If you don’t recognize it, the number above is the ICD10 code for “Supervision of elderly multigravida, first trimester.” So what is an ICD10 code? It is the International Classification of Diseases, 10th Edition. The World Health Organization (WHO) owns the ICD system and it is adopted by the US Healthcare system. Basically, these ICD10 codes are how we tell coders, insurance companies, government regulators and so many other what diseases or diagnoses a patient carries as well as what procedures were done for the patient. Each version gets more detailed, and therefore, more complex.
Enough about ICD10. The real point of this post is to discuss this awful designation of ELDERLY multigravida. ELDERLY. Sounds depressing, huh. So what makes a pregnant woman elderly? Get this…being over the age of 35. No, seriously. 35. Most OBGYN’s refer to this as “advanced maternal age.” It’s nicer. Apparently the WHO is not nice. But even then, when did 35 get old? I just turned 38 and I still feel like I’m trying to figure out my life.
About 15% of women in the US give birth at the age of 35 and older and are considered AMA (advanced maternal age.) Less than 3% give birth at age 40 and older. Why the big deal about age? Well, age comes with some risk. Women who give birth in the US who are AMA have an increased risk of stillbirth compared to women under the age of 35. Additionally, women in the AMA category are at increased risk for miscarriage, an increased risk for chromosomal abnormalities, an increased risk for high blood pressure, gestational diabetes, growth restriction of their babies, c section and other complications of pregnancy and delivery. Once a woman reaches the age of 40 each of these risks sharply increases. For women over the age of 40 we have special protocols to monitor their pregnancy and recommend they deliver by their due date or sooner.
So why would anyone have a baby after the age of 35? And who are these nutty women having babies after the age of 40? Surprisingly, I don’t hear this question a lot. What I most commonly hear is “when should I stop having babies?” I always ask the patient if they want my personal or professional opinion, or both. If you know me, you know my personal opinion. I love babies…when they belong to others. Two of them was more than enough for me. But seriously, what I tell the patient really depends on where they are in life and how many children they have. When I am seeing someone who is over 35, has no children and wants to start a family I try to carefully counsel them on the small risks of complications for their age. What about women approaching the age of 35 who already have one or more children and want to have “just one more”…or just two or three more? Again, I counsel them carefully on the risks of their age. This includes risks to both the mother and the child.
Last week I was asked “in your personal and professional opinion, what age is TOO OLD to have a baby?” I loved it. I told her that personally I am WAY TOO OLD AND TIRED to have any more kids (can I get an AMEN from Pastor Jason??). But then I went on to tell her that I think someone should carefully consider whether or not they want to have children once they reach the age of 40. I think when most women think about having a baby over the age of 40 they think about the possibility of having a child with Down Syndrome or some other chromosomal problem. But for me it’s all the other risk factors that make me nervous for my patients. You see the risk of a chromosomal problem is about 1 in 70. (For more information on screening for chromosomal problems go to a podcast found on perinatal quality.org ) That’s something I can personally live with. But the increased risk of high blood pressure, diabetes, stillbirth and c section…that’s what gets me. So what did I tell my patient? I told her that if she wanted that “one more baby” I would advise her to be done by age 40. What if she had no children? Well, that’s a harder conversation for me to have. I want her to know the risks, but I also want her to know that I support her strong desire to have a child despite life’s circumstances that have not allowed it to happen before the age of 40.
My best advice? Try never to call a pregnant woman “elderly.” Secondly, don’t ask women when they are going to be done having babies or if they are going to have babies. But if you are considering when to begin or when to end your childbearing, ask your OBGYN or your MFM (high risk OB specialist). I’m sure they will be open and honest with you and support you in your decision whether or not to enter the “elderly pregnancy” category. You see, we all make different choices in life. When we have kids and how many, where we send our kids to school, what we like on our pizza. Some of these decisions are trivial, some have important consequences in our lives. But we all deserve to be given compassion and understanding. May we strive to understand our opposite, those that would choose a strikingly different path than us. The kingdom will come near when put aside our differences and see each other as we are: people just trying to make the best in a world full of hurts.