28 March 2007A new study proposes strategies for health care professionals to ease the transition to motherhood for women who give birth after fertility treatment, writes Karin Hammarberg

AMONG the women who give birth in Australia each year, the proportion aged 35 and over has increased from 12.7 per cent in 1994 to 19.5 per cent - or nearly one in five - in 2004. Many couples who try to start a family when they are in their late 30s and 40s discover that they are unable to conceive and resort to assisted reproductive technology (ART). The birth rate after fertility treatment in Australia is increasing; in 2004, over 7000 children were born as a result of ART, accounting for 2.7 per cent of all Australian births that year. But the evidence suggests that ART creates a unique set of challenges for women.

Delayed childbearing is due to a range of factors. Women are leaving the parental home and forming permanent relationships at an older age. Marriages are more likely to break down and cohabiting couples have a high rate of separations. More women are pursuing a career and are increasingly financially independent. And, of course, contraception is more reliable. Recent research also suggests that some women miss their opportunity to have children due to their partner’s reluctance to commit to parenthood.

As a nurse with 20 years experience of working with couples with fertility problems, I became acutely aware that this pathway to parenthood is not without its personal and physical consequences. To better understand the needs of the growing group of women who become mothers after assisted conception, the Key Centre for Women’s Health in Society at the University of Melbourne conducted a prospective longitudinal study of the experiences of childbirth and early parenting after assisted conception.

This study is the largest and most comprehensive Australian investigation of mothering after assisted conception, with over 150 women completing three questionnaires after the birth of their child. My colleagues and I compared this data with the general population and with data from other studies of childbearing women.

The ART group was more socioeconomically advantaged than other women of comparable age. On average, they were five years older when they gave birth, and more likely to be first-time mothers (70 per cent versus 42 per cent), have twins (18 per cent versus 1.6 per cent) and experience a caesarean section delivery (51 per cent versus 25 per cent). When asked about their experience of the birth, they were more likely than other women to feel disappointed, particularly if they had a caesarean section birth. Furthermore, they were more likely to report feeling anxious about caring for the new baby when they left hospital.

The study found that women who conceive with ART experience more early-parenting difficulties than comparison groups, including a lower sense of maternal confidence, a three times higher rate of admission to residential early parenting services in the first eighteen months, lower rates of breastfeeding at three months, and more anxiety about being separated from the baby.

Becoming a mother is a significant event in any woman’s life. This study shows that when the path to motherhood has been complicated by infertility and ART it may be more emotionally complex. We believe that infertility, the need for technology to conceive and an operative birth may have a cumulative effect in eroding a woman’s confidence in herself and her own body. On top of that, these women are often immensely grateful that the treatment worked and have a very low sense of entitlement to complain about the problems and anxieties they are facing when adjusting to motherhood.

The findings of this study allow us to think of ways to meet the needs women who give birth after ART. Some suggested strategies include the following:

• Make it very clear during pregnancy that there is a high chance that the birth will be by caesarean section to lessen disappointment if that happens.


• Reinforce to women that it is normal to feel ambivalent about the baby and being a mother, even if the baby was very wanted and conception was difficult.


• Increase awareness that being a new mother, especially if the baby is unsettled and cries a lot, can be extremely exhausting and isolating.


• Provide clear, concise and consistent advice about feeding and settling babies.


• Reassure women about their ability to care adequately for their baby.

These strategies could be used by health care professionals to ease the transition to motherhood for the growing group of women who give birth after ART. •

Karin Hammarberg is a research fellow in the Key Centre for Women’s Health in Society, University of Melbourne.

Photo: Ronnie Comeau/iStockphoto.com