First-time mothers at 50: "When he's 20 I'll be 70, but I know I'll be fine"

Motherhood at 50 is possible through assisted reproduction and donated eggs, but Spain's public healthcare system limits it to age 40, and experts warn of increased risks. Cases are growing and the bioethical debate remains open.

Montse turned 50 in March and on May 30 gave birth at the Maternitat in Barcelona to her daughter S. The conversation with La Vanguardia takes place with the baby at her breast, asleep in her arms. She agrees to tell her story, which several other women declined out of stigma, because she would like it to inspire other women. "My life has been intense and my daughter is a gift from the universe," sums up this Catalan woman, daughter of parents from Extremadura, who admits her maternal instinct awoke at 27.

Back then, her parents' health problems caused an existential halt and led her to rethink her life after a frenetic and successful career. "I thought I wanted to start a family if life was going by so fast," she explains. She had a partner, but things were not going well. In parallel, she was diagnosed with rheumatoid arthritis. She left her job and her partner. The illness, which later developed into lupus with chronic pericarditis, along with depression, prevented her from starting the motherhood project then. "I couldn't consider it," she laments. That was when she froze her eggs on medical advice. She is proud of the psychological work she has done to move forward despite her depression diagnosis. Yoga also helped her a lot, and she has continued practicing it throughout her pregnancy.

More than a decade passed between the first time she went for advice about the in vitro process and when she actually went through with it. It was in 2013, at 37, that she first sought information, right after her mother's death. But at the time she did not feel strong enough due to her own illness and because she had to care for her father, who died later. Years later, at 48 and living in the Canary Islands, her instinct awoke again and, after talking it over with her psychologist, she sought information once more. When she made up her mind, the next step was undergoing a "heap" of tests. She even went before a medical board because of her health problems. She remembers those moments with great uncertainty until a phone call gave her the green light for motherhood. "It was an IVF and I got pregnant on the first try."

## Two stories of motherhood at 50

Elena (a fictional name to protect her identity) gave birth in September by cesarean at Sant Pau hospital in Barcelona to her daughter L., a few months after turning 50. A pharmacist by profession, she admits that between the start of her career and her desire to travel and enjoy her first years of financial independence, she did not feel the desire for motherhood in her thirties. At 38, without a partner, a colleague told her about egg freezing to preserve fertility and she decided to do it, although at the time she was still not sure she wanted to be a mother. At 40 she started dating her current partner, who already had children. The pandemic came and, at 45, Elena considered the option of motherhood with the eggs she had frozen, whose storage costs about **300 euros a year**. The endometriosis she suffers from and several fibroids prolonged the process longer than she would have liked. At 49, in a second in vitro fertilization, she became pregnant.

She spent the first months of pregnancy with nausea, for which she had to take medication. At first she was closely monitored because of her age. Despite her age, she boasts of having had no blood pressure problems. L. was born in week 41 after a cesarean prompted because the baby would not descend. She admits the first few weeks have been a bit chaotic. She is now adjusting and already has a nursery place for when it is time to return to work.

At the Catalan clinic where Elena had her treatment, they told her they do not usually treat women over **52**, and she herself says that had she not succeeded at 50, she is not sure she would have tried again. A lifelong athlete, she says she has always led a healthy life but admits that now "I have to take care of myself to be well for my daughter." "I didn't want to be a mother beyond 50," Elena admits. She believes motherhood at 40 is possible but that it needs to be "normalized" that "becoming a mother at 50 can happen."

Montse boasts of having enjoyed a "really beautiful" pregnancy, although the first months she was closely monitored and could not do yoga. At risk of preeclampsia, she gave birth in week 37 of gestation after an induction. They attempted a natural birth but it was not possible, and after a full day trying to dilate, the baby was born by cesarean. She is grateful for the empathy her doctor showed at all times, though she admits she had to request a change of doctor because the previous one only predicted preeclampsia and diabetes. "I was very strong when I took the step of wanting to be a mother," she says.

## The risks that evidence links to advanced maternal age

Advanced maternal age is a risk factor for pregnancy, and even in healthy women "adverse outcomes" occur, notes Dr. **Leire Rodríguez Gómez**, member of the Perinatal Medicine Section of the Spanish Society of Gynecology and Obstetrics (SEGO). In women over 50, the increase in miscarriage incidence is especially significant, already rising to **50%** in women over 45. The incidence of chromosomal abnormalities, preterm birth rates, perinatal mortality, and maternal mortality also increase — "more than **42 times** in 50-year-old women," she notes.

In Spain's public healthcare system, the limit for assisted reproduction techniques is **40 years**, extended to **42** in the Basque Country and **45** in the Community of Madrid, according to SEGO. In the private sector there are no limits, although the Spanish Fertility Society (SEF) recommends **50** as the maximum age. From SEGO, considering the increase in maternal risk, they call for an "ethical limit." In pregnancies of 50-year-old women, it is common to use donated oocytes because eggs from a younger woman reduce the risk of chromosomal abnormalities.

