The pregnancy experiences of women aged 40 years and over

Increasing numbers of women are giving birth when older, yet they face being labelled ‘at-risk’ due to associations between their age and complications in pregnancy. The primary aim of this study was to explore the pregnancy experiences of women aged 40 or over from the perspectives of these women and their community midwives, with a particular focus on risk status and risk communication.

This research used a grounded theory approach underpinned by symbolic interactionism. Research participants comprised ten pregnant women aged 40 to 47 and their ten named community midwives. One antenatal appointment per woman-midwife pair was audio-recorded during the second trimester of pregnancy, followed by individual interviews with
each participant. Some women were interviewed again following antenatal appointments with a consultant obstetrician and all women were re-interviewed three to five weeks postnatally. Data were transcribed and analysed using initial and focused coding techniques.

Three concepts were identified from the data. ‘Navigating risks’ involved women’s understanding of their pregnancy-related risks and associated decision-making, from the women’s and midwives’ perspectives. Decision-making is complex and fluid; it can be emotional and may result in older pregnant women going with the flow of health-professional advice. ‘Responsibility’ for choices and for balancing their personal, their families’ and babies’ needs was demonstrated through women’s desire to make the right decisions, sometimes within a state of uncertainty. ‘Enabling relationships’ between older women and their community midwives can contribute to normalising older women’s experiences of pregnancy and developing balanced understandings. Community midwives can be instrumental in optimising older women’s experiences of shared care, although balancing the demands of their workload to meet women’s needs can be challenging. These three concepts are linked and underpinned by the notion of ‘doing the right thing’, which was evident throughout the data. Women’s and midwives’ voices and actions demonstrated a determination to do the right things for themselves, for others and for each other, despite the challenges this might pose.

Regardless of experience and efforts to make responsible choices, older pregnant women are likely to have additional needs. Involving them in the development of flexible guidelines to meet these needs could enable care to be more meaningful, supportive and beneficial for older childbearing women and their midwives.