How is pregnancy different in your 40s? 6 things experts want you to know

The average age mothers give birth in England and Wales may be 30.9, but there are increasing numbers of women choosing to welcome babies in their 40s - and their experience will be a little different.

From pregnancy monitoring to post-birth recovery time, there are several things to take into account when it comes to carrying a child in this decade. Evidence suggests that conceiving may be harder and there is an increased risk of complications, however there are also numerous unexpected positives that are delivered when bringing a newborn into your life at this time.

We have spoken to mothers who have welcomed children in their 40s, as well as experts on what they see on the frontline of pregnancy at this age. Often, women are happier, more knowledgeable and have greater confidence bringing a little one into the world than perhaps they may have been when they were younger.

To give you the most important information about what to expect when you’re expecting in your 40s, we have called on the insight of Dr Shazia Malik, a consultant obstetrician and gynaecologist, Fleur Parker, a practice coordinator and antenatal teacher at the NCT and midwife Angie Willis, also known as ‘The Eco Midwife’. Additionally, it is vital to receive your own tailored medical advice, and also stay up to date with the latest NHS advice on pregnancy.

How is pregnancy different in your 40s?

1. There are some pregnancy differences

Dr Malik insists: “It's crucial to note that many women in this age group experience healthy pregnancies and deliveries, even if conception takes longer due to declining fertility.” She emphasises the importance of proper prenatal care and close monitoring to address any potential risks promptly.

However, there may be an increased risk of certain health complications compared to those pregnant in earlier decades. “The risk of gestational diabetes is approximately two to three times higher for women in their 40s,” warns Dr Malik. “Preeclampsia risk increases by about 1.5 to 2 times.” Risk of placental issues and pregnancy induced hypertension also increases with age.

Additionally, Willis, who is working in partnership with MAM, notes: “There can be a small increased chance of congenital abnormalities, and the chance of miscarriage increases slightly as women become older, as does the chance of stillbirth.” Although she notes that these risks are still small. “For clarity, one study reported that the stillbirth rate for women aged 16-25 was 4.7 per 1000 births, compared to women over 40 where the rate was 8.1 per 1000 births,” she adds.

2. Labour may be different

There may also be a greater need for birth interventions. “The likelihood of requiring a cesarean section is higher, with rates of 40-50% for women over 40, compared to 20-30% for younger women,” explains Dr Malik. If any of the aforementioned health complications occur, then induction of labour or a caesarean birth are recommended. “Many units also offer women over 39 weeks who are over 40 years old the opportunity to have an induction or a caesarean birth too, given the small increased chance of stillbirth over 39 weeks for women over the age of 40,” adds Wallis.

However, for many women, they can still give birth as they choose in this decade. “For my fourth child, when I was 44, I knew I wanted a home birth,” says Judy Bartkowiak, now a 68-year-old child and teens therapist based in Berkshire, who was already mother to children aged 8, 11 and 12. “It was wonderful and I think we all as a family really benefited from being together - although the other kids complained about my screaming and said they had to turn the TV up!”

3. You may need extra monitoring

“Women over the age of 40 will normally be advised to see an obstetrician during pregnancy,” says Wallis. “As part of this, they will have a risk assessment and a personalised care plan will be created based on their own individual medical history.”

Wallis continues: “For some women, there might be the recommendation of additional appointments, aspirin from 12 weeks of pregnancy or growth ultrasound scans – but all these additional screenings are based on the individual’s medical history and the guidelines of the hospital she is under."

4. Recovery may be the same

“This can be individual to the person,” insists Wallis. “For example, one woman may be physically healthy and fit, exercising and eating a well-balanced diet and recovery will be quicker. In contrast, another in their 40s may not exercise often or may have other health behaviours which could impact on recovery - such as smoking, obesity or other lifestyle factors. Age is less of a factor, with support from partners, friends and family also really important.”

Additionally, Parker points out: “The more complex a labour and birth then the more complex recovery may be. Tiredness is a big factor in the first few weeks and eating healthily, staying hydrated and taking moments to rest can all aid recovery for women of any age.”

