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Jacob M. Appel

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Motherhood: Is It Ever Too Late?

Posted: 07/15/09 04:26 PM ET

The recent death of Maria del Carmen Bousada de Lara, the world's oldest confirmed mother, is likely to generate debate surrounding the ethics of offering in vitro fertilization to women in their sixties and seventies. The retired Spanish department-store employee gained international attention in 2006, when, at the age of sixty-six, she gave birth to premature twins, Christian and Pau, via caesarian section. At that time, questioned about the moral and practical implications of raising her young sons as a senior citizen, Bousada said, "My mum lived to be 101 and there's no reason I couldn't do the same." The unfortunate reality is that Bousada died before her sons' third birthdays, likely of cancer diagnosed shortly after their delivery. Another woman, Omkari Panwar, a seventy year-old grandmother from the Indian state of Uttar Pradesh, gave birth in 2008--but her age cannot be formally documented. Meanwhile, seventy-two year-old Londoner Jenny Brown has reportedly spent £30,000 on IVF in the hope of becoming the world's oldest mother. Births to women in their late fifties and early sixties, while not yet commonplace, are no longer international news. Whether these births are empowering or irresponsible has been a matter of ongoing debate.

Many American fertility clinics refuse to inseminate women beyond a set age. In Bousada's case, she had to lie to the Pacific Fertility Center in Los Angeles, claiming she was actually fifty-five, in order to qualify for treatment. At that time, the clinic's director, Vicken Sahakian, expressed indignation at Brousada's deceit and promised "to be more careful" in the future. Other hospitals set limits as young as fifty. What is not so clear is why these clinics impose such age restrictions. Are they concerned for the physical health of the mother during pregnancy? Or do they merely have ethical qualms about women embarking on child-rearing beyond a certain age?

During an off-the-record conversation with the head of one leading IVF program, the director candidly told me that social, rather than medical, factors were the primary determinant in his clinic's age limit. "You have to draw a line somewhere," he said. I followed up by asking whether his program sets any age limit for the male partners of these women. It does not. Nor does any other American fertility clinic, as far as I can tell. So while a sixty year-old woman with a twenty-five year-old husband will have difficulty obtaining IVF in the United States, a forty-nine year-old woman with an eighty-five year-old husband will face no age limits--even though the child of the twenty-five year-old is far more likely to have at least one parent survive into adulthood. If these cutoffs are imposed for purely social reasons, rather than medical ones, then they appear to be both illogical and discriminatory. It is not even clear to me that they should be legal. The right to IVF is only meaningful if physicians will actually provide it. Unless clinics can do a better job of justifying their policies on medical grounds, state legislatures should seriously consider rules banning such arbitrary age limits--particularly in hospitals and clinics paid for with public or publicly-mandated funds.

Those ethicists and social critics who oppose motherhood beyond a certain age risk adopting a troublesome double standard. Our society has long accepted, even acclaimed, fatherhood in later mid-life. An occasional eyebrow may rise when Tony Randall fathers children in his upper seventies, or Saul Bellow sires a daughter at eighty-four, but a man who becomes a dad at fifty-five or even sixty usually receives a proverbial cigar--not a lecture on social responsibility. The only difference between fatherhood at that age and motherhood at that age, assuming there are no excessive health risks during pregnancy, is that nature allows men to have children beyond fifty-five, but technological assistance is required for women to enjoy the same opportunities. One might question any use of IVF technology at all--and a small minority of conservative bioethicists have done so. However, if one believes--as I do--that IVF is a highly-valuable tool for empowering women, and that its benefits far outweigh any drawbacks, then one has already rejected the "naturalist" argument. Or what may be thought of as the natural fallacy: that the natural way is inherently preferable. (If that were so, we would also reject antibiotics for infectious disease and allow the myopic to stumble around without eye-glasses.) Once one rejects such an approach, relying upon nature to oppose IVF, only in cases where much older woman are concerned, strikes me as unreasonably arbitrary.

