Dr Thomas Stuttaford

The age at which it is considered old to have a first child has varied in the fifty years that I have been in medicine. When I qualified any woman over thirty was described as an elderly primip (a woman having her first child) and most were very offended by the description. You are quite right. There was a stage where even thirty was considered later than is desirable but now I am glad to say 35 is the usually accepted age at which the problems of pregnancy are considered to be appreciably increased.

I don’t think you should postpone your pregnancy at all. Although the complications of pregnancy and delivery are not significantly increased until you are 35 fertility starts to fall around the age of 32. There is every chance that you will conceive straight away, but there is an ever increasing risk that as you grow older this becomes less likely. It is always difficult to combine family life with a career but it is often easier to achieve career success rather later, than it is sometimes to become pregnant in the late thirties. Good luck with both.

I’m 39 and 13 weeks pregnant. I have bleeding, the obstetrician says that the scan looks okay and he doesn’t know what is causing it. Will it go away? Is it harming or harmful to my baby? Can I do anything to make it stop? Is this common? Thanks. Name and address withheld

The most common complication of early pregnancy (the first 16 weeks) is bleeding, it affects between one in four and one in five women. It always has to be taken seriously, as you have done. Fortunately although everyone will be on the watch out for important complications in most cases none are found and the pregnancy continues normally to term. The significant and comparatively common conditions that early bleeding may be a symptom of include a threatened miscarriage and an ectopic pregnancy in which the baby is either outside the womb, in the fallopian tube or in the narrow part of the uterus leading up to the tube. The ultrasound you have had done will have excluded this. Your doctor will have also checked your cervix to see that this is not bleeding. It is impossible to exclude the possibility that this bleeding wasn’t a sign of a threatened miscarriage but the good news that if the scan showed that the baby’s heart was beating there is a 90 per cent chance that you won’t miscarry.

Is there anything you can do? The traditional advice was to take life easily and even to go to bed. It is now unfashionable to recommend bed rest but it is still a good idea not to over exercise, to have a full night’s sleep, to stop drinking and of course smoking if you do. When travelling in a car stop every forty minutes to walk around. When in a car seat the blood tends to pool in the pelvis. Avoid air travel.

If the pregnancy continues normally the baby is no more likely to be damaged than any other child.

My mother had the menopause relatively early (in her 40s). Does this mean I will, and what effect might that have on my fertility? I’m 35 and would like a third child. Myriam Lemaigre, Brussels, Belgium

There is a family and racial pattern to the time of the menopause but of course you will carry the genes of both your father’s side of the family as well as your mother’s. An early menopause is associated with an earlier loss of fertility. If you are now 35 and would like a third child I shouldn’t waste any time but start straight away. If you don’t conceive reasonably quickly, say within six months, resort to IVF early.

I am 37 years old and in March 2005 I had surgery to remove five fibroids, one of which was very large, from my uterus. The surgery was done by one of the best specialists in Sweden and it was sucessful. I have had no problems since. I am not trying to get pregnant yet but I will do so within shortly. How do you think the surgery has affected any future pregnancy? Do you advise me to do a scan before I try to get pregnant? Name and address withheld

Women who have a tendency to have early fibroids have an increased chance of having problems with fertility and there is every likelihood that you will in time grow more fibroids. Sometimes the actual surgery results in scar formation that makes conception more difficult. You should certainly not waste any time but try and become pregnant as soon as possible.

Very occasionally the surgery to remove fibroids may damage the uterine muscle wall but your surgeon will be well aware of this and will bear it in mind throughout your pregnancy. It may effect the time and method of delivery. The baby will be perfectly all right provided that there is not a big fibroid already distorting the womb cavity, which in your case we know is not so. I wouldn’t have thought that another scan was necessary yet.

I will be 35 in April, have suffered one miscarriage, have rhesus negative blood group (so was given anti D injection), and also received a letter from the hospital saying they found I was a carrier of Group B streptococcus. I am a coeliac although this is under control through following a gluten free diet. What are the chances of having a successful pregnancy? Name and address withheld

Don’t worry about the rhesus negative blood, the anti-D injection should have looked after this.

Many women with coeliac disease have large families. My mother had coeliac disease, lived to be eighty and had four children. One of my nieces had the same trouble and now has three children.

Occasionally an infection precipitates the miscarriage so you should see your own doctor so he may give you the appropriate antibiotic so that you may rid yourself of it. He or she may also want to take swabs from your husband so that the whole household is free of streptococcus. The chances of a successful pregnancy are good.

Does being older (I am 38) make me more likely to have a difficult birth? I was a reasonably fit person before I became pregnant and try to walk every day. Helen, London

Older women tend to have a slightly longer birth but this is only a statistical finding. I have known many women of 38 who have had very quick deliveries, and similarly young ones who have had trouble. The uterus is not as powerful as it was in the early twenties but you have a family history of labouring well this may well compensate for this. It is important to be reasonably fit but the very athletic woman sometimes doesn’t labour as well as those who just take a brisk daily walk. Obviously throughout the pregnancy you will have to watch your blood pressure carefully. You will have to put on just the right amount of weight and you will need your urine tested frequently to exclude any latent diabetes.