Technically, I’m not a “geriatric” pregnancy — they replaced the term with “advanced maternal age,” which feels the same but, admittedly, has less punch. I DO feel old. I feel like a horny uncooked potato, one bad haircut away from looking truly like someone’s middle-aged mother. During my prenatal appointments, my care providers are cautious and sensitive about the terminology making me feel old. They’re quick to reassure me the term means nothing.

Geriatric Pregnancy & A Growing Connection To The World Around Me

But being old(er) does mean something. I think about it all the time — the differences between the first three children I had in my 20s (22, 25, 27) and this one now at 35. I keep finding old photos and showing them to my unimpressed, slightly mortified teenage/preteen boys. We’ve been through a lot together, me and these three.

In the decade between them and this new baby, I’ve done the personal growing up that got lost inside the growth of motherhood. (You can’t escape your 20s, turns out.) I look back on my experience, not with judgment about being young but curiosity for how being young changed the course of my experience and how age shapes it now.

Disclaimer: OK, look, while having children in my 20s, I was in a very difficult relationship with a partner who was rarely present and cheated on me frequently. I was also dealing with a special-needs child, undiagnosed PTSD from childhood abuse, anxiety, a serious eating disorder, and chronic depression that didn’t include the rounds of postpartum and prenatal depression. Fun times, I know! So, obviously, with a decade of therapy, divorce, intense recovery, older children, and a new, fully engaged and supportive partner, any experience was going to be better. But when comparing the differences, there are things deeper.  

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Physical Differences & My Perception Of Health

Youth wins. I won’t even pretend to bury the lede. Youth wins and wins. Youth laps you, does some pushups afterward, and stays up until 2 a.m. hoarding precious alone time, because it is only “tired” the next morning. I do not understand, looking back, how I ever managed to grow and carry children and just do things.

I don’t know how I went to the gym. I don’t know how I went on rock-climbing trips and carried my younger children 5 miles into the woods. I don’t know how I raised two toddlers, wrote books and started a career in publishing. Somedays, I sit on my couch now, exhausted by 9 a.m., trying to remember how I even moved.  

Don’t get me wrong, I was tired when I was 22, 24, etc. My pregnancies then weren’t easy — I had a rough first pregnancy (culminating in a 36w6d induction for preeclampsia), but even in my subsequent healthy ones, I had Braxton Hicks contractions constantly from 15 weeks until delivery. One time, an elderly OB gave an exasperated sigh, looked me over, and said: “I’m not supposed to give this advice, but you just need to relax. Go home, get in a warm bath and sip some red wine.”

The problem with relaxing in my 20s was that I didn’t even know how to recognize I was stressed in the first place, let alone give my body what it needed. I didn’t occupy my body. I had no idea how to even breathe, let alone breathe into my belly or pelvic floor. Relaxing techniques were things I thought were only needed during the trial of labor, nowhere else. My idea of health was having a fit pregnancy, not respecting my needs for rest and growth. I wanted to prove pregnancy was just a function of life, rather than honor the cycle of life it was part of.

All those things have changed with age (and a lot of work). I’m much more comfortable living inside my body and not running from either its pain or pleasure. Ironically, after three “irritable uterus” pregnancies in my 20s, I have had maybe four contractions total during this “geriatric” one. I’ve been sicker, more exhausted, and unable to do much more than walk the dog, eat carbs and drag myself to my desk for work, but there is some net gain in the ability to respect my body and the work it’s doing to create another life.

It is undeniably easier to be physically pregnant in your 20s. But when you are older, the maturity and knowledge you’ve obtained from living in your body for that long and for that many seasons does help make up a lot of that ground.

Youth: 1

Geriatric: 0

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Mental Strength & Handling Things You Can’t Control

In the wise words of Justin Bieber, “Youngblood thinks there’s always tomorrow.” Before my first kid, I struggled with infertility and had a prior miscarriage. And yet, when I finally got that positive, I felt sure this one would stick. At my 20-week ultrasound, I was mostly excited to see the gender. When I developed preeclampsia at 28 weeks, the idea of meeting my son sooner made up for any worry about his outcome. Of course, he was going be fine.

He was born blue and not crying, and I just watched it like I was watching a movie. I just didn’t know enough — both about what to fear and how to handle it. The universe seemed, at that age, transactional. If I ignored it, it could not happen.

Ignorance is bliss. As you get older, you know too much. You understand how fragile life is. How difficult it can be to wrench life out of chaos. You know how many things can go wrong, for no reason at all, and how little control you have over any of it. But you also have a lot more time sitting in those fears and learning to find acceptance.

This fourth baby came after three consecutive miscarriages, and fear has been my constant companion. I had an anxiety attack during the viability scan. At his anatomy scan, I just wanted to see four chambers to the heart. But when the ultrasound revealed a spot in the heart and in his bowels, we went through a nerve-wracking few months eliminating genetic problems, viral infections, and monitoring his growth and the anomalies. It was a struggle, but I had the tools to both feel the fear and process it. Even now, I wake up in the middle of the night and my first thought is if he is moving, if he is still alive. Being 35, I know this is just the fragility and anxiety of bringing life into the world, and I lay there each time, breathing in the dark, and accepting the moment for what it is.  

In my opinion, it’s a draw. Ignorance is a wonderful kind of insulation. But being older gives you the ability to handle what inevitably breaks through to reality.

