By Ariel Caspar, Casey Rafter and Raymond Purscell

Sacramento residents Ruben and Donna Arroyo recently pulled up to New Life Community Church in a large 12-seater van with eight of their own children filling the seats.

The children piled out: Their oldest, Isabelle, 17; then Anthony, 15; Alana, 14; Christian, 13; Hayden, 10; Everleigh, 4; Dominic, 3; and lastly, 2-month-old Coleman.

Donna gave birth to Coleman at 40-years-old. Like her, more and more women in the Sacramento region are giving birth at the age of 40 or over.

According to data from the Center for Disease Control and Prevention, the number of births to mothers 40 and older in a four-county area including Sacramento County has steadily climbed from about 985 in 2016 to over 1,250 in 2022, which is a roughly 27% increase.

And this trend is not only occurring in Sacramento County, but nationwide. As births among women 20-29 years old have declined since 2007, women over 40 have only seen an increase of births, according to data reports from the CDC. They now make up almost 4% of overall births in the U.S.

According to Gina Mut, a prenatal registered nurse with Kaiser Permanente, there are many reasons why women are choosing motherhood after 40. She said the vast majority of her patients 40 and over are continuing to have children into their 40s, and many of these women are making this decision after committing to a relationship with a new partner.

Mut said it is also recently becoming more common for her to see new mothers who are in her 40s, and the most common reason she sees is infertility issues. She said most of her patients over 40 had to use an infertility treatment of some kind, such as in vitro fertilization, to get pregnant and have had several miscarriages before using an infertility treatment.

“Because at that age [over 35], a lot of research over the years has shown eggs decrease significantly and it can be very difficult to get pregnant,” she said.

The risks of giving birth after 40

According to Mut, if a person gets pregnant after the age of 35, it is called a geriatric pregnancy, meaning the mother is considered to be at an advanced maternal age. Geriatric pregnancies are at much higher risk for complications through the pregnancy and during labor and delivery.

“So, they noticed that it’s increased down syndrome incidents, other chromosomal issues, birth defects in women that conceive after the age of 35,” Mut observed, adding that many older pregnant women are more likely to deliver C-section and often undergo emergency C-sections due to unforeseen circumstances during delivery.

Emergency C-sections are usually performed depending on the position of the baby, the mother’s blood pressure and amniotic fluid levels.

According to nationwide CDC data, between 2020 and 2022, almost half of all births in women over 40 were by either scheduled or emergency C-section due to pregnancy or birth complications.

Donna said she originally planned to deliver Coleman vaginally, but she had an allergic reaction to an antibiotic that was administered to her at the hospital and her blood pressure dropped significantly.

“So, my blood pressure went down and then he fell off the monitor,” Donna said, referring to medical staff not being able to locate Coleman’s heartbeat or any bodily movements. “They couldn’t get him, so by the time they took me to the operating room it was within 20 minutes they finished the C-section.”

All was well when Donna and Ruben heard the baby’s first cry.

This was Donna’s first emergency C-section. She previously had three scheduled C-sections with her other children.

IVF common among older mothers

Although Donna has never had issues with fertility, others are not so lucky.

Mut said many older women have gotten pregnant through either IVF or other infertility treatments.

Some women in this bracket who go the IVF route or seek infertility treatment will try to freeze their eggs, but if their eggs are not viable they will use an egg donor. If the father’s sperm is not viable, they will use a sperm donor and oftentimes the issue is with both the mother and the father.

According to CDC data, use of infertility treatments that resulted in a pregnancy and live birth among women over 40 saw a roughly 35% increase nationwide between 2020 and 2022, with 12% of women who successfully got pregnant using infertility treatments in 2022. In comparison, California has seen an even greater increase since 2016, with 15% percent of all pregnancies that resulted in a live birth to women over 40 in 2022 achieved through infertility treatment.

A profile of older mothers

Mut, who works for Kaiser Permenentae, said most of her patients are likely at a point in their life where they can afford health insurance and are in a higher income bracket. They also overwhelmingly have partners or are married and have some form of higher education.

