The birth of triplets to a 55- year-old woman this week is drawing attention to a small but growing phenomenon: older women becoming pregnant.
Tina Cade, a university administrator in Richmond, Va., acted as a surrogate for her daughter, a Johns Hopkins doctor who couldn't conceive. Other women in their 50s - and even 60s - are becoming pregnant to have children of their own.
But as more older women turn to science to beat their biological clocks and fulfill their desire to become mothers, it is raising a number of medical and ethical questions.
"How realistic is it for a young woman today to expect to delay her childbearing into the fifth or sixth decade of her life?" Linda Heffner, an obstetrician-gynecologist at Boston University School of Medicine, wrote last month in a New England Journal of Medicine article on the topic.
While by no means common, babies delivered by women in their 50s and beyond "is not like something you're going to see on Ripley's Believe It or Not," said Eleanor Nicoll of the American Society for Reproductive Medicine.
Last month, for example, a 56- year-old New York City woman gave birth to twins. A 59-year- old Georgia great-grandmother, meanwhile, is expected to deliver her own set of twins any day now - 44 years after her firstborn arrived.
Oldest, at 63
In 1996, a California woman became the oldest known mother in the United States when she delivered her first child at age 63.
In 2002, the last year for which there are solid numbers, the National Center for Health Statistics reported 263 births among women 50 and older, a 10 percent increase from the year before. By comparison, the total number of babies born in the United States in 2002 was 4,021,726.
Advances in in-vitro fertilization and other reproductive technologies have made it increasingly possible for women in their 40s and beyond to become pregnant. Even women who have experienced menopause can use the eggs of younger donors.
But there are hazards. Older women, Heffner notes, are at higher risk for pregnancy-induced high blood pressure, or pre-eclampsia. They are also more likely to develop gestational diabetes and deliver by Caesarean section. Although increasingly common, C-sections are still considered major surgical procedures that pose risks to both mother and child.
Older women who attempt to become pregnant also have a higher chance of having a baby with Down syndrome and other chromosomal abnormalities. To prevent this, many older women who want to become pregnant turn to eggs donated by women in their 20s and 30s, which have much lower risks for abnormalities.
And older women who turn to hormones and in-vitro fertilization to become pregnant frequently produce twins and triplets, who have a greater chance of arriving prematurely.
"If you're going to use technology to beat the biological clock, you have to ask yourself: Is it in the best interest of the child?" said Arthur Caplan, a bioethicist at the University of Pennsylvania.
Couples, he said, need to think about questions such as who will take care of the children if the parents die before their offspring are grown. Also: How will a child feel if mom needs a walker to prowl the sidelines of a soccer match?
"If your child is entering junior high school when you're entering Medicare, I think there could be a problem there," said Caplan.
Susan Wolf, a professor of law and medicine at the University of Minnesota, said that women also need to think about the energy demands of caring for a newborn.
For a woman in her 50s or older, "It can be hard to get down and up off the floor a million times a day or be sleep-deprived," said Wolf, who became a first-time mother five years ago at age 45.
With the number of older mothers growing, the American Society for Reproductive Medicine recently began a campaign to make women more aware of the health and social consequences of delaying motherhood.
Giving up the baby
Surrogacy also raises potentially thorny questions, experts say. Even a grandmother might experience trouble relinquishing control after the baby is born. Another question parents will confront, says Wolf, is this: "In whose tummy did I grow and what does that mean?"
On ABC's Good Morning America yesterday, Cade explained that she and her husband came up with the surrogate idea and suggested it to their daughter, Camille Hammond, a resident in preventative medicine at Johns Hopkins Bloomberg School of Public Health.
"We had seen a movie many years ago that showed a similar predicament," Cade said.
Hammond had received a diagnosis a decade ago of endometriosis, a condition that affects the lining of the uterus and makes it difficult to become pregnant.
Although Hammond initially resisted her mother's suggestion, after four years and six unsuccessful in-vitro treatments, she and her husband, Jason, a resident in orthopedic surgery at Hopkins Hospital, eventually relented.
Cade underwent in-vitro fertilization in the spring at Greater Baltimore Medical Center's Fertility Center. Dr. Ricardo Yazigi, the center's associate director, said the Richmond woman was "among the oldest" patients the center has treated, although he added that it's becoming less unusual to see women in their later 40s walking through the door.
Cade gave birth at a Richmond hospital on Tuesday by Caesarean section to two boys and a girl, simultaneously becoming both their gestational mother and genetic grandmother. The babies, who have yet to be named, ranged from 3 pounds, 12 ounces to 4 pounds, 10 ounces.
"We just knew we had to do something to make a difference to Jason and Camille," Cade told ABC yesterday morning. "And we think that this has."