However, it is important to note that postpartum recovery for women in their 40s may be slightly prolonged. “This is primarily due to the natural slowing of the body's healing processes with age,” explains Dr Malik. For Sarah Stephens, 47, her third birth experience aged 41 was stress-free compared to her first two. “It was more relaxing because I opted for an elective caesarean,” she explains. “Although I still ended up in the high dependency unit and then a private room afterwards for almost a week.”

Wallis adds: “The other aspect to consider is that stress incontinence can increase over the age of 35 due to skin elasticity changing. It is important to do your pelvic floor exercises - for woman of any age, but in particular women over the age of 35 - every day to reduce the chance of urinary stress incontinence.”

5. There are perks to giving birth later

“Many women find that pregnancy in their 40s comes with unique advantages,” says Dr Malik. “They often approach motherhood with greater confidence, emotional maturity and life experience. Financial stability is typically more established, allowing for better preparation for the costs associated with raising a child. Many women in this age group have progressed in their careers, potentially offering more flexibility in balancing work and family life. Additionally, they may have a more extensive support network in place, which can be invaluable during pregnancy and early parenthood.”

Indeed, this was the experience of Sarah. “I think the advantage in having my third in my 40s is I was more confident in arguing with medical people and standing up for myself,” she explains. “They tried to persuade me on my birthing choices, but I argued and refused to budge on them - I had been more easily persuaded in my 30s.” This continues after birth, suggests Parker: “Having spoken to many women in their 40s in the first few weeks after having a baby, the reassuring message is that their age hasn’t had any negative impact on becoming a parent, and that there is a certain calmness, resilience and certainty that comes with this decade.”

It was exactly this for Judy. “Giving birth felt easier - partly because it’s a familiar process for your body and mentally and emotionally you’re prepared,” she says. “Meanwhile, parenting was a doddle in my 40s. My career was well established so I wasn’t worried about the whole work-life balance thing, and with my partner we knew each other very well and worked as a team.” However, for others it isn’t quite so straightforward. “Being a mother in my 40s has been trickier - I have a wonderful partner but no family support, and I have struggled to make friends and find community,” says April Hunter, a Cheshire-based midwife, 45, who gave birth to her third child aged 42 after having her first two in her 20s. “I also don’t quite fit into the ‘first time mum’ group with having older children - so that’s been challenging!”

6. You tend to be better-prepared

“I think one of the biggest positives is women over the age of 40 are more likely to be

interested in the evidence and research, come to appointments armed with questions, knowledge and facts and are better able to advocate for themselves,” notes Wallis. “From experience, these are the mums more likely to attend pregnancy, babywearing, breastfeeding, antenatal groups during pregnancy too to give them a support network of people going through pregnancy at a similar gestation.”

Additionally, Wallis notes: “There is research showing that women over 35 are more likely to adjust health and lifestyle behaviours than women at other ages during pregnancy.” For example reducing or stopping alcohol consumption, quitting smoking, starting exercising or eating more healthily.

“For women embarking on pregnancy in their 40s, it is important to work closely with healthcare providers to develop a tailored care plan,” insists Dr Malik. “I recommend taking prenatal vitamins, maintaining a healthy lifestyle and not hesitating to ask questions or voice concerns.”

Dr Malik adds: “It's crucial to stay positive, as countless women have successful pregnancies and healthy babies in their 40s. It can be hard not to be made to feel that somehow you are ‘less than’ as an older mother - when in fact you can bring so much to motherhood that makes it just as rewarding and enjoyable as anyone else."

We spoke to the following expert

Dr Shazia Malik

Dr Shazia Malik is a consultant obstetrician and gynaecologist, and UK medical director at gynaecological health company and virtual women's health clinic Daye. She gained her medical degree in obstetrics and gynaecology in 1991. She went on to successfully complete her subspecialty accreditation in reproductive medicine and surgery at the prestigious University College Hospital in London, at which she still remains an honorary consultant.