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Advanced Maternal Age and Recovery: Sharing Grace



This week, I will share Part Two of Recovering Women and Advanced Maternal Age: A Story of Hope (and Grace, who you will meet at the end of this blog).

To read Part One of Sheira’s story, click here.ama

Last week, Sheira shared about some of the obstacles she worked through in order to have a baby at age 50.  Here is the final excerpt of the interview in which she shares the obstacles she worked through, and the miracle that she birthed, at age 50:

Emotional Clearing

There was all this evidence stacked up supporting the fearful belief that I couldn’t have a baby. It was important to go in there, make conscious those fearful beliefs, and express them. When I touched in those beliefs, I felt like throwing up. I had just tried an embryo donation that had fallen through. I touched into this very deep grief about my family life not working out. And I really felt like throwing up. That’s what my body really wanted to do. This sounds strange, but I let myself dry heave and tear up and cry all at the same time. And it was cathartic! It was a layer of grief that was so unconscious. It felt good for it to be out. So that was one of the turning points.

I had another turning point when I was deciding between two sets of embryos. I didn’t know if either one would work out. I had reason to believe I wouldn’t be able to carry a child. I was afraid there had been too much damage done. I was telling this to a friend who’s had three children. I was explaining how it doesn’t get to work out for me and I have evidence supporting this belief.  She turned her around and she said:

“This sounds like depression.”

She had a word for it. It was a relief to name it as depression, as it had only ever been the truth to me. And then she said:

“Having children came really easily to me. Give your depression to me. I can help you with that.”

And she did. She put her hands out and we kind of held on each other’s forearms and I just closed my eyes and I said “OK, I’ll give it to you. I give you my depression about family.” And she just accepted it, and it ended in her unafraid psyche.

My fears finally had someplace safe to go. There was another human being who got in there with me. After, that I would still get fearful thoughts sometimes, but they just didn’t have the same hold. And then some events happened that went counter to the (fear-based) evidence.

Practical Steps

After my second marriage ended, I knew I was going to have to do it on my own. So I got my mind around adopting the embryo and I went on an embryo donation web site.  I knew two people who had embryos, and they both came forward and offered them to me. Then it became a question of what the requirements and wishes of the donating families, and which was a better fit. I decided on a certain set of embryos. Then there was a very expensive legal transfer of the embryos to my posession. There was no legal precedent for transferring embryos, so my lawyer had to do original scholarship on it. The lawyers fees and transferring the embryos from one physical location to another took a lot of time and money. But finally, I was able to move forward.

Happily (Mostly) Ever After 

And then I met someone who basically was a much better suited partner for me than the other two I had chosen. For me that really settled and we entered into a long honeymoon period. I was having all this evidence that contradicted the fearful belief that I wouldn’t be able to have a family. (NOTE: Finding my partner was a very important piece, But I had already made the decision to have a baby. I know many single mothers, and anyone who wants to be a single mother, I would encourage you to do that. I made the decision to have a baby first, and then the right partner came.)

The embryos were transferred and then I began the medical procedures that I needed to do. I was in full menopause in 2009 and in 2014, I got pregnant.

On Fertility:

I was 45 when I went to through menopause. I think it was related to my eating disorder. Eating Disorders mess up your hormones. That’s probably why I went into menopause early. My mother was 55 when she was in full menopause and I was 45. If you have had an eating disorder, the good news is you can have a baby. There’s so much help now, in so many ways, to get pregnant.

So once we had the embryos in the right place, I started doing the medical procedures. I got the green light from the head of the fertility department that we could implant. It was an amazingly easy procedure. I had a very mild dose of the pain medication and I was completely awake. There was a teeny tiny tube that had the embryo in it and they had to look at it with a magnifying glass to make sure the embryo was in it. And then they put it into me and checked with their magnifying glass that there was nothing in the tube. The they said:

“That’s great, it must be in there.”

What I want people to know is: it felt like a conception. One of the members of the embryo donation family was there, and my partner was there, and a very dedicated acupuncturist. It seems futuristic and scientific, but that’s how my baby got conceived! It was love. It was different, but it was still love. It was not anything like I pictured, but it was still great.

I was afraid to get my hopes up. My whole world had been turned around as far as what I thought I knew about finding a partner, the kind of partner that I thought would be a good partner, and what I thought I knew about how I would make my family. So I didn’t want to get my hopes up. Looking back, I realized that there was a knowing, but it wasn’t like fireworks at all. Then I went to the doctor for a real pregnancy test. And I was pregnant!