After Mut prepares the patient’s chart, they are free to select either an OB-GYN for the rest of their prenatal care or even a midwife.

With a client base that reaches about 100 miles — Sacramento being at its center — Midtown Nurse Midwives’ owner and director Bethany Sasaki said she’s seen the trend in her client base, moving steadily toward older mothers engaging with the services offered by her business. Sasaki has over 13 years of experience working with mothers in the Sacramento region: She’s also a staff midwife who has seen her business grow from the clinic she opened in 2010.

Sasaki notes that the mothers she works with start with her as soon as they find out they’re pregnant and, through the mother’s parental education, labor and ultimately the child’s first six weeks after birth. The services she offers tend to answer nearly all of the needs of a mother going through the process of birth, but noticed that younger mothers engage with some resources that many of her older clients do not.

“We provide them with a very comprehensive set of resources, so they really don’t need to go outside,” Sasaki remarked. “Normally … my WIC patients tend to be younger.”

Pointing to several barriers that women face in the workplace, Sasaki added that, in her experience, more women are choosing to wait to give birth because of the potential career risk while they’re on maternity leave.

“The problem is that men are not taking an equal share in the parenting, which is also a risk to a woman’s career,” she said. “We often need to wait till we’re much more established in our jobs and in our education before we have children because…the time that is required to take off for disability and to take care of a young child is prohibitive in a lot of employment situations.”

While the act of birth often takes no more than a day, Sasaki said the trouble lies in the time, care and attention it takes to parent newborns. She criticized the postpartum healthcare system in the United States, saying a lack of paid childcare is problematic for young mothers and families.

“It’s absolute rubbish,” Sasaki emphasized. “It encourages women to go back to work before they are medically and psychologically ready. It damages their relationship with their babies.”

Yet Sasaki also acknowledged that mothers considering birth at 40 and beyond do so at risk to their own health and that of their babies. If mothers have already given birth at a younger age, the risk factors they encounter are reduced.

“The highest medical risk is with having your first baby after the age of 40,” Sasaki said. “There is clear scientific evidence that there are more complications with pregnancy and birth when you’re over 40. You don’t get any younger, so those issues would only become compounded the older you get.”

With over 20 years of experience as owner and midwife at The Birth Center — Sacramento’s first of its kind — Ruth Cummings said that, in recent years, she doesn’t have a majority of clients in their 40s or over who haven’t already had children or IVF engaging with her services. However, she has seen an increase in clients over 35.

“Overall, the numbers are such that yes, the birth rate is down but yet, women are still having babies and they can have them a little bit later,” Cummings reflected. “They may have had babies earlier in their 30s and then, they’re continuing to have one or two more children and that takes them past the age of 35. I don’t see too terribly many that are over the age of 40 having first babies because it just gets more difficult to get pregnant unless there’s some IVF involved in most instances.”

Cummings said she doesn’t look at age as a factor of exclusion in her clients, but acknowledged that some of the risk factors that older mothers may experience are hypertension, gestational diabetes and preeclampsia. She said her clients are often in good health, those factors are often not a common occurrence like they might be with mothers who engage with an OBGYN.

“It’s just a known quantity that there may be some other risks that can come with that age,” Cummings said. “But oftentimes, my clients take really good care of themselves, so I don’t see those kinds of experiences like what the OBs may be seeing in their practices.”

Rebecca Gardner Moy, a professor at Sacramento State and a partner of HMS Law Group, had her first child when she was 38. She believes the trend of women waiting to have children until later in life shows no signs of slowing down.

“I do think some women will continue to have children later in life,” Gardner Moy said. “Women have more options now for education and careers than we did a few generations ago and I think there’s definitely a move towards a zest for living life before settling down and having kids – no matter where someone is on the gender spectrum.”

Gardner Moy also spoke to an increased awareness of the emotional toll that can come with waiting until later in life to have children.

“I have a number of friends who married later in life and wanted to have kids, and many of them have struggled with that, and some have decided to remain childless,” Gardner Moy noted. “The pain of realizing that biological children isn’t in the cards can be very upsetting.”