Midwifery care in the UK for older mothers

In many countries, including the UK, a large proportion of care for women during pregnancy, labour and the postnatal period is provided by practising midwives (International Confederation of Midwives (ICM), 2011). While complications may occur in any pregnancy, there are specific risks to both mother and baby associated with advanced maternal age, defined as 35 years or older at the time of delivery (Cleary-Goldman et al, 2005). Primagravid women of advanced maternal age have a higher chance of experiencing complications during delivery due to rigidity of the birth canal, and women of any parity have an increased chance of having a baby with a chromosomal abnormality as they age (Munné et al, 2007). The risks of other complications such as placental abruption, placenta praevia and postpartum haemorrhage are also increased in older mothers, while their offspring are more likely to be stillborn or die in the neonatal period than babies of younger mothers (Royal College of Obstetricians and Gynaecologists (RCOG), 2013). However, the number of childbearing women of advanced maternal age is increasing globally; for example, birth rates in Canada are continuing to rise from 4.9% in 1981 to 19.2% in 2011 for this age group (Milan, 2013). In comparison, there is wider variation in European countries where birth rates for women of advanced maternal age in 2010 ranged from 10.9% in Romania to 34.7% in Italy (European Perinatal Health Report 2010). For the first time, the average age of mothers having their first child in Japan has risen above the age of 30, from 25.7 in 1975 to 30.1 in 2011 (Ministry of Health, Labour and Welfare 2013). In the UK the average age of first time mothers in England and Wales rose to 28.1 in 2012 from 26.8 in 2002 (Office for National Statistics (ONS), 2013a). Birth rates of mothers aged 35 years or over in England and Wales has continued to grow steadily from 13.7% of all births in 1997 to 19.8% in 2012 (ONS, 2013a).