How was the pregnancy?

I have terrible insomnia and I have had terrible insomnia since I was born. I didn’t sleep through the night till I was three years old. When I was pregnant, I slept great. I could sleep anywhere. I could fall asleep in 10 seconds, get woken up, and go right back to sleep. My experience of being pregnant was I was never so calm. I still feel that way when I hold my daughter. My whole system just goes calm. And I feel her system going like that. You know we just got lucky on that.

But in other ways, the pregnancy was very difficult. One way I had recovered from my eating disorder was to learn to eat when I was hungry and stop when I was full. But I didn’t feel hungry. I actually lost weight in the first trimester. I was getting worried because I thought the baby wouldn’t get enough nutrition. People were saying I looked funny. I was at my goal weight of what I wanted to be when I was in high school. I was so skinny. Why did I ever think that was attractive? I had to require myself to eat. As the pregnancy progressed, people said the sickness was going to go away. It didn’t for me. It kept going. I was worried I was carrying small. I had an ultrasound and the technician stopped the appointment to call the doctor and say:

“We have a 6th percentile here.”

My baby was only in the in the sixth percentile of growth. I became very worried. I was instructed to stop working. I had to stay at home. I was instructed to stop exercising. Then I had to come in every week, just to make sure the baby was growing.

Miracles happen

By about a week before she was born, my baby was in the normal range. It’s very unusual if you start out at the sixth percentile that you would get back into the normal range. I can’t say exactly what happened. The doctor thought it was because I was working at home and stopped exercising. Clearly that helped.  But it’s still a mystery to me how she could have grown that much.

Labor and Delivery

10 days before the baby was born, I found a doula to interview. We met on a Friday and we planned to meet again on the following Monday. Well, on the Sunday night before I had to lay down for a nap. And I felt all this wetness. Throughout the night the fluid that was coming out was pink, and then it came out brown and the doula said:

“You have to go to the hospital now.”

My friend drove me and I got there and they wanted to give me pitocin. I had heard that there was a cascade of interventions that they give you from there. I wanted to have a childbirth with as few interventions as possible. But an hour later, I still wasn’t progressing and they gave me a drip of pitocin.

I dilated very, very quickly. I pushed with no pain medication, doing everything with the help of the doula. I pushed and her head crowned. I could feel her. I did tear, and it really hurt. I’m never going to forget how painful it was. It’s not fair to women that you don’t remember it. This should be remembered.  My beautiful baby came out and she was strong. She was five pounds eight ounces at five pounds seven ounces, they take the baby into the NICU. She just made it. When they sewed me up, they were singing songs to her. It was very sweet.

Grace

The strange part was I thought I was going to have a completely empowered expansive experience when I was giving birth. I thought it was going to be like the earth mother would come through me and I would feel so competent. But it wasn’t like that. My inner critic was huge and loud every minute. It said I was doing it wrong.  That’s the only voice I heard in my head. I was so surprised. I was so pissed off!

After the birth I heard them talking about me at the nurses station. They said “No pain medication?”  Then the nurse came into my room and she said:

“You are my queen. I’m going to give you a tiara. All other all the other girls on this floor are 25 years old and they’re asking for epidurals. And you came in here with your doula and you did your thing.”

That was exactly what I needed to hear. I could not undo my own critic and this lovely nurse did it for me. It prompted a healing where I realized I am complete in all of my body. I can’t believe I ever rejected it. I realized I had thought the hardware was flawed. But the hardware was not flawed- it never was. The software was flawed. I had

miracle-babybelieved that my body was incompetent and wrong. But It wasn’t my body. My body knew what to do. My actual body is like a strong and powerful tree, or a flower in its infinite wisdom.

Her name is Gracie. It’s my way of thanking the family who donated the embryos and thanking God for finally giving me what I what I had so much.

Sheira Kahn, MFT, is a marriage and family therapist in the bay area who gave birth to a beautiful baby girl at age 50. To read more about her professionally, you can visit her website here

 

 

Recovery and Advanced Maternal Age: A Story of Hope

I’m in the process of interviewing professionals and recovering women for my book, Good Enough Mama: Taking Care of Yourself and Your Recovery During Pregnancy and Postpartum. And I’m being blown away by the amazing women I am meeting. So I’ve decided to share some of the experience, strength, and hope they are offering in their stories.