Critics of later-life mothering often argue that bringing a baby into the world, when one is unlikely to accompany that infant into adulthood, does such a child a disservice. However, one thing is nearly certain about women who spend upwards of $50,000 attempting to bear children: Those babies are wanted. That places these kids well ahead of the many children born to indifferent or mildly-enthusiastic parents. IVF mothers are also carefully screened--a process that should filter out women likely to abuse or mistreat their offspring. Moreover, such older mothers might have fewer years with their children, but they likely possess a great deal of age-acquired wisdom. Emphasizing life expectancy over the many other factors that define successful parent-child relationships oversimplifies a deeply complex--even mystical--equation. Needless to say, in the nineteenth century, long before IVF, far more children lost their parents prior to reaching majority. (This phenomenon explains why the twenty-something heroes of Jane Austen and George Eliot novels have already inherited their fortunes.) Our own concerns about later-life mothering may reflect our heightened expectation that children know their parents, and even grandparents, into adulthood, rather than any universal or socially-essential norm.

Parenting is among the most personal choices anyone ever makes. At the same time, no other individual decision has as significant a societal impact. Finding a careful balance between personal autonomy and the public welfare is often a considerable challenge. Fortunately, in the cases of sexagenarian and septuagenarian mothers, the private benefit is obvious--and the social harm, if any, is rather hazy. In some cases, women like Ms. Bousada will live to be 101. In others, tragedy may strike--much as tragedies also strike twenty-five year-old moms. If women choose to have children into their sixties and seventies, we should make sure that they are informed of any potential health risks entailed. And then we should do what we always do when devoted parents give birth: We should offer them our congratulations and our best wishes. In this regard, the ethics of parenting are surprisingly simple. Mothers should be judged on their love and commitment, not their chronological ages.

 
 
 
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HUFFPOST SUPER USER
booker52
avid reader
10:17 AM on 07/19/2009
No one knows when their time is up, but in the matter of giving birth, it's almost a sure bet that a younger women is more likey to live til their child reaches their late teens or older. The older woman after age 55 is putting that child at risk for having a mother that dies before they reach grade school.
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peacekitten
primum non nocere.
01:23 AM on 07/18/2009
thank you for your wise, compassionate article.
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Jeany
Woman w/ Pitchfork
09:28 PM on 07/17/2009
My Aunt Pearl had a kid when she was 53, long before there was IVF.
HUFFPOST SUPER USER
maryoca
04:28 PM on 07/17/2009
Let's keep in mind that there are no guarantees in life. My husband died from cancer only 4 years after my daughter was born. Was he irresponsible in having children? You would probably say no, because he was only 37. Yet you criticize this woman's personal decision as if she had some crystal ball into her future.

I also feel there is a significant double standard here. Here are couple quotes from above with the gender changed. How do they sound now?

A [father] who goes to such lengths at 50+ years old is not thinking about the child, [he] is thinking about [him]self and how much [HE] wants to be a [dad].

