THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, September 18, 1994 TAG: 9409160284
SECTION: VIRGINIA BEACH BEACON PAGE: 18 EDITION: FINAL
TYPE: Cover Story
SOURCE: BY PAM STARR
STAFF WRITER
LENGTH: Long : 186 lines
KATHY MARTIN, wearing a blue surgical gown and latex gloves, reached into the tiny opening of the incubator and lovingly stroked her premature baby, Isabelle.
The 3-pound infant was sleeping on her stomach, but at her mother's touch she sighed and shifted her weight. Martin continued to stroke Isabelle, cooing and smiling at her. Isabelle has resided in Virginia Beach General Hospital's Neonatal Intensive Care Unit since her birth Aug. 12.
``Hi sweetie, hi Isabelle,'' she said softly. Isabelle weighed slightly more than a liter of soda when she was born three months early. Her blond eyebrows and eyelashes are wispy stubs and her nails are as tiny as microchips. ``She knew me from day one - she follows my voice. It's amazing,'' Martin said.
At 37, she is just one of a growing number of women who have children after 35. It is estimated that by the year 2000, one in 12 women with babies will be over 35. That age group, in fact, is the fastest growing one in the United States having babies - after teenagers.
But with advanced maternal age there come additional risks, such as an increased incidence of hypertension, diabetes, cardiac disorders, genetic abnormalities, spontaneous abortions and Caesarean delivery. In Martin's case, placenta previa caused Isabelle to be born prematurely. That's where the placenta covers the cervical opening and causes bleeding, usually during the seventh or eight month.
Martin, the mother of three other children, knew she was considered to be a high-risk pregnancy but didn't opt for an amniocentesis, a procedure performed around the 15th week of pregnancy that can detect genetic defects.
``We knew we wanted Isabelle no matter what,'' said Martin, referring to husband, Trent.
``I started later - at age 32. The other three pregnancies had been normal so this one was kind of scary. I have asthma and it was exacerbated in the first trimester.''
Neonatologist Dr. Robert J. Balcom is the neonatal unit's medical director and he has monitored Isabelle's progress since she was born. She had respiratory distress due to underdeveloped lungs, he said, but several doses of artificial surfactin has helped to build up her lungs. Now, a month after birth, Isabelle is doing ``remarkably well'' and will be sent home when she reaches 4 1/2 pounds, probably by her due date Oct. 15.
``The most important thing to stress is that the vast majority of pregnancies, well over 90 percent, have normal outcomes,'' said Balcom. ``At the age of 40 versus 20, women have more problems with medical conditions, but in general women in their 30s and 40s take excellent care of themselves. Very few women come in here with no prenatal care.''
Most obstetricians and gynecologists would agree that prenatal care should start as soon as any woman, especially one over 35, decides she wants to get pregnant. The motto at Virginia Beach General Hospital's Tidewater Perinatal Center is ``we turn a high-risk pregnancy into a low-risk delivery,'' according to the center's director, Dr. Steven Warsof. The perinatal center is the only one in Virginia Beach.
Specialists at the center, which is affiliated with the Division of Maternal/Fetal Medicine at the Eastern Virginia Medical School, see about 300 women a month who require specialized tests and genetic counseling to monitor their health and that of their unborn babies. Women over 40, said Warsof, have an increased incidence of miscarriages and are more likely to develop medical problems.
``The most common medical problems we see in high risk pregnancy are hypertension and diabetes,'' said Warsof, who has directed the center since its opening in October 1991. ``Diabetic patients really require a lot of work. During pregnancy, insulin needs change week to week. But that doesn't mean anything is wrong - it means the baby is growing and healthy.''
Karen Coffren is a 38-year-old patient who was borderline diabetic during her second pregnancy, but said that everything went as ``smooth as silk.'' Her first pregnancy, at the age of 35, also had gone well but baby Christian was born by emergency Caesarean section with Down's syndrome and a heart defect. She did not have an amniocentesis and does not regret it, although she thinks the test would have prepared her and husband, Rick, better.
``Christian is a real joy,'' said Coffren, who had undergone in vitro fertilization unsuccessfully years ago. ``I had tried to get pregnant for seven years and decided to take a break from trying. That's when I got pregnant naturally. I was so excited.''