But first, a bit on Advanced Maternal Age (and how it relates to eating disorders):

There are many reasons why women are delaying having a baby until later in life, including: effective contraception, gender equality, women reaching higher educational

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image from Everydayfamily.com

levels, cultural value shifts, divorce or partnering later in life, lack of childcare support, an absence of supportive family policies in the workplace, economic hardship, job instability or work in male dominated fields that are not supportive of or understanding of motherhood.*

Along with reaching higher educational levels, many recovering women want to do personal growth work and solidify their eating disorder recovery prior to becoming a parent. However, delaying childbirth until after age 35 can further inhibit fertility for women that may already have fertility problems leftover from their eating disorder history.

Twenty million women and 10 million men have an eating disorder at some point in their lives, according to the National Eating Disorders Association. Fertility problems, though they can be overcome, are among the potential long-term consequences of such conditions, with some studies suggesting that eating disorders account for about 18 percent of patients seen in infertility clinics, says Dr. Leslie A. Appiah, associate professor in the University of Kentucky College of Medicine’s Department of Obstetrics and Gynecology. **

OK, enough with the stats. I’d like to get to the stories of hope because the purpose of this blog (and the upcoming book) is sharing hope: hope that recovery is possible, hope that motherhood is possible, hope in the knowledge that you are not alone.

So without further ado, let me introduce you to Sheira Kahn, MFT. Sheira is a marriage and family therapist in private practice with two decades of experience in treating eating disorders and three decades of her own recovery. For those of you struggling with hope that you can still be a mom later in life: She had a baby at age 50.

Here is her recovery story:

When I was a teenager and I was bulimic. The house where lived was filled with turmoil that I literally couldn’t stomach. Thankfully, when I moved out, I stopped purging. However, hatred of my self and my body persisted. I still hated my body and I hated every bite of food that I ate. The mental part of the disorder persisted. I was in pain and I knew that I didn’t want live that way. So I joined a meditation school where they taught us about how to work with the critic. And since my critic was always criticizing me about my body, I did what they said to reduce your critic. Every time my inner critic was loud and mean, I practiced. And my relationship with my body changed, because there was less hatred being channeled from a critic toward myself. Then, a book on hunger and fullness signals taught me how to listen to my stomach, not my critic, when making food decisions.

What inspired and motivated you to get into recovery?

I was in so much pain. I wanted the pain to be reduced. I think with some people, the coping mechanism (of the disordered eating) works to keep them numb to the pain, so  they keep doing the coping mechanism. But for me I was in pain. It wasn’t a hard decision for me. I felt so bad. I thought recovery was going to make me feel better, so I threw I threw myself into it.

Did you always know that you wanted to be a mom or did that desire come later?

I always did growing up and then, in my 20s, I thought I didn’t. And then it came back. And then it came back very, very strongly. I assumed that would happen for me, as it seemed to happen so easily for other people. I had no idea that it that I would have to go through a lot actually to become a mom.

What happened?

For me it was a combination of factors. I wanted to be partnered.  I married someone that I had fallen in love with when I was 21. He wanted to have kids, and I didn’t. Then I changed my mind, but then he had changed his mind! That relationship wasn’t working out for several reasons. Then I got married again. I was in my I was 40’s when we started trying, so I was on the late side as far as far as fertility. It might have happened if I had felt safer in the relationship. However, I didn’t feel safe in the relationship to bring in a child. I believe this influenced my already shaky fertility. However, I knew I really wanted to have a baby, and I was ready to do whatever I needed to do. I was ready to have a baby or have a family, even without a partner who is willing to do it. I just knew that I had to go for it.

By that time there were some things in place that showed me I could be successful being a mom. I felt healed enough in myself. I had a sense of inner strength and I had support. I was making good livelihood on my own at that point, so I knew I’d be able to provide for a baby.

What happened in the decade between 40 and 50?

Three things during that decade: internal readiness, emotional clearing, and practical steps.

