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Abstract: Background: There is a global trend, in high resource countries, for delayed childbearing beyond the age of 35. Women of advanced maternal age are considered to be at higher risk of poor maternal and neonatal outcomes. Women''s views and experiences of delayed childbearing are relatively unexplored. Objectives: To gain an understanding of factors influencing women''s decisions to delay childbearing and explore their experiences and perceptions of associated risks. Design: A qualitative phenomenological study. Setting: Greater Manchester, United Kingdom. Participants: Purposive sample of 18 women aged 35 and over in three groups; six women with no children who were not pregnant, six women pregnant with their first child and six women with no children attending a fertility clinic. Methods: Data were collected by in depth semi-structured interviews, managed manually and subjected to thematic analysis. Results: Three main themes were identified; the chapters of life, the need to know, and childbearing being within or beyond women''s control. Women focussed on the need for a stable relationship, being “ready” to have a baby, and acquisition of life experience. Their experiences reflected a lack of awareness of many of the risks associated with pregnancy over age 35 and disbelief that age alone necessarily increased the likelihood of poor outcomes. Women perceived a lack of choice in the timing of when to start a family. Women suggested that although they may have reached a juncture in their lives, at which they felt ready to have a baby, the circumstances in which they found themselves may not support this; factors such as relationship, financial stability, health and fertility, were often outside of their control. Conclusions: Women do not perceive that they have ultimate control when it comes to the timing of childbearing. Health professionals and the media should be aware of the complex interplay of factors surrounding women''s reasons for delaying childbearing. Sensitive information and support should be provided allowing for varying perceptions of risk status. Women may benefit from pre-conception education. [Copyright &y& Elsevier]

Abstract: Delayed childbearing is a growing trend in developed countries. Between 1989 and 2009, the number of live births to UK women over 40 almost trebled. This accelerating demographic shift is of major clinical and public health concern, because advanced maternal age has consistently been associated with adverse pregnancy outcomes. Current evidence suggests a strong association with increased risk of miscarriage, ectopic pregnancy and stillbirth. Most studies also report elevated maternal morbidity resulting from hypertensive disorders and gestational diabetes. Many questions remain unanswered regarding the underlying mechanisms. The contribution of age per sé versus co-morbidities is unclear, as is the age threshold at which increased risks become significant. Despite the increased risks, there are potential psychological and social advantages to delaying childbirth and absolute numbers of complications are small. Further studies are required to develop effective strategies to reduce poor outcomes and provide optimal care for pregnant women of advanced age. [Copyright &y& Elsevier]