Late-Late Motherhood

In her hometown of Highland, at the foot of the San Bernardino Mountains, Arceli Keh feels she can hide the fact that, at age 63, she became the oldest woman on record to have a baby.

Keh says few townspeople seem aware of the controversy surrounding 5-year-old Cynthia’s 1996 birth, and when people mistake her for Cynthia’s grandmother, she rarely bothers to correct them.

“I just wanted to have a healthy baby and live a quiet life,” Keh says.

But the normality of Keh’s life and her desire to blend in belies her extraordinary quest to have a child--and the resulting impact she and similar women have had on society and the field of reproductive medicine. While it appears that raising a child in one’s 50s and 60s is not a choice many women would make--fewer than 300 U.S. women age 50 and older give birth each year--this small group of mothers wields enormous influence. Their well-publicized successes, Keh’s chief among them, have made pregnancy in one’s 40s appear almost young.

“I think that there are women who saw Mrs. Keh and say, ‘I’m only 51. She was 63,’” says Dr. Richard Paulson, the USC infertility specialist who helped Keh become pregnant with the use of eggs donated by a younger woman. “She’s the one who makes it so much easier for the women 15 years younger.”

The birth rate to women ages 40 to 44 rose 44% from 1990 to 2000 while the number of births to women ages 45 to 49 reached its highest number in more than three decades. Among women ages 50 to 54, births jumped from 174 in 1999 to 255 in 2000, according to the recently released National Vital Statistics Report, which cites infertility therapies as one factor behind the increases.

Such births evoke both the nation’s fascination with medical miracles and its empathy for women who want children so badly they’re willing to undertake pregnancy at an advanced age. Reports that actress Geena Davis gave birth earlier this month at age 46, and Britain’s first lady, Cherie Blair, had a son two years ago at age 45, generated intense interest.

But such late-life pregnancies are not without criticism. Some social critics and medical experts suggest that the births do not always take into account the welfare of the child.

And the effect on women is great as well, says Sylvia Ann Hewlett, founder and president of the National Parenting Assn., which promotes family-friendly policies in the workplace and communities. The medical risks and emotional and financial costs of having a baby late in life are enormous, she warns.

In her new book, “Creating a Life: Professional Women and the Quest for Children,” Hewlett writes that post-50 moms “send a dangerous message: that women can wait to have children because technology will be there to save them when they are ready. But for every 52-year-old woman who succeeds, thousands more waste an inordinate amount of energy, time, and money.”

While in vitro fertilization success rates are 28% per attempt (one cycle of treatment) for younger women, the success plunges to 8% per attempt in women age 39 and to 3% for women age 44.

Even the medical specialists who discovered a way for post-menopausal women to get pregnant (by using a younger woman’s donated eggs) now urge younger women to be realistic about their chance of bearing a child. Last year, the American Society for Reproductive Medicine began a public education campaign to raise awareness that peak fertility occurs in a woman’s 20s and that trying to become pregnant after age 35 can be difficult.

But Keh couldn’t care less about what kind of message she sends or her place in history. Like other older mothers, she was driven by her deep desire to have a baby.

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She Thought She Still Had a Chance

Unlike some women who delay bearing children until well past their 30s, Keh did not arrive at late-late motherhood because of career demands. She and husband Isagani were married in 1980 in their native Philippines when she was 47 and he 44. They immigrated to the United States to be near relatives.

“I thought I would still have a chance to have a baby then because I was under 50,” says Keh, granting a rare interview on a recent afternoon in the couple’s home. Keh kept her identity secret when Cynthia was born and has revealed very little, publicly, about her family’s life until now.

Like many women, Keh mistakenly thought she could still get pregnant simply because she had not yet completed menopause. Years passed with no pregnancy, and she came to think she’d never have a child. But her hopes were renewed when she read about the use of donor eggs. In 1993, scientists reported that even post-menopausal women could have a baby through in vitro fertilization if a younger woman’s eggs were used.

“I thought maybe I still had a chance,” Keh says.

In 1995, Keh made an appointment at USC’s infertility clinic, which has a liberal policy on treating older women, taking qualified patients until age 55. Most clinics turn down women older than 50.

Keh arrived bearing medical records that she had altered to put her age at 51. She was 61.

“I lied,” says Keh, who defends her actions by saying, “I felt young.”

Keh retired from her job as a bank secretary and underwent five cycles of IVF, exhausting the couple’s $40,000 retirement savings, before becoming pregnant.She delivered Cynthia--whom Keh named after model Cindy Crawford--by Caesarean section on Nov. 7, 1996. Keh had gained a scant 22 pounds and had navigated the pregnancy with no more trouble than morning sickness and mild high blood pressure.

The Kehs’ relatives and friends warmly accepted the couple’s choice. But the public response was not as kind. The remarks ranged from fears about the unknown medical risks faced by an older woman giving birth to doubts that a retirement-age parent could adequately parent a teenager. Others wondered whether such desperation to have a child was “healthy.”

And ethicists questioned the decision to have a baby that the couple might not live to see graduate from high school. The Kehs would be 81and 78 when Cynthia receives her diploma.

Public attitudes about late-late motherhood have softened in the five years since Cynthia’s birth, Paulson says.

“I think it’s still controversial but not to the extent it was in the beginning,” he says. While sticking to an age-55 limit for patients at his clinic, Paulson think it’s wrong to deny a woman the chance to become pregnant based on her age.