Internal Readiness

There was an internal readiness that I didn’t achieve until I was 48 years old. I came from a family where there was emotional trauma. There was extreme disconnection: fighting, antagonism, conflict, and fear between my parents. That set me up to have very few skills for building long term relationships. It gave me a layer of fear. When there are emotional injuries like this, it’s like a layer in your body. It felt like a layer of beliefs that went along with this fear. I thought that I would never be able to have a family. Or that it could happen for other people, but not me. I saw it happening for other people, and I believed it couldn’t exist for me. There was all this evidence that had confirmed the belief I held: Sheira doesn’t get to have family. I had been divorced once and then was getting divorced a second time. I had miscarried…

(Don’t worry! Remember this is about hope. The story doesn’t end here! Stay tuned next week for part two where we get to the Hope part of Experience, Strength, and Hope)

Sheira Kahn, MFT, is a marriage and family therapist in the bay area who gave birth to a beautiful baby girl at age 50. To read more about her professionally, you can visit her website here

References:

*Mills M, Rindfuss, RR, McDonald P, Te Velde E,“Why do people postpone parenthood? Reasons and social policy incentives,” ESHRE Reproduction and Society Task Force: Hum Reprod Update, 17(6):848-60, Nov/Dec 2011.

** Medaris Miller, Anna “The Lasting Toll of An Eating Disorder: Fertility Issues,” US News and World Report, March 31, 2016.

 

Motherhood, Body Image, and Disordered Eating in Middle Age

I remember going to my first ObGyn visit when I was pregnant. The Doctor put “AMA” in my chart. Having worked in treatment settings for eating disorder recovery for many years, I thought she meant “Against Medical Advice,” the term clinicians use when a client is choosing to leave treatment despite their providers’ recommendations. I quickly said to my Doctor:

“I just want you to know am willing to implement any medical advice that you give me regarding my pregnancy!”

She gave me a blank stare.

I explained that I noticed she had written “AMA.”

She smiled. That means “Advanced Maternal Age.”

“Oh.” Long pause. “Oh.”

Being a mother of “advanced maternal age” is becoming more and more common in developed nations, as women work toward completing higher education, solidifying their careers, finding the right partner, and doing personal growth work prior to having children. The Center for Disease Control and Prevention reports:

Delayed childbearing in the United States is evident in the 3.6-year increase in the average age at first birth between 1970 and 2006…The dramatic increase in women having their first birth at the age of 35 years and over has played the largest role in the increased average age of first-time mothers…many other developed nations have observed increases in average age at first birth with some now averaging near 30.0 years of age. 1

What does this phenomena have to do with disordered eating and body image?

Although data regarding body image in middle aged and older women remains sparse, a study published just this past month in the International Journal of Eating Disorders suggests that body dissatisfaction and drive for thinness do not diminish with age. In a survey of 715 women just out, of which 76.5% were married with children, 4.6% met full diagnostic criteria for an Eating Disorder and 4.8% met criteria for Subthreshold Eating Disorder (SED). 2 Together, that makes roughly 10%. So that means 71 of those women with children are suffering with disordered eating.

And yet the myth persists that eating disorders primarily affect adolescents. Why?

There is a reason why the myth that eating disorders affect young women in adolescence exists. According to the National Association of Anorexia and Associated Disorders (ANAD): Over one-half of teenage girls…use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.3 Adolescence is a huge rite of passage for a woman. When a rite of passage is not celebrated, ritualized, or supported, the growth required to complete crossing the threshold of this rite of passage goes underground. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls (2005), writes:

“I think anorexia is a metaphor. It is a young woman’s statement that she will become what the culture asks of its women, which is that they be thin and nonthreatening…Anorexic women signal with their bodies “I will take up only a small amount of space. I won’t get in the way.” They signal, “I won’t be intimidating or threatening. (Who is afraid of a seventy-pound adult?)” 4

Similar to adolescence, both parenting and middle age are rites of passage in a woman’s life. When not honored, seen, and embraced, these can also turn into eating disorders and body image distress. Ageing women also face the cultural taboos of not taking up too much space, speaking too loudly, or being seen and valued. They face the task of loving themselves and embracing aspects of the beauty of mortality, power, and wisdom that western media culture is terrified of in women: wrinkles, thick middles, saggy boobs, gray hair. I remember reading one article on “objectification theory” in my doctoral research that linked media and female body image obsession with western culture’s fear of mortality. Female body objectification may veil unconscious existential fears. 5 Other stress factors that affect women in middle age that are similar to adolescence are hormonal changes. However, middle age women also face different stressors such as: medical scares, death of a parent or a spouse, divorce, and career challenges. 6 Margo Maine, co-author of The Body Myth: Adult Women and the Pressure to be Perfect, writes:

