By Birth & Baby University · Last updated: October 2026 · 3 min read
“Advanced maternal age” is a label many parents over 35 dislike, and the research behind it is often misquoted. Risks do rise with age on average, but they rise gradually, differ by outcome, and are often reported as relative risks that sound larger than the absolute numbers. This article reviews the large studies and suggests ways to talk about age without fear or false reassurance.
Key takeaways
- Risks of stillbirth, preterm birth and cesarean rise with maternal age in large cohorts, and some of the clearest increases are from 40 onward.
- Elevated risk persists after adjusting for parity, ethnicity, deprivation and body mass index in a 215,344-birth cohort.
- Severe maternal morbidity increases with age, but the adjusted absolute increase for ages 40 to 44 was about 0.9 percentage points compared with ages 25 to 29.
- Age is one factor among many. Individual health, history and care matter, and averages do not predict one person’s pregnancy.
What the research says
A large contemporary cohort
A population-based study of 215,344 singleton births in northwest England compared women aged 30 to 34, 35 to 39 and 40 or older with those aged 20 to 29, adjusting for parity, ethnicity, social deprivation and body mass index. Women aged 40 and over had higher risks of stillbirth (RR 1.83, 95% CI 1.37 to 2.43), preterm birth (RR 1.25), very preterm birth (RR 1.29), macrosomia (RR 1.31) and cesarean (RR 1.83). The authors stressed that the risks were independent of parity and remained after adjusting for factors that usually favor older mothers, such as higher socioeconomic status.
Severe maternal morbidity
A Canadian retrospective cohort study found severe maternal morbidity rose with age, from a crude odds ratio of 1.2 at ages 35 to 39 to 5.4 at 50 and older. After adjustment, risks remained increased for those 35 and older. Among those 40 and older, amniotic fluid embolism and obstetric shock were more common, and among those 45 to 49, renal failure, complications of interventions and ICU admission. The adjusted risk difference compared with ages 25 to 29 was 0.9 percentage points (95% CI 0.7 to 1.2) for ages 40 to 44 and 1.6 for 45 to 49. The authors noted that statistical power was insufficient for maternal death and very rare conditions.
Meta-analysis at 40 and above
A 2022 systematic review of 27 studies (over 31 million women, mostly retrospective cohorts) found women aged 40 or older had a higher risk of stillbirth (RR 2.16, 95% CI 1.86 to 2.51), and of perinatal mortality, growth restriction, NICU admission, preeclampsia, preterm birth, cesarean and maternal mortality (RR 3.18). Risks rose further above 45 and above 50, where maternal mortality ratios were far higher. Because these events are rare, relative risks can be large while absolute risks remain small for most people, and the data come from varied health systems.
Labor and induction
A retrospective cohort of 4,027 first-time mothers undergoing term induction found cesarean more frequent at ages 40 to 44 (OR 1.79, 95% CI 1.50 to 2.14) and 45 and older (OR 3.95), mainly because of failed induction. No other adverse maternal or neonatal outcome was associated with age in that population. The authors recommended individual evaluation of the risks and benefits of induction for older women.
What this means for doulas
- Do not treat 35 as a cliff. The cohorts show risks rising across ages, with the larger increases in the forties.
- Translate relative into absolute risk. Say “more likely on average” rather than “high risk,” and invite the client to ask their provider what their own risk is.
- Do not pathologize. Many older parents have uncomplicated pregnancies. The label should not shape how you speak to a client.
- Leave screening and timing to clinicians. Extra monitoring or earlier induction may be offered. Help families understand the reasons and options.
Putting the evidence into practice
- Ask clients what they have been told about their age and listen for fear or frustration.
- Offer a question list about monitoring, timing of birth, induction and what extra support is available.
- Support the parts of preparation within the client’s control, such as rest, appointments, mental health and postpartum planning.
- Be mindful that infertility, loss or treatment history may sit behind the label and treat it gently.
The bottom line
Maternal age is associated with gradual increases in several risks, but averages hide wide individual variation and most pregnancies at every age go well. Doulas help by speaking accurately, avoiding fear and supporting informed conversations with clinicians.
This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.
Sources and further reading
- Kenny LC, et al. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE 2013. Read the source
- Lisonkova S, et al. Maternal age and severe maternal morbidity: a population-based retrospective cohort study. PLoS Medicine 2017. Read the source
- Saccone G, et al. Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis. International Journal of Gynecology and Obstetrics 2022. Read the source
- Claramonte Nieto M, et al. Maternal and perinatal outcomes in women ≥40 years undergoing induction of labor compared with women <35 years: results from 4027 mothers. Journal of Obstetrics and Gynaecology Research 2022. Read the source
Supporting parents of every age and circumstance is central to doula work. See the training and mentorship options on the For Doulas page.
More for professionals: the Professionals Blog.
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