Imagine you have a busy full-time job. You get married at age 31. You and your new partner travel to Italy, Ireland, and Hawaii before settling with the kids. You both make pretty good money, so you buy a house. Of course, it needs furniture. And you have to have the new I-phone that just came out. You’re finally ready to get pregnant, but after two years, it hasn’t happened. Now you’re 37, and your obstetrician suggested IVF: in vitro fertilization.
The above scenario is typical of the patients I care for as an antepartum/postpartum nurse in the San Francisco Bay Area. They are AMA, or advanced maternal age, 35 years or older. Due to this high-risk age group, they often have gestational diabetes and gestational hypertension. Much to their dismay, labor is often induced before their due date. Bi-weekly antenatal testing is required during their third trimester, and they have many other additional appointments with high-risk obstetricians, ultrasounds, and lab work. They are miserably trying to juggle work, home, partner, appointments, and dietician-approved meals. What happened to the “glow” of pregnancy?
By the time I get them as patients in postpartum, they are overwhelmed and exhausted. They have two days to learn infant and self-care and master the art of breastfeeding. Due to their advanced maternal age and often higher education, they have read every 5-star book on pregnancy, labor, and motherhood. They “think” they know everything but probably haven’t changed a diaper. Some of them have even hired nannies for $8,000 per month!
The fallout of this older maternal patient is a massively increased workload for the already over-taxed nurse. There is often vital sign frequency, serial infant blood sugars, feeding issues due to an earlier birth, and an increased need for education and demonstration. This clientele frequently is used to being in control of their environment. They are now sleep deprived, impatient, and dumbfounded with their crying infant. Consequently, they frequent the call light!
This older mom wants to understand everything – from all ways to swaddle and burp a baby to hands-on assistance every time they breastfeed. I’ve actually had dads video tape me demonstrating a diaper change! They often have unrealistic expectations and are shocked when you inform them they aren’t going to get much sleep over the next month. These patients need additional support, and there isn’t the time to give it.
Additional care of these patients means additional charting and additional content in the report for the next shift. Incremental overtime is common, which consequently upsets management. Postpartum nursing may not have the same urgent situations as ICU or the ED, but with staffing issues and fewer breaks, they are negatively impacted. Often there aren’t nursing assistants, so nurses are bussing trays, frequently filling water pitchers for mom and her partner, and answering call lights.
I believe this older group of moms could be better prepared prenatally. A medical assistant or other health care provider could offer a list of tasks to master at OB appointments: diaper changing, swaddling, and using a car seat. More specific information should be provided on what to expect in pregnancy and beyond. Prepare them for what a 3-day induction looks like, little sleep and sore nipples. Because, believe me, they tend to have no clue!
This group of advanced maternal-age moms is not going away. They need to be understood and supported. Fortunately, they are capable and teachable. There needs to be a way to get more information to them before they deliver.
Donna Barnett is a nurse.