Women in their 30s, 40s and beyond face increasing pressure to look slender and youthful despite years of childbearing, hormonal changes at menopause and the demands of careers, parenting and caring for aging relatives…Some researchers call it the ‘Desperate Housewives effect,’ referring to the cultural influence of the hit TV series, in which improbably thin women in their 40s prance around in short shorts. 7

It is an interesting journey being “advanced maternal age.” Sometimes I look at young(er) women or young(er) mothers and I think You look so not tired. Or Wow your stomach looks so not stretched. I remember that. That feels like a long time ago. Or I envy younger moms who are more likely to have their grandparents be present for their children’s growing up. My child will already never meet one of his Grandpas. He died before my baby was born. However, there are gifts I have being “middle aged” that I couldn’t have come by earlier in my journey. I had not yet solidified my eating disorder recovery in my twenties. I had not earned a doctoral degree in Psychology in my twenties. I had lots of ideas and lots of difficulty with follow-through. I thought being earnest would pay the rent. The concept of income needing to match or be greater than outgoing expenditures was not a concept I truly understood or felt applied to me. Because I now have financial clarity, I don’t have to “deprive,” “restrict” or  “binge” or “purge” with money, like I used to do with food in my twenties. Interestingly, though I hated my (flatter) stomach in my twenties, I now love my (stretched) stomach in my early middle age. I also have much more capacity to pause and come back to difficult interactions in relationships rather than avoid, hide, or leave. I would not have been ready for marriage in my twenties. I would not have had the “distress tolerance” skills to go toward a young child and stay emotionally present through individuation-attempting tantrums. I would have been inadvertently shaming or stuffed the discomfort with food. I can tolerate it now. I would not have been a good, or frankly even good-enough, mother in my twenties. I wasn’t ready. I remember studying for the Psychologist licensure exam learning that the executive function of the brain (the part that fully understand cause and effect and is able to therefore pause impulsive actions) is not fully developed until the late twenties, or even 30. Does that mean all women should only have children after age 35? Or that only women over 35 are good (enough) mothers? Of course not. And not all women are able to. One always has the potential to become a good (enough) mother. In fact, the eating disorder recovery process mirrors the journey of becoming a good enough mother to one’s self: allowing and embracing imperfection, listening to and honoring emotions, communicating clearly, getting enough sleep, eating in a balanced way, practicing mindfulness or spirituality, connecting with support. And THAT is always possible and always a work-in-process, regardless of one’s chronological age.

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Dr. Linda Shanti McCabe is a Mom and Licensed Clinical Psychologist who works with women recovering from Eating Disorders, Body image difficulty, Depression/Anxiety, Perinatal Mood Disorders, and New Mommy “boot camp.”You can read about her work professionally at www.drlindashanti.com

Resources:

1. T.J. Mathews, T.J. and Brady E. Hamilton, “Delayed Childbearing: More Women Are Having Their
First Child Later in Life,” Center for Disease Control NCHS Data Brief, Number 21, August 2009. http://www.cdc.gov/nchs/data/databriefs/db21.htm

2. Mangweth-Matzek, Barbara, Hoek, Hans W. et al, “Prevalence of eating Disorders in Middle-Aged Women,” International Journal of Eating Disorders2014; 47:320-324.

3. National Association of Anorexia Nervosa and Associated Disorders websitehttp://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/

4. Pipher, Mary, Reviving Ophelia: Saving the Selves of Adolescent Girls (2005).

5. Grabe, Shelly, Routledge, Clay, Cook, Alison, Anderson, Christie, and Arndt, Jamie “In defense of the Body: The Effect of Salience on Female Body Objectification”, Psychology of Women Quarterly, Vol 29, 2005.

6. Harding, Anne Eating disorders: Not just for the young, CNNHealth.com, June 27, 2012. http://www.cnn.com/2012/06/26/health/mental-health/eating-disorders-not-just-for-young/

7. Barton, Adriana, “Are middle-aged women succumbing to ‘Desperate Housewives syndrome’?” The Globe and Mail, March 6, 2013.http://www.theglobeandmail.com/life/health-and-fitness/are-middle-aged-women-succumbing-to-desperate-housewives-syndrome/article578178/

8. Tiggemann M., “Body image across the adult life span: Stability and change,”Body Image 2004; 1:29-41. 9. Slevec JH, Tiggemann M., “Predictors of body dissatisfaction and disordered eating in middle-aged women,” Clinical Psychology Review 2011; 31: 515-524.

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