Pregnancy after 40 and factors you should weigh when making the decision: 5 Things podcast

On today's episode of the 5 Things podcast: Pregnancy after 40

Is there an ideal time in life to become a parent – a time when parenting is typically easier, more well-timed or just better overall? For some women, that time is at 40 and older. According to the U.S. Census, that’s a trend that has been steadily building over the course of the past 3 decades. But what are the factors you should weigh when making that critical family-planning decision? Parenting expert Emily Oster is a mother of two, a professor of economics at Brown University and a New York Times best-selling author on the topic of pregnancy and parenting. Emily joins the 5 Things podcast to discuss parenting and what to factor in when making the decision to become pregnant at or after the age of 40.

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Hit play on the player above to hear the podcast and follow along with the transcript below. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

Dana Taylor:

Hello and welcome to 5 Things. I'm Dana Taylor. Today is Sunday, July 30th, 2023. Is there an ideal time in life to become a parent, a time when parenting is typically easier, more well-timed out or just better for you emotionally, physically, or economically? For some women, that time is at 40 and older. According to the U.S. census, that's a trend that has been steadily building over the course of the past three decades. But what are the factors you should weigh when making that critical family planning decision? Our guest, Emily Oster, is a mother of two, a professor of economics at Brown University and a New York Times bestselling author on the topic of pregnancy and parenting. Her popular newsletter, Parent Data, is for parents, for people who want to become parents and anyone who likes to do their research before making a decision. Emily joins us today to discuss parenting and what to factor in when making the decision to become a parent at or after the age of 40. Emily, thank you for joining me.

Emily Oster:

Thank you so much for having me. I'm delighted to be here.

Dana Taylor:

So a pregnancy in your 40s is termed a geriatric pregnancy. That is not the most flattering term. I think we can agree on that. A common theme that I've come across from women in that age group though is a feeling of resentment about having to fight to simply enjoy their pregnancy and to not feel judged about it. So specifically on that point, how do you advise women who are considering a pregnancy later in life?

Emily Oster:

One of the things, that word geriatric is so loaded, and I think this is kind of the first thing many women hear. And the first question I often get is, "What does the data say about the chance that I can get pregnant? So even before I become the geriatric pregnancy, what's my possibility of being in that group?" And I think here for women who are over 40, there's positive news and there's more complicated news, which it is definitely is possible to get pregnant over 40. Sometimes when you get the impression that at 35 or 40, everything just shuts down and you definitely can't get pregnant, that's certainly not true. In the data, plenty of women, they get pregnant after 35, get pregnant after 40.

It does become more difficult, particularly as you go above 40 to get pregnant and there are higher risks of complications. And so it often is a more medically complicated environment. But at the same time, if you are pregnant in that group, the vast majority of women have healthy pregnancies that go the way that they would if you were younger. And so that's where I think the tension lies, that you can both be slightly higher risk and also recognize that in almost all cases everything's going to go great. And that's sometimes a hard thing for us to hold in our heads at the same time.

Dana Taylor:

Yeah, I mean that judgment, I don't know where that comes from. Women who decide to do this later in life, why is there a judgment there about that?

Emily Oster:

I think whether there's a judgment or not depends on the people that you're talking to. And the reality is that one of the features of being a parent is no matter what choices you make, much of the time people judge you. So if you choose to become a parent in your early 20s, people will judge you. "Why didn't you get your career started earlier than this?" You choose to be a parent in your 30s. There's plenty of things people can judge you for there. Unfortunately, there's no time that one can become a parent when people won't feel the need to comment on whether that's the right choice or not. And so it's certainly the case if you are parenting over 40 that people will give you looks, people will say things. But at the end of the day, we have to be confident in our own choices. And if this is the right time for you to have a kid, then it's the right time for you to have a kid. And if other people have other feelings about that, that's kind of none of their business.

Dana Taylor:

So what are some positive ways that you found for women to manage a pregnancy in their 40s to help mitigate those risks?

