By Lydia Namubiru

DOCTORS say to begin childbirth in your early 20s is the healthiest motherhood choice because then is when your body is most prepared to nurture and deliver a baby. If only the choice was as simple as, ‘my body is ready so off we go to the labour ward’.

“Having my first baby in the early 20s would be fine if I was not going to fundraise for its upkeep,” says Janice Mukulu, a 23-year-old mechanical engineer. Normally, in the early 20s, one is at the tail of the income ladder.

Nassuuna Mirembe, a road engineer, says: “I would not have babies in my early 20s because I am still accomplishing my personal goals and defining who I am, what I want to be and achieve.” Who would throw a stone at her?

“I would love to but I cannot because I have to think of my career,” says Jackie Lukoma, a public relations officer. God knows; juggling a career and motherhood has so many young women thinking in circles. Dare I add that the early 20s are one’s party years and choosing motherhood then, means sacrificing them? Let us not go into Mr. Right’s elusiveness or the prospects of further study.

For the above and a host of other reasons, women these days are choosing to delay motherhood, sometimes well into their 30s or even 40s. After all, ours is the era of medical miracles. The effects of the long hold can be countered by modern medical skill and technology. Or can they?

Hellen Amanya (not real name), a very successful professional, postponed childbirth while she ‘extended her career and academic horizons’, conceiving for the first time at 31. Before the full term of the first pregnancy, she bled and eventually lost the baby after an emergency caesarean section that was done in an effort to remove the baby prematurely. For the next four years, she hunted for conception in vain, conceiving again at 35. Again, she bled before term but this time the caesarean section done at seven months saved the baby. At 37, she conceived and had her baby by c-section at full term following an uneventful pregnancy. At 39, she conceived again, got more complications and another emergency C-section had to be done before full term to salvage the baby.

“The longer you wait, the more complications. Four pregnancies, four c-sections, three premature babies and one lost. You may regret waiting,” she says with raw emotion.

She is not alone. Medical evidence shows that the chances of complications during pregnancy gradually increase with age, especially after 35. “It is true both for first time conception as well as subsequent ones, although the first timers are more at risk,” says Dr. Robert Busingye, a consultant gynaecologist at Mulago Hospital.

According to Busingye, older women are more likely to; have miscarriages, bleed especially late into the pregnancy, have premature deliveries and the foetus they carry are more likely to suffer intra-uterine growth retardation (leading to underweight at birth) as well as genetic disorders such as down’s syndrome. “Older women are more likely to have faulty eggs, which produce faulty embryos, leading to abnormal babies or miscarriages,” he says.

According to statistics, 0.8% of the babies born by the mother’s 35th birthday have genetic abnormalities while it rises sharply to 7% of babies born by 45. Older mothers also stand higher chances of pregnancy-induced hypertension and diabetes. These increase the mothers’ chances of caesarean delivery and/or maternal death. “The chances of maternal death could be as high as four times those of a young mother in the same circumstances,” says Busingye.

“Fertility significantly starts to decline after 35 and even more sharply after 40. and fertility treatments are less successful the older the woman,” Busingye points out.

Fertility treatment costs millions of shillings. However, recent medical studies show that the picture is not as bleak for all mothers.

For poor mothers and those of failing health, the risks are very high, while healthy, well-to-do mothers are nearly as safe as young mothers since they can afford proper medical attention.

So would it be of negligible consequence for a woman to delay childbirth because they will in future be able to afford good medical care to counter the effects? “No,” says Busingye. “The reproductive system works best when the mother is young. With less money, a young mother will achieve better results than an older mother with more money.”