Advanced Maternal Age
Advanced maternal age: The words reverberated through my mind as I lay on the examining table during my six-week twin pregnancy ultrasound. After these words a barrage of even more disturbing words followed, Downs Syndrome and Intrauterine Growth Retardation among others. All very scary terminology apparently used for those of us grey haired old ladies who dared to have babies when it was really, “too late.” I also had experienced a pregnancy at thirty-four and miscarried and no remarks regarding my age were made then. However, a mere five months later when I became pregnant at the magic age of thirty-five, I was suddenly and assuredly as old as the hills.
It turns out that Advanced Maternal age is a medical phrase used for pregnant women thirty-five or older. I knew, of course, that at age thirty-five, I fit the practical definition of a grown-up. I was on my third job that offered insurance, I owned my second house and my first car with four doors, complete with air-conditioning, and I was married. Accepting this practical definition was easy and even gratifying but also gradual and effortless to adjust to because I didn’t have to really consider its full connotation.
Those words that were bandied about at my doctor’s office were neither gradual nor gratifying but instead were blunt and unforgiving. I was a grownup and there was no turning back; it was serious and official. I knew this because Advance Maternal Age was written in bright red ink on my chart. In case I missed that clue it was also conveniently written on the ultrasound computer screen. I was a documented “woman instead of a girl, and even worse than that, a “Ma’am instead of a Miss” In a daze I slowly collected my precious ultrasound pictures and scheduled all the tests that were recommended before my twenty-week big ultrasound. I took a deep breath as I wondered what the next startling revelation would be. Sure enough, I did not have long to wait as my first, “adult decision” occurred within thirty minutes after my ultrasound. My doctor asked me the question, “Are you okay with two, because there are alternatives?” I was taken aback at the important level of decisions the person in front of me thought that I, as an, “adult,” was allowed or even considered, without question, capable of making for another human being much less two human beings. I quietly gathered my thoughts as I realized this grownup thing was surprisingly as simple as it was profound. I was now responsible for the well being of my totally helpless unborn children. I needed to stop focusing on how my irritation at being labeled a person of advanced maternal age was affecting my vanity and image of myself as a carefree modern pregnant lady. My focus needed to be at this time, more than any other time, on what was crucial to them. A lesson would repeat itself time and time again as I moved further on in my journey through motherhood. In that critical moment, finally and surprisingly, I came to discover that I know myself. I know my values and what is important to me and my answer was there within me. I was not aware of myself speaking yet I heard myself saying,” I’m fine” in a loud and firm voice that left no room for any other discussion.
With that first revelation out of the way I found myself embracing and even celebrating my status as a grown-up. I began to relish my ability to throw away the superficial while embracing what was real. Case-in-point- my obsession with diet and exercise. I had always been proud of ability to remain slim into my thirties and I was determined to maintain my physique. I had read every pregnancy magazine where models and celebrities detailed their diet and exercise programs designed to gain the minimal weight while pregnant while maintaining a high level of fitness, so that after giving birth I could snap right back to my pre-pregnancy self. Well, it turned out that my body had other ideas. Carrying multiples is completely different than single pregnancies. I would need to gain much more than the fifteen to twenty pounds suggested for one baby and I needed to gain it fast in case I went into labor early. Exercise was the next idea to go. I waited patiently until the twelfth week to buy special maternity work out clothes and to inform my doctor that I was ready to go back the gym. However, my blood pressure started rising as my feet and hands started swelling. I already knew the answer in my heart before the doctor even said to me, “are you crazy?” “You need to eat and rest as much as possible until time to deliver.” So, that’s what I did, wholeheartedly and cheerfully until I went on bed rest at seven months and delivered at eight months.
I knew I was a grown-up when I learned to appreciate my blessings and to not question the package they came in. I was determined to have twin girls. I daydreamed about the life lessons I would teach them and the beautiful baby clothes and shoes they would wear. I think I was really scared of boys and was afraid I would not know what to do with them, even with my husband’s guidance. I had little experience with boys because I grew up without a father and was surrounded my female relatives, teachers and friends. Finally at 20 weeks the anticipated moment of, “The Big Ultrasound.” arrived when my husband I would know the sex of the babies. I was so excited that this time I did not even flinch when the dreaded, “Advanced Maternal Age” sign popped up on the ultrasound screen. “One boy” the technician said and then,” another boy.” “Two boys” I kept repeating to myself and to everyone else who called or stopped by my house to inquire that evening about, “The Big Ultrasound” and they answered in shared disbelief, “you mean two boys” and, what are you going to do with them?” Now 6 years later after countless dinosaurs, cars and trips to the emergency room I can’t ever imagine any other life than one surrounded by masculinity.
At age 35 women are offered a multitude of invasive and complicated sounding medical tests with names like Quad Screen and Chorionic villus sampling to check for abnormalities. Nearly all offer a small risk of miscarriage, which increases substantially for multiples. My doctor explained that these risks are acceptable when measured against the peace of mind the parents have when things are okay or the ability to make a choice if things are not. Again, this unfathomable idea that I was grown-up enough to make this impossible choice, however, my choice remained easy. Despite, the doctor’s recommendation and the shock of my family and friends, I dared to not follow conventional medical advice. My husband and I refused the tests. We said no to cells being taken out of my placenta and to long needles being placed in both amniotic sacs. To my mind any risk of miscarriage was unacceptable. We accepted the, Quad Screen, a simple blood test that can detect possible problems and “The Big Twenty-week Ultrasound.” We were supported wholeheartedly by our doctor.
At the even more advanced maternal age of forty-one, I am now a mother of four and a proud and unadulterated grown-up. After I gave birth I went back to the gym and did get my figure back-for the most part. I listen both to NPR and to The Black Eyed Peas. I attend all Parent Child conferences and I do not ever wear mom jeans. However, I know that these things in themselves do not really have much meaning. I found that in my journey being a grown-up is not about big achievements like climbing a mountain or hiking the jungle. It is about your commitment to your values and to the important people in your life when it is easy and especially when it is difficult.
I realize I am a grown-up because I love and appreciate my family and I find joy in the day to day minutia of life whether it be closing down the mall after a day of shopping, lying on a beach or making lunches, doing the laundry and cleaning my children’s room. Knowing you are a grown-up is based on your emotional maturity and mindset that evolves from an enduring process dependent on knowledge culminating from both expected and unexpected experiences. My realization is that growing up is not at all what I anticipated but has become everything that I want. It is not the end result but is instead the beginning-a hope filled joyous event—a unique individual journey that is unending and fluid, changing by the day, minute or even by the second of every day.