Emily Oster:

So the first thing is having an open and honest relationship with your doctor. So again, as I said at the beginning, I think we can hold in our head at the same time the view that this is on average a higher risk environment, and at the same time for most women it goes great. And having an open relationship with your doctor where you can talk about what are the risks, what are the things we want to do differently, but without the fearmongering that can come with that, that's I think a really important piece of advice.

And I think the other thing I often tell people is like most people's pregnancies are unique to them. And so sometimes no matter whether it's because we're over 40 or there's some other aspect of our physical or personal situation, when something is more complicated, it can be easy to blame yourself. Say, "If only I were 10 years younger, my leg wouldn't be hurting so much. This is because I'm over 40." Well, no, I assure you as someone who had a child in her 30s, your leg can also hurt then. And so I think just giving ourselves grace to say not everything is about this particular thing, some aspects of pregnancy are just hard. I think those two things, honesty and recognizing that age is only one of the factors about you in this environment, those are pretty important to hold in your mind.

Dana Taylor:

What other kinds of unique challenges do women over 40 face in pregnancy and afterwards with kids? I'm thinking of economics, psychological, even physical challenges. What are they and what's your advice about how to deal with those?

Emily Oster:

What's interesting about older parenting for many people is I think that some challenges get less complicated and some challenges get more complicated. So physically, you are on average more tired at 40 than you were at 21. And so the experience of parenting, particularly the early years years, which are physically very draining, are probably on average going to be a little bit more of a slog than they would have been 15 years before.

On the other hand, the economic circumstances that many of us find ourselves in our 40s are much different and often much better than in our early 20s. So I think part of what's really hard about this and part about the decision of whether to wait or have kids earlier is that these factors can push against each other, that you can feel like, "I'm not emotionally ready or I'm not economically ready to have a kid at the time when maybe I would've been sort of physically most ready." And we're always balancing those, but recognizing that in that, that there are some real advantages of this later period, both in terms of economics, but also sometimes in terms of our perspective and our comfort with ourselves and our ability to show up in the way we want for our kids. That can be much easier when you're 45 than when you're 27.

Dana Taylor:

Did you see any data that related to the potentially high earning years in your 40s and that having either a positive or negative impact?

Emily Oster:

All careers are different. And I think the intersection of women's economic choices with their childbearing choices are almost always very complex. I think many people find that having kids in your 30s is a complicated time because it's for many people the time that you're sort of building a career. By the time people get to their 40s, they may be more established, it may actually be easier or it may be harder. I think that's so specific to who you are.

Dana Taylor:

I think I was 23 years old when I first felt the pain of endometriosis, and then in my late 20s finally diagnosed with it. And something that we never discussed, we just managed the pain. We didn't really talk about fertility and whether or not that would affect fertility. Now women have a lot of options in terms of choosing when they would like to try for pregnancy. If they're dealing with something like endometriosis, there are some options that are available now, having your eggs extracted and stored, that cryo-preservation and IVF, but those options can carry a significant cost. So what are some of the economic pressures to consider when deciding if you want to become pregnant later in life?

Emily Oster:

It's an extremely interesting question because the technology here has totally changed. We went from an environment where the idea of harvesting your eggs when you're 25 and then saving them until you're 40 was sort of in the realm of sci-fi fantasy to something where that's advertised in YouTube ads, right? So we're in a place where it can feel like the options are myriad, are greater than they were before, and I think that's very exciting. On the flip side of that, the economic costs of many of those interventions are very large. They are not as a result available to everybody. And I think there can be times when it feels to younger women somehow you must do this because if you don't, you're turning off some option for you later. And I think that kind of pressure intersects poorly with the expense of these things. So it can feel like if you don't spend this money to freeze your eggs, somehow this is not going to be an option for you, and that's not true for many people.

So like with all new technologies, with great power comes great responsibility. And I think thinking carefully about how we market those and how we give people the information they need to see, "Is this the right approach for me?", those are considerations I'd like to see us engage with.

Dana Taylor:

So your book's focus on using strong data points to drive some of the decision making in parenting - of course, with kids, it is not connect the dots - talk a little bit about parenting from instinct, the gut versus database parenting, and where personal preferences come in.