“Would you want someone to tell you that you can’t have a child because you’re in a particular age group or sexual orientation or whatever? I don’t think we want to do that,” he says.

There is also more information now about how such mothers and their babies fare. And that news is relatively good, Paulson says.

In a study awaiting publication, Paulson examined 78 women age 50 and older who sought treatment at USC from 1991 to 2000. Using donor eggs, 56 women became pregnant, and 43 gave birth to a total of 58 babies.”Besides the question of ‘Should you be doing this and is this the right thing to do?’ the fact is that this works very well,” Paulson says.

The births to post-menopausal women confirm that a woman’s uterus and hormonal system can sustain a pregnancy even after menstruation ceases and the ovaries stop producing eggs.

The pregnancies are more complicated than those in younger women, however. About 25% of the women had gestational diabetes, a potentially serious complication that only about 7% of women in their 20s experience. And 32% of post-50 mothers had high blood pressure, a rate that is double that of even pregnant women in their 40s.

But because these maternity patients had access to expert medical care and were considered high-risk because of their age, the problems were identified promptly, Paulson says. Many of the older mothers gave birth early (the average was 38 weeks), and most had C-sections. But the babies averaged a healthy 6 pounds, 9 ounces. Cynthia weighed 6 pounds, 2 ounces.

“The risks are present, but they are not prohibitive,” Paulson says. “Our study provides one more tidbit of information that we have no scientific reason to oppose pregnancy in women in their 50s.”

But there is little known about the lives of these families after the child’s birth. Do much older parents have the energy to tend to a toddler? Do children care if their parents look like grandparents? How many children will experience the death of one or both parents before graduating from high school?

Keh and other older mothers say they have carefully weighed those questions. The Kehs, who are both retired, will depend on their extended family to care for Cynthia should they die or become infirmed. In the meantime, they and Arceli’s mother, 90-year-old Liwayway Solis, dote on the cherubic and shy Cynthia.

The child’s crayon drawings are taped to the living room walls, and the couple proudly show off her new bicycle and Barbie car. Cynthia, who was crowned a little princess at a local Philippine club event two years ago, has many friends in kindergarten and loves to accompany her parents to Circus Circus in Las Vegas. She is obedient, but silent and unsmiling, when visitors from the media arrive one recent day after school. Out of the earshot of strangers, however, she loves to sing, says Arceli Keh, tucking the little girl next to her during an interview.

“Being a mother keeps you young,” says Keh, who says she dyes her hair to maintain a more youthful appearance. She says she knows that Cynthia will someday quiz her parents about their age.

“I will tell her that I wanted to have a baby--that ‘I wanted you,’” says Keh of the inevitable question.

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For Other Couples, Different Challenges

The Kehs downplay the rigors of late childrearing. But Judy Bershak, who gave birth at age 50 to daughter Sarah, says it’s tough.

“If I had not married a much younger man, I would not have done this,” says Bershak, a Los Angeles teacher who married David Cook, a lawyer, when she was 44 and he 24. Daughter Sarah is now 5.

“I felt one of us had to have full-out energy,” Bershak says. “I do not roll around on the floor with her. My husband takes her out and plays ball and rolls around on the floor with her.”

Bershak is planning to retire soon to devote her energies to child rearing. That strategy is also something 57-year-old Marilyn Nolen says she plans to rely on. The St. Louis woman gave birth to twin boys two years ago after undergoing treatment at Paulson’s clinic.

“I have looked forward to the fact that, when the boys are in school, I should be retired and can be very involved. I consider that a blessing,” says Nolen, who was a member of the 1968 U.S. Olympic volleyball team. “Having a family has such a huge impact. People need to have a lot of support lined up; the cleaning, cooking, shopping, laundry. We realized we weren’t prepared enough. But I think that has more to do with having twins than my age.”

Nolen, now the women’s volleyball coach at St. Louis University, says she believes attitude matters more than age when it comes to parenthood. She was 42 when she married Randy, who was 36. The couple spent 12 years undergoing infertility treatments. They even tried to adopt a child but were told they were too old.

Like her Keh and Bershak, Nolen says her circumstances reflect that “we just really wanted a family.” The desire to have a baby remains with many childless women long after the prime childbearing years slip away, says Hewlett. In a 2001 survey of childless career women ages 41 to 55, Hewlett found that only 14% said they were childless by choice.

“I think this shows the depth of the baby hunger,” she says.

But Hewlett argues that younger women shouldn’t think that they can ignore their prime fertility years and be guaranteed a baby later in life. In her survey, she found that almost 90% of women ages 28 to 40 believed that assisted reproductive technologies would help them to get pregnant into their 40s.

“I’m not saying [infertility treatments] don’t open up wonderful opportunities,” she says. “I celebrate it. But if women are to make smart choices they need to have all the information at their fingertips. Failure is the norm among older women who seek infertility treatment. And then there is the ordeal. There is a high rate of miscarriage in older women. I think women should understand what they might go through.”

Age, it seems, is a heartbreaking obstacle to older women who fail infertility treatment and irrelevant to those who succeed.

“My sense, in talking to them, anecdotally, is that they are all very happy,” Paulson says of his post-50 patients. “It is something they wanted very much. It’s a very select group. They thought about it, planned it, went to a great deal of trouble for it. They are motivated to be happy.”

Says Keh: “I feel like any other mother does when she calls me Mom.”