Wellness and Healthy Living: BJC Medical Group


Published on Friday, November 11, 2016

First Comes Love, Then Comes Marriage…..Then Comes Baby in A Baby Carriage? (Maybe)

While conventional old wisdom tells us that is the order of things, many of these societal attitudes have evolved. For example, more recently engaged or married women are waiting to have kids. Even so, there are steps that you and your partner can take now to ensure that you are physically and emotionally ready when the time is right.

Do People Still Get Married In This Day and Age?

Yes! Most women still get married. In 2013, all but 4.6% of women under age 70 had been married at some point. For women, the average age of first marriage in the United States is 27. For men, it is 29. This is up from 23 for women and 26 for men in 1990 and 20 and 22 respectively in 1960.

Not only has the age of marriage shifted, but attitudes related to marriage, cohabitation and childbearing have all shifted. The percent of women who reported disapproving of cohabitation prior to marriage decreased from 35% to 28% from 2006 to 2013. At the same time, nearly 75% of men and women reported approving of having and raising children out of wedlock. Same sex couples now have the right to marriage and a growing segment of society supports the rights of same sex couples to adopt children. 

Who Is Having Babies and When?

The average (or mean) age of first-time moms has gone up by five years in the last 45 years— from 21.4 years old to 26.3 years old. In just the last 15 years,  the average age jumped from 24.9 to 26.3 years old. This increase is largely due to both ends of the spectrum shifting; there are fewer teen moms and more older first-time moms. The drop in both teen births and abortions since the 1990s has been outstanding and largely due to improved sex education and contraception for teens. The increase in older moms is due to shifting social dynamics and rapidly advancing assisted reproductive technologies allowing women to push the biologic envelope when it comes to carrying a pregnancy. Birth rates for first-time moms ages 40-44 increased four-fold from 1985 to 2012 from 0.5 to 2.3 

In 2014, 40% of all births occurred to nonmarried women, demonstrating a decline in the birthrate for unmarried women for the 6th year in a row. One subgroup that saw an increase in nonmarital birthrates is women over 35. Not surprisingly, nonmarital births amongst cohabitating couples has increased significantly in the last 8 years. There is a lack of data on birthrates amongst now married same sex couples.

Do I Need to Hurry and Buy a Baby Carriage?

So first came love, then came marriage (maybe), and now it is time for a baby carriage! Well, maybe not. The average married couple in the United States waits 3 years between marriage and child. Many refer to this time as the ‘honeymoon’ time and enjoy the benefits of marriage without the presence of children. Utah is the state with the longest honeymoon phase at 4.7 years, while Louisiana reports the shortest at 1.9 years. Remember, this is the length of time from marriage to baby, so marriage to conception is about 40 weeks shorter.

As I have written before, timing is key when it comes to having a baby! In this day and age, women who chose to control their fertility and plan pregnancies have great contraceptive options to do so, and under the Affordable Care Act, contraception is free. But, getting or stopping contraception is usually the easy part. Making the decision to actively try to get pregnant or to avoid pregnancy is often the hard part. Social pressures from old clichés like the baby carriage one above can lead to real and perceived social pressures to have a baby. Personal desires to pursue personal goals first can fall on deaf ears of eager grandparents-to-be. Encouragement to delay childbearing to ‘enjoy life’ or focus on your career first may feel contradictory to the baby fever you feel when you hold a friend’s newborn.

It is a complicated ‘forever’ decision, and I encourage all my patients to give themselves the freedom to be honest with themselves about what they want. I remind them that is ok to deviate from the life plan they set out for themselves at 22, or the life plan their mother laid out for them. I often simply ask patients, ‘why do you want to have a baby?” or ‘what about a baby excites you?” I encourage them to talk to their partner about his or her desire for pregnancy and child raising. Your partner may be on a totally different page than you are when it comes to pregnancy timing. My experience is that couples almost always do better when both parties are equally invested in a pregnancy and child; sometimes I find that women just assume their partner is at the same place they are when it comes to having kids and that that is frequently not the case. So talk to your partner about this! It is a big deal. Listen to what he or she says and incorporate that information into your feelings, desires and plans for a pregnancy.

Ok, We Are Getting Close to Wanting a Baby. Now What?

· Make a pre-conception appointment with your ob/gyn! Don’t have one? Find a physician that you connect with. You should feel comfortable with their credentials and their bedside manner.

· At your first appointment, you should expect to review your general health and any medications you are on. It is key that any medical conditions such as high blood pressure, asthma, Crohn’s, anemia, Lupus, depression or thyroid disease are in optimal control PRIOR to getting pregnant.

· Prepare a menstrual calendar of your prior 3-6 months of menses to take to the appointment for your doctor to review.

· Work towards your ideal body weight; this may mean losing weight for many American women. Ladies who start a pregnancy at or near their ideal body weight have fewer complications and healthier babies compared to women who start a pregnancy overweight or obese.

· Begin an exercise program even if your weight is ideal. Women who are fit going into pregnancy and exercise during pregnancy do better in pregnancy and have less complicated births.

· Work towards eating a well-balanced diet rich is fresh fruits, vegetables and beans and scant in highly processed foods such a bologna, prepared boxed meals, soda and chips.

· Start an over-the-counter prenatal vitamin daily.

· Make sure you are up-to-date with your vaccines, including the flu vaccine.

· Make a list of targeted questions or concerns for your doctor.

· Invite your partner to join along for this visit! This is the first exciting step towards actively planning your family! And after the visit, the two of you can go for a carriage ride and enjoy these sweet moments of dreaming about your future and family together.

Many factors have evolved in the last 40 years, including the age when women give birth, who they are partnered with to raise their child, how long they wait to get pregnant after marriage, how many babies they have on average and who is the breadwinner in the parental dyad. What has not changed is that having a baby is a life-changing event that can’t be undone; it is the single biggest decision a woman ever makes in her life in my opinion. And, this is why I love my job. I love partnering with my patients to help them figure out the best time for pregnancy, and then helping them have a healthy and outstanding pregnancy and birth experience. And yes, I do love seeing all the new snazzy new baby prams at the 6 weeks postpartum visit! Fortunately, baby carriages evolved along with the compositions of our families, but I am still waiting for the day when a patient rolls in with a traditional old baby carriage all shrouded in lace and eyelet with her angelic baby in it.


Rosanna Gray-Swain, MD, is a board-certified physician at West End OB/GYN. She is on staff at Barnes-Jewish Hospital.







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