Emily Oster:

So it's interesting. For me, I will say, and this is probably revealed by the fact that this is how I write, data is a really helpful grounding in making choices. So it's really helpful for me to see, "Here's what the evidence says on this. Here's what the evidence says on the chance of getting pregnant at these different ages. Here's what the evidence says on the potential complications in those different times." That's something where you can ground in the data. Rarely though does the data give you a decision. Rarely is it bossy. Almost always the answer is you take the data and you put your preferences on top of it.

So I'm always a little wary of this idea that there's data and then there's preferences as somehow separate, that really all of these decisions have to involve our preferences because no matter what the data says, it may not be the right time for you to have a kid when you're 31. It may be a good idea to wait. But knowing what the evidence is can be helpful for many people in putting some grounding into where they'll add their preferences. But then of course, people tell me, "I like to parent with my gut" and I think that's also great. I like to parent with numbers, but I get it. Sometimes it's a little much.

Dana Taylor:

So I believe you wrote your first book, Expecting Better, while you ere pregnant. What was the catalyst? Was there one thing that happened that made you write this book?

Emily Oster:

There were many things. I mean, I think one of the things I would point to was at the end of my first prenatal visit, I was 10 weeks pregnant, somebody kind of came running after me as I was leaving, and they were like, "Oh, here's this list of what not to do." And they sort of handed me this list of kind of no context list. It was very long. It had everything on it. Don't smoke. Don't eat deli meats. Don't have any sushi. And I was sort of like, "Well, can I have a question?" They're like, "No, we'll see you in four weeks."

And so some of the book is a response to that, to both the feeling of these rules seem pretty arbitrary and I don't exactly know where they came from, combined with the feeling of, "You're not really hearing me. You're not really hearing what I need." I always have loved data, and my job as an economist involves analyzing data and thinking about what we can learn from data, so the book grew out of my own interaction with my first pregnancy. It's the book that I wanted and I made it, I guess.

Dana Taylor:

I'm just trying to imagine you midstream, like, "I have to write this book." With all the things that had to have been going on, it's like, "No, I have to write this book."

Emily Oster:

And I think that's actually a really good way to describe how I felt, which is just I felt like it had to come out, like, I just have to do this. I think this book needs to exist. Maybe no one else will be interested in having it exist, but I feel like it should be there.

Dana Taylor:

I hear that you have a new book that is coming out April of 2024. Tell me a little bit about that.

Emily Oster:

So the new book's called The Unexpected and it is about navigating pregnancy after complications. So it's really a book that was motivated by what I hear from readers after Expecting Better. Many people came and they said, "I had a miscarriage. I had preeclampsia. My first pregnancy was complicated in this way. Is it going to happen again? How do I navigate that?" And this is a book for those people. It's about recurrence risks and treatment options. And it's written together with an amazing doctor named Nathan Fox. He really talks through how to have these conversations with your provider. We're trying to provide resources for what we know and what I know from readers is such a difficult time. So I'm just really excited to have this resource out in the world in nine months.

Dana Taylor:

I have to think a lot of the feedback that you get from the people who follow you is that they're able to have a better conversation with their doctor, with the person that they're having a baby with based on the data that you provide.

Emily Oster:

I do hear that, and that is probably some of the most gratifying feedback I get. Because I recognize very clearly that the relationship that people have with their doctors when they're pregnant is so important and can be really amazing and can also feel very stressful. I think part of the value of Expecting Better in particular is to just give people enough information that they can come into those conversations in a way that makes them as productive as possible. And that's some of the goal with the new book as well, is just to close a bit of the gap in a way that we can get the information we need to make the decisions that work for us and for our families.

Dana Taylor:

Thank you so much for joining me, Emily.

Emily Oster:

Thank you so much for having me.

Dana Taylor:

Thanks to Mark Sovel and Cherie Saunders for their production assistance. Our senior producer is Shannon Rae Green and our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. I'll be back tomorrow filling in for Taylor Wilson with another episode of 5 Things.