the thought of having a baby beyond a [man's] early 40s is really quite preposterous.
12:08 PM on 07/17/2009
It was not right for her to have had children. Clinics should be regulated. There is a related post at http://iamsoannoyed.com/?page_id=588
09:19 AM on 07/17/2009
Re: paragraph 5. Those kids may be wanted, but I really believe that it is way more about the mother than the kid. A mother who goes to such lengths at 50+ years old is not thinking about the child, she is thinking about herself and how much SHE wants to be a mom. She isn't thinking about what it will be like for the kid to be without a parent, possibly at a crucial time of life. It's selfish and self-serving. If an older woman wants so desperately to be a mom, why not adopt or foster an older kid? There are plenty of them, and it would actually help the child? But I forgot, many don't want to do this because it's not THEIR precious DNA being carried on through history. They don't want to die without the experience of giving birth, and that is SELF-SERVING and has nothing to do with the child.
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sunnybunny
01:48 PM on 07/18/2009
Another advantage of adopting or fostering a child for an older mother is it could be an older child. Not only could they skip some difficult stages like diapers etc.but an older woman who really wants a child might be better equipped to deal with the issues that led to that child needing to be adopted. Personally, I really have trouble understanding why someone would want to go through a high risk pregnancy anyway.It seems like something a sensible person would want to avoid?
06:25 PM on 07/18/2009
You make a good point. I think in today's world, when our population is far from being scarce, and with the planet's depleting resources, having children is to some degree self-serving as well irrespective of age, when there are so many children that can be adopted. Instead, people live in their own micro-cosm, their own neediness of "I want kids" without regard to how overpopulation affects us all in the long run. I think having children needs to be really thought out carefully.
been2there
Facts have a liberal bias.
07:34 PM on 07/16/2009
It is both troubling and empowering. That being the case, there will be no perfect answers.
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kbella
04:22 PM on 07/16/2009
I frankly think they have age restrictions because it is harder for these older women to actually get pregnant with IVF, which could really wreak havoc with these clinics' success rates...which are huge draws for women looking to get pregnant. When in doubt...follow the money!
03:04 PM on 07/16/2009
While I do think that later-in-life motherhood can present problems, I think the language used about it feeds a looming sense of stress that underlies nearly every decision a woman makes. We hear about our biological clocks all our lives; we're told we can't have it all. So if you can't have it all, you better pick right -- and fast, the clock's a-tickin! It infuses every life choice with an additional layer of worry: that it's too late. My blog (http://undecidedthebook.wordpress.com/2009/07/16/stop-the-train-i-want-off-i-think/) is about how women's access to all sorts of options hasn't led to the rainbows and unicorns second-wave feminists might have hoped, but instead to a lot of indecision, analysis paralysis, and grass is greener syndrome. And I think the constant hum of worry over whether or not it's too late has a lot to do with it.
02:32 PM on 07/16/2009
Mr. Appel, as Program Director for The American Fertility Association I deal with the heartbreak of infertility on a daily basis. As emotionally connected as I get personally with the men and women who contact us, I continually circle around a specific criteria. What is in the best interests of the child? It may be a child not as yet conceived, or a child living in an orphanage or in the foster care system; each story, and individual, is different. I think very highly of Dr. Sahakian and Pacific Fertility, but he himself has expressed discomfort with this situation and did so prior to Maria's death. It is very hard to say that no, these two little twin boys should not have been born. But still. My own personal opinion is that Maria, despite the fact that she had so much love to apparently give, should have restrained from jumping through all the hoops required for her 66 year old body to bear children. I myself carried twins at 39 and it was no picnic at that age. I can't imagine what it must have been like for her as a 66 year old. She did endanger herself and her health. She did endanger the health of the boys. That has nothing to do with the fact of her dying. It had to do with the fact of her living and conceiving at an inappropriate age.
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sunnybunny
10:16 AM on 07/16/2009
I think it is just as irresponsible to have a baby over 40 as it is to have a baby in your teens (planned or not). I do however think there is a big difference between planned and unplanned at any age.
09:15 AM on 07/16/2009
Good article, Jacob.

Personally, I think IVF should be stopped altogether. Too many mess-ups: multiple births, special needs, enabling individuals who already have two children (in an overpopulated world) to have more, etc. My objection has no religious basis.

I am also a realist. I know that is not going to happen. So, as long as IVF is available, if there is no age limit for men, then there should be none for women. Period. No valid argument for anything different. Impose an age limit on women, then impose the same age limit on men.
08:24 AM on 07/16/2009
I can't help but think the author if this piece doesn't have children.

I'm twenty-eight, and I think that running around after a three year old and an infant is exhausting. My parents, who are both healthy and in their fifties, have a noticeably harder time of it. My grandmother, who's in her 70s? Forget it!
02:11 AM on 07/16/2009
It's a biological fact that giving birth at an earlier age is healthier for the baby and the mother. I feel blessed that my mother gave birth to me in her early 20's. Women giving birth in their 50's /60's is such a deprivation to the child's development needs. A senior citizen can't take care of a child the same way that a person in their 20's/30's. Also, the risk that the parent dies in their senior years is an inevitable fact and can create havoc for a young child.

The problem is that the society in the U.S. has been telling women that it's OK to wait until your 40's/50's and now even your 60's to have children. It's the feminist movement gone to such an extreme. Unfortunately, many women bought into this delusion that they can wait until their late 30's to have a family.

(continued below)
02:11 AM on 07/16/2009
The problem is that by waiting, their chances of having a successful pregnancy and having a healthy baby diminishes greatly. Also, finding that partner to share a family is much harder. I see thousands of older women milling around the city that bought into all those feminist values.....and the majority of them are alone; No husband, no children, no one to take care of and no one to take care of them when they come home after work. They are truly alone. Yes, many can have a boyfriend/lovers, but it's not the same thing. It's quite sad, but I believe everyone has choices in life and it's the indivdual that must face the consequences of their earlier actions, or inactions. Good luck ladies!
03:45 PM on 07/16/2009
I dunno...pumping out a lot of kids might keep folks from being alone, but having a family to go down with you as the world chokes on pollution, lack of resources, climate change, and other results of overpopulation isn't such a cheery thing either.
06:36 PM on 07/18/2009
Agree.