Youth: 1

Geriatric: 1

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Spiritual Understanding Of The Human Experience

I don’t feel much connection in the identity of “woman” (though I am comfortable in the body of one), and I outright reject the Victorian hyper-gendered worship of the identity of “mother”. But in my 20s, the depth of my understanding stopped there. I was busy dissociating from my body, sure, but also from any profundity of experience in pregnancy. Part of me thought that if I found meaning in the experience, I would have to grapple with meaning in my gender or the narrow role of “wife and mother” I was trying to escape. I feared losing myself more with each birth, with each new child to care for. In my 20s, my understanding of the fullness of my own humanity was so immature that rather than connect the pregnancy experience to more universal truths, I simply checked out of the connection at all.

Ten years (and a lot of therapy and spiritual work later), and of course there is a deep, spiritual connection through the experience of pregnancy that has nothing to do with being a woman or being a mother, but simply being a human. The process of sex, death, creation and transformation is universal to the human experience — it’s in any change, any growth, any creation of art. Pregnancy is just one of the manifestations of this universal experience. Now that I’m older, I can connect with the deeper story unfolding.

I still fear losing myself — maybe even more than I did in my 20s, having spent so many years and sacrificed so much to become the person I now am — but I understand now that I will lose the self I am now, and I will transform again and continue to grow. That there is a self that remains beyond my experiences, as well as a self that must constantly be dying and reborn in order to come into deeper alignment with that self beyond. That this is simply the process of being human.

In this third trimester, I take my dog for walks every morning, waddling through the neighborhood before the sun rises over the hill, and I hear the cicadas sing. They sing of the story we all live, man or woman, pregnant or not. The self we are now eventually must die and be reborn. It is easier, with age, to surrender to this death; to feel the fear and release it; to trust that the rite of birth is another way to connect with the spiritual journey of being human.

Youth: 0

Geriatric: 1

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Awareness Of Politics In Health Care

There’s no way around it — a gestating body is a political body. In my 20s, it felt incredibly difficult to find care that felt affirming and respectful, that wasn’t controlling or condescending. And for a young woman coming out of abuse and into the vulnerable state of pregnancy, the more controlling health care felt, the more I reacted defensively, trying to find a way to have agency.

At my routine gestational diabetes screening, the nurse looked at my address — in Black West Baltimore — and then looked at me with pity in her eyes. During her heartfelt appeal to consider what I was doing, what options I had to get rid of the pregnancy, what kind of life she presumed I’d be giving this child, I felt shocked. It was the first time I had ever been faced with the end of my political status as “white.” It didn’t end there. When I brought my newborn to the pediatrician, I was asked if I had anyone at home to support me, if I really felt capable of caring for this child. When I asked why certain vaccines had to be administered (I was young and trying so hard to make knowledgeable decisions), the doctor simply informed me, “Because people smarter than you have said that’s what needs to be done.” The shame was overwhelming. I went home with this deep, unrelenting fear that I did not deserve to be a parent.

The experience was radicalizing. It opened my eyes to the disparities political class brings to health care. If I was being counseled to get an abortion, how were my neighbors being treated? If I was struggling to feel deserving and supported as a mother, how were my neighbors feeling? Being in a vulnerable political class and having to interact with the institutions in America often means conflict, defensiveness and struggling to be heard.  

During pregnancies two and three, I drove an hour and half for every appointment just to stay with an OB/midwifery practice that felt supportive. And my midwife, who managed my second labor and delivered my third, was very affirming and gentle and careful with me. I finished my first three births feeling as if I had, ultimately, had good experiences and care. But it’s nothing compared with the treatment I receive now in my mid-30s.

Part of this shift in my experience is that, in the ensuing decade since my third birth, medical care has become more trauma-informed, more cognizant of social and political biases, more aware of the impacts of the birth experience on everyone involved. And there are other factors — I’m in a new OB/midwifery practice that is mostly serving a nonwhite community, in a good-size liberal southern city, with community resources. (I literally want to become best friends with the community resources liaison lady — she doesn’t know this, and I’m trying not to be weird.) Every nurse, tech, doctor and midwife I’ve interacted with has been supportive, empowering and trusting. At every visit, I’m screened for mental health and given the option to get food from the in-house food bank. No one ever seems rushed; they talk easily about their own lives and experiences; and above all, no matter what, I’ve been respected and treated as a fully capable human. I look back and wish I could have received this kind of care when I was young, raw and more vulnerable.

But in this past decade, I am also more trauma-informed and cognizant of social and political biases. It’s easier to communicate with doctors and nurses because I’m less defensive about my safety. I’m used to navigating the boundaries of my class and race, and it’s gotten much easier to walk into these spaces certain of my own worth, rather than hoping to be affirmed in it.

Despite how individual health care practice might have improved within a decade, the institutions it’s working inside have only worsened. I look around me and think about how many people are, despite the best intentions of individual practitioners, still experiencing the vulnerability and having to fight for care that affirms their humanity. Bodily autonomy and humanity-affirming care is being rolled back. According to the CDC, Black mothers are three times more likely to die from a pregnancy-related complication than white women. The things that can over time give me, as a white woman, more safety inside health care cannot insulate Black (or immigrant or trans) women from those outcomes.

In the end, even though my experience is so much better, no one in this situation comes out ahead.

Youth: 0

Geriatric: 0

Totals: Youth 2/ Geriatric 2

According to the numbers, it’s a draw. And this is probably true — no matter when you have a baby, the journey is full of twists and turns to navigate, and each individual pregnancy is its own separate experience. But for many reasons, I can’t help but be biased toward being older. This final pregnancy has been a joyful experience where I feel so much more connection with my growing child, my partner, my body and the world around me. However, I have nothing but love and grace for my past self or any other young mother. Lord knows, it’s difficult enough.

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Xx,

Sarah