**Francesc Figueras**, head of the maternal-fetal service at Hospital Clínic in Barcelona, where Montse's case was handled, confirms that although few women become mothers at the edge of 50, the data point to a rise in cases of advanced maternal age, something they see in consultations and which, he says, is happening worldwide. "It has gone from being an absolute exception to no longer being one," he notes. The specialist, unlike other experts, asserts that "at 50 there is no biological cliff" because risk is pogre from **35 years** onward, though he admits that at older ages there are more complications in achieving a vaginal birth and that spontaneous fertility drops sharply after 40. He points out that in the 1950s advanced maternal age was considered 35.

The doctor argues that a woman's state of health is more decisive than age itself when carrying a pregnancy to term. It could pose a greater risk in a younger woman with many comorbidities than in a healthy older one, an idea he insists on throughout the conversation. In Montse's specific case, Figueras highlights that she is an example of many women who were not advised to become pregnant for medical reasons, who go through "hardships" and therefore end up accessing motherhood late.

The Clínic gynecologist recalls that today there is a big gap between biological and social age, so a 50-year-old person today is young from a social and work standpoint but older in biological terms. For the expert, the 50-year threshold responds to regulatory bioethical limits that could be debatable. He believes the problem for a baby born to a 50-year-old mother is having a mother or parents of advanced age, but he also notes that life expectancy keeps rising. Although the medical recommendation is not to delay motherhood, whose best period from a reproductive standpoint is between 20 and 30, the doctor laments that the gap between reproductive and social age keeps growing due to difficulties accessing the job market, independence, and housing.

## The social age of motherhood and the judgment placed on these women

Biology plays a key role and there are reproductive limits after a certain age, but it is also important to focus on "social age," notes sociologist **Anna Berga**, head of the Gender Commission of the Professional Association of Political Science and Sociology of Catalonia. Berga reflects on "normative trajectories": there is a time to study, a time to form a couple, a time to have children. These moments have been shifting, which delays the decision to have children, which perhaps in another era was a decision that "came more given."

Berga stresses that these very late motherhood cases are a minority and believes that, sociologically, we can "neither idealize nor stigmatize them" because they are "individual decisions made in a specific social context." Beyond biological age, whose importance she does not deny, the sociologist considers it relevant to see how life trajectories have changed or the reproductive possibilities that exist today and did not before. Berga laments that gender inequalities also run through this, because a man having children at 50 is not questioned, while it is for a woman. "Beyond biology, the social judgment falls on them," she laments. Berga points out that "it is on the woman that the burden falls of squaring all these social expectations, the life trajectory, and the ideal moment to have children." "Society regulates motherhood, especially women's. Reproductive age is also a social norm," she says.

Montse, whose only direct family is a brother and who became a mother on her own, acknowledges the "stigma" around her decision, but says she has mostly felt supported and understood. She confesses her brother was "amazed" by her decision because he did not expect her to take the step into motherhood "at such an age," but he "respected" it and already knows that if anything ever happens to her, he — who has grown children — will take care of her daughter. Her friends have also offered. But she stresses she has no intention of anything happening and takes great care of herself.

Montse's neighbors were not surprised by her pregnancy, because she does not look her age. She joined the mothers' club and recalls that the others were surprised by her age because "I don't look it," but she did not feel judged. Elena has at times felt a bit "strange," as in the childbirth preparation course, where most mothers were in their twenties or, at most, thirties. And that despite the fact she thinks they believed she was in her early forties.

Elena is grateful that new reproduction techniques allow the decision to become a mother to be extended a little. She knows her decision is not understood by everyone: "they tell me that when my daughter is 20 I'll be 70." But she counters that she is "biologically" in good health, has no hypertension, and that today's 50s "are not our grandmothers' 50s." Although she admits that at 50 "you don't have the same energy as at 30" for mothering, she has a support network. She has found support in her circle and there have been more cases of motherhood beyond 50, though she admits it is more common for some friends to have become mothers at 40. Others chose not to, and she laments that they are criticized too. By contrast, few cases of mothers in their thirties have occurred in her circle, because she admits there are "plenty" of reasons to delay motherhood: studies, the job market, housing. She admits her family was initially taken aback by the decision and that her parents had to "mature" and "understand" that Elena is not a traditional person: "I didn't get married and I had a daughter at 50," she sums up. But her parents are delighted with the little girl: "a granddaughter at 80 is a joy, they dote on her."

## "I take care of myself for me and for her"

"I have thought a lot about when I'm older… when she's 20 I'll be 70," Montse admits as she looks at her sleeping daughter. Although she says the only thing that comes to mind is that she is going to be fine. She does not smoke, drink alcohol, or take other drugs. "I'm super healthy and I do yoga." Montse believes her self-care will carry her well to 70 and also argues that today's 50s "are not our mothers' 50s." "I take care of myself for me and for her." Despite her decision for late motherhood, she finds it "normal" that the percentage of women who become mothers at 50 like her is low, because she herself "would have done it earlier if I could," she admits. She would have liked to have 3 or 4 children. The pregnancy has gone so well that she does not rule out a new motherhood or an adoption. She is now focused on her daughter, whose immune system has been at 0 so far because of the medication Montse takes for her illness. She looks at her and attributes things to every gesture. "She is the best thing that has peine to me in my life."