I have to smile when I see the leaflets handed out to local
women that advises them quite firmly to start having children
at age 20 and complete their families by the time they are
25. That’s a pretty narrow window period to find the
right mate, settle into a home and produce offspring, as well
as squeeze in a career. This advice is of course is based
on the fact that women are more likely to produce an infant
with a genetic disorder such as Trisomy (“Downs syndrome”
or what the local people term as “Idiot”) as they
grow older. For example a 25 year old mother has a 1 in 1350
chance of giving birth to a baby with Downs’s syndrome.
This risk gradually increases over the years and the risk
for a 45 year old mother is 1 in 28. These days however most
of the Mums- to-be that I see are over the age of 30. There
are positive and negative aspects to having children later
in life, and here we look at a few of them.
As a generalisation, women over 35 are often more satisfied
with their jobs and careers, are financially comfortable and
have well established relationships with their partners (we
hope!) — all good foundations for starting a family.
On
the flipside, they have an increased risk of having troubles
conceiving, experiencing miscarriages, having children with
chromosomal abnormalities and giving birth to twins.
Thankfully these days there are simple non-invasive tests
that can be performed as early as 12 weeks into the pregnancy
that will give you a fairly accurate risk factor of giving
birth to a child with a chromosomal abnormalities. Having
these tests would be based on the assumption that the parents
could choose to terminate the pregnancy if a serious birth
defect was predicted. Those parents that do not wish to know
if their child is affected, and would not opt for termination,
would probably not wish to have these tests performed
anyway, and each person has a right to choose which path is
right for them.
Pre-natal screening and pre-natal diagnosis
Between 11 to 14 weeks after the first day of the last menstrual
period a nuchal translucency / nasal bone formation ultrasound
(or “first trimester screen”) can be performed
to look at the thickness of the fold at the back of the baby’s
neck to screen for chromosomal problems such as Down’s
syndrome. Blood tests are also conducted to assess specific
pregnancy-related chemicals in the mother’s blood that
alert doctors to that pregnancy being at high or low risk.
If your risk is calculated as being “high” more
invasive tests are often recommended. After 11 weeks into
the pregnancy a CVS (chorionic villus sampling) can be performed.
This is where a sample of the placenta is taken through the
mother’s stomach or cervix. At 15 weeks an amniocentesis
can be conducted, which is when a sample of the fluid is taken
from around the baby. In each of the tests the chromosomes
are examined and the results offer definite diagnosis. (There
is a one in 200 risk that the diagnostic tests will lead to
miscarriage). If you are diagnosed as “low risk”
at the initial scan, a follow up detailed fetal anatomy scan
can be performed at 18 – 20 weeks which will look at
the growth and development of your baby, just to make sure
that things are going along nicely. Initial scans can now
be performed in Bali, and there are specialist obstetricians
on the Island that have recently trained overseas in these
specific diagnostic scans. I would be more than happy to refer
anyone that is interested in these procedures. Further tests
of CVS or amniocentesis can be performed in Australia or Singapore.
If you are considering becoming an older Mum for the first
or subsequent pregnancies, there are a few things that you
can do to improve your chances of becoming pregnant and maintaining
a healthy pregnancy.
- If you are considering pregnancy, it is wise to take folic
acid supplements to help prevent spina bifida and other neural
tube defects.
- Stop smoking and encourage your partner to do the same.
- Have sex a few times a week to boost the chance of conception,
not just once or twice around ovulation.
- If you are seriously overweight talk to your doctor about
getting fitter and healthier.
- If you are on medications speak to your doctor about their
suitability during pregnancy.
- Ensure your rubella (German measles) immunisation is up-to-date.
- Check your immune status against diseases such as
toxoplasmosis and cytomegalovirus.
- Check that you are not positive for diseases such
as Chlamydia, HIV, hepatitis B & C, Herpes virus.
- Have a pap smear and a breast examination if you
haven’t had one for a while.
“Kim Patra is a qualified Registered Nurse and Midwife
that has been living and working in Bali for almost twenty
years. She now runs her own private practice and medical referral
service from her Kuta office. Kim is happy to discuss any
health concerns with you and she may be contacted via e-mail
at info@chcbali.com”.