Her second baby, Avery, is 11 months old and Coffren is six months pregnant with her third child, a girl. With this pregnancy, Coffren has diabetes and RH disease, where her RH negative blood has crossed over into the placenta. RH disease can make the baby anemic in the womb, requiring a transfusion before birth. Coffren's blood is tested every two weeks and she has had several ultrasounds. Despite the problems, Coffren is confident her baby girl will be born healthy.
``I have complete faith and trust in Dr. Warsof,'' she said. ``He's a special person. I count my day lucky when I found him.
``You know, I worried about starting a family so late,'' Coffren added. ``But my children are the best things that ever happened to me.''
The decision to start a family later in life is never an easy one to make. Newly married couple Jim and Cindy Kuhn have been debating the pros and cons of having children early in their marriage because Cindy will be 35 in December. The couple live at the North End with a 4-year-old Dalmatian, Sam.
``I don't want to be at my child's high school graduation at 72,'' said Cindy, an executive secretary for Bank of Tidewater. Jim, 30, is an F-14 instructor at Oceana Naval Air Station. ``But I just had back surgery in May and I want to wait another year before getting pregnant. But I know that after age 35 there's more of a chance of having a baby with Down's syndrome.''
Jim worries about possible genetic defects but thinks that a baby will ``keep us young'' and that he would make a pretty decent dad.
``Having a baby is like buying a car. You have to be an educated consumer,'' said Jim. ``You have to think ahead. But it comes to a point were we say, well, we gotta try.''
To alleviate their concerns, the Kuhns, along with dozens of other prospective parents, attended Virginia Beach General Hospital's Baby Talk seminar last month for ``thirtysomething plus'' women. Doctors Balcom and Warsof discussed the problems and treatments of high-risk pregnancies and deliveries during the lecture.
Three percent of all babies, regardless of age, said Warsof, have a birth defect or genetic disorder.
``The odds are still in your favor,'' Warsof told the group. ``Even at the age of 48, you have a 92 percent chance of not having a Down's syndrome baby.''
Warsof is not concerned about older women having children, as long as they take care of themselves before becoming pregnant. This means to stop smoking, normalize your weight, improve nutrition and tune up any medical problems, he said.
But receiving the proper prenatal care is the best way to reduce the risk of problems, he added.
``Of all the developed countries in the world, we have this thing of no prenatal care,'' he said. ``Some university did a survey of women who didn't have prenatal care. The most common reason given was they didn't think it was important.
``Unfortunately, it's becoming a bigger problem with drugs and everything.''
And what does he think about that 64-year-old grandmother in Italy who had a baby?
``I think it's great. What about a 64-year-old guy who fathered a child?'' he said. ``The problem isn't the older women having babies. It's the 15-year-old unwed mothers with three children.'' MEMO: Virginia Beach General Hospital will hold a Baby Talk seminar on
Tuesday, Sept. 20 at 7 p.m. in the hospital's Health Education Center,
located across from the Emergency Center. For information, call
481-8888.
ILLUSTRATION: [Cover]
BABY TALK
Thirtysomething women learn about pregnancies later in life
[Color] Staff photo by D. KEVIN ELLIOTT
Dr. Steven Warsof performs a sonogram on expectant mom Terry Leavitt
at the Tidewater Perinatal Center in Virginia Beach.
Staff photo by D. KEVIN ELLIOTT
Kathy Martin, 37, caresses her daughter, Isabelle, who weighed 2
pounds, 14 ounces at birth.
Staff photos by D. KEVIN ELLIOTT
Isabelle Martin, who has resided in Virginia Beach General
Hospital's Neonatal Intensive Care Unit since her birth Aug. 12, has
fingernails as tiny as microchips.
Terry Leavitt, 30, whose first baby was born prematurely, isn't
taking any chances this time. She had an ultrasound done.
Michelle Kucharczk, 5, watches Lori Morgan, 33, and Marc Kucharczk,
36, hold her sister, Lisa. The baby was born nine weeks early.
OLDER MOTHERS
Advantages of older motherhood
Maturity.
More stable relationships.
Better financial resources.
Disadvantages of waiting until after 35
Decreased fertility.
Increase in genetic abnormalities.
Increase in spontaneous abortions.
Maternal medical complications.
Fetal growth abnormalities.
Dysfunctional labor.
Increased Caesarean delivery.
Increase in maternal/fetal deaths.
Source: Dr. Steven Warsof, Tidewater Perinatal Center
by CNB