starting a family, take heart—more options and resources are available than ever to help you have a safe and healthy pregnancy. Whether it’s through natural conception, midwifery-led care, or the use of assisted reproductive technology, your path to parenthood is just as valid and achievable as anyone else’s.
— Stay Strong! Jaelin —
Additional Reading:
- Pregnancy after 35: Healthy pregnancies, healthy babies / Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-20045756
- Geriatric Pregnancy: Pregnancy After 35 / Web MD: https://www.webmd.com/baby/pregnancy-after-35
- Pregnancy after 35: What an OB-GYN wants you to know / Flo.health: https://flo.health/getting-pregnant/trying-to-conceive/pregnancy-after-35
About the Author:
Jaelin Stickels, CNM, WHNP, is a deeply passionate and highly skilled Certified Nurse Midwife, Women’s Health Nurse Practitioner, and the owner of Holistic Heritage Homebirth in Houston, Texas. With over a decade of experience, Jaelin has had the privilege of helping several hundred women welcome their babies into the world. In addition to her advanced practice licensure training, she has additional advanced training in twin and breech births, making her one of only a few with these skills in her area. Jaelin approaches every birth with expertise, compassion, and a deep respect for the birthing process. Jaelin is finishing her doctorate and looking forward to being Dr. Jaelin in early 2025.
Jaelin’s journey into midwifery began with a profound love for supporting women through the incredible experience of pregnancy, labor, and postpartum. Since 2010, she has been dedicated to walking alongside families during these transformative moments, offering guidance, support, and care tailored to each individual’s unique needs. She is a big believer in informed consent and ensures clients are given the best evidence-based information to make the best decisions for themselves and their families.
Married to her high school sweetheart Ted (aka Chef Ted) since 1984, Jaelin is the proud mother of three grown children and the delighted grandmother of one amazing granddaughter. When she’s not assisting in births, Jaelin finds joy in going to the movies with her husband, quilting, and cherishing time with her family. Known by the other midwives in her practice (Holistic Heritage Homebirth) affectionately as the “Birth Hog,” she brings an unmatched dedication and enthusiasm to her work—no one loves birth quite like she does.