They are called elderly primiparae. Women who fall pregnant for the first time over the age of 35. Or in Rhondalynn Korolak's case, an extremely elderly primipara, given her first-born arrived when she was aged 46.
For the last decade, an increasing number of women have fitted into this rather unflattering medical category and some have feared their bodies will not take pregnancy well.
But research shows that while many women do struggle to conceive naturally in their 40s, if they do get pregnant – especially with eggs from a younger donor, which tend to have a lower risk of abnormalities – they face fewer challenges than you might think.
A leading Melbourne fertility specialist, Kate Stern, recently told an Australian Society for Psychosocial Obstetrics and Gynaecology conference that although women in their mid 40s are more likely to have miscarriages, most have healthy pregnancies that go well.
A Victorian study that assessed problems in the pregnancies of women aged 45 and above recently reported that they do experience more complications including pre-eclampsia (potentially catastrophic high blood pressure), gestational diabetes, ante-partum haemorrhage (bleeding between 20 weeks' gestation and birth), and placenta previa (where the placenta becomes implanted at the bottom of the uterus over the cervix, meaning the baby cannot be born through the vagina).
But compared to women aged 30 to 34, there is only a slightly increased risk of serious pregnancy complications. For example, the study published in the journal Midwifery found that 2.5 per cent of women in their early 30s suffered pre-eclampsia compared to 4.6 per cent of women over 45. For diabetes it was 5 per cent versus 9.7 per cent and for placenta previa, it was 1 per cent against 4.6 per cent. And both groups had a similar rate of post-partum haemorrhage (bleeding after birth).
Women aged above 45 were also more likely to have caesareans, with half having the operation compared to a third of women in their early 30s. However, it is unclear how many of these were for medical reasons, rather than patient preference.
Associate Professor Stern, of the Royal Women's Hospital and Melbourne IVF, said the data suggested the risk of complications increased with advancing age, and became more worrying in the late 40s and escalated from about 50 onwards. For this reason, she said, Melbourne IVF tended to not treat women over 50.
"I think women [in their 40s] should feel reassured, but there are other issues. It's no picnic. Getting pregnant is difficult on your own, there is a higher risk of miscarriage, and finding an appropriate egg donor and taking on all the ethical and genetic complexities of donor eggs can be hard," she said.
Other studies have recently shown that older women did not experience increased rates of post natal depression or an inability to cope with their baby.
Having given birth to her first baby at 46, Ms Korolak said she was not surprised by the statistics. The business coach and motivational speaker said before she delivered her baby girl Eden in 2012, she tried to fall pregnant at 43 with her own eggs. With the help of IVF, she had six embryos transferred into her uterus on separate occasions, but she was not successful. She did get pregnant once but miscarried at eight weeks' gestation.
After that, she decided to find an egg donor. A 37-year-old woman volunteered and embryos were created using the donor's eggs and sperm from Ms Korolak's partner, Justin Ward. The first embryo created Eden, who was by and large a smooth pregnancy. Ms Korolak did experience a pregnancy-induced thyroid condition but it did not create much illness.
"I had one of the top obstetricians in Melbourne, Guy Skinner, and he said I had probably one of the healthiest pregnancies he had seen in someone who was 45 and 46 years old," she said. "I didn't have a problem other than my baby getting stuck sideways and needing to be born by C-section at the end."
With several embryos frozen, Ms Korolak said she was hopeful she might fall pregnant again. Despite struggling with the sleep deprivation, particularly in Eden's first few months, she said she felt good about becoming a mother in her 40s when she had travelled the world and achieved other goals.
"It's not over until it's over. I feel pretty young and healthy," she said.
