women s decisions about timing of motherhood

© 2006, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses JOGNN 625

Objective : To examine the factors that infl u-ence women ’ s decisions about the timing of mother-hood from a life span perspective.

Design : Qualitative. Setting : Large Western Canadian city with a

high rate of infants born to women aged 35 years and older.

Participants : 45 Canadian women aged 20 to 48 years.

Results : Independence, a stable relationship, and declining fertility infl uenced women ’ s decisions about the timing of motherhood. Women integrated child developmental transitions into a projected life plan as they considered the timing of motherhood. Partner readiness and family of origin infl uences played a lesser role. Delayed childbearing has be-come more socially acceptable, with subsequent negative connotations associated with younger moth-erhood. Parental benefi ts have limited infl uence on the timing of motherhood.

Conclusions : Recognition by nurses of the vari-ous and complex factors that infl uence women ’ s deci-sions about the timing of motherhood may fl ag the importance of pregnancy-related counseling for woman across the fertility life span. Policy decision makers must be cognizant of the need for additional high-risk obstetric and neonatal health services when societal norms encourage women to delay childbear-ing in favor of completing education and establishing a career. JOGNN, 35, 625-633; 2006. DOI: 10.1111/J.1552-6909.2006.00079.x

Keywords : Decision making — Delayed child-bearing — Infertility — Policy — Pregnancy — Qualita-tive research — Women ’ health

Accepted: March 2006

In Canada, the average age at childbearing is in-creasing ( Astofi & Zonta, 2002; Wu & MacNeil, 2003 ). In 1983, 14% of fi rst-time mothers were 30 years and older; by 1999, this proportion more than doubled to 32% (Statistics Canada, 2001). In 2003, 48% of mothers were 30 years and older when they gave birth (Statistics Canada, 2005). In Alberta, between 1990 and 1996, the proportion of births to women 35 years and older increased by 51.2%, with concomitant increases in low-birthweight (11%) and preterm delivery (14%; Tough et al., 2002 ). On aver-age, older mothers tend to be married, highly edu-cated, and affl uent ( Hansen, 1986; Joseph et al., 2005 ). These psychosocial advantages may balance the reproductive risks for women who delay child-bearing ( Ferguson & Woodward, 2000; Stein & Susser, 2002 ). However, there is limited knowledge on the factors that infl uence women ’ s decisions about the timing of motherhood, particularly among younger women. The purpose of this qualitative study was to examine the factors across the fertility life span that infl uenced women ’ s decisions about moth-erhood. In this study, fertility life span is the term used to defi ne the time during a woman ’ s life when she has the ability to bear children.

There is limited knowledge on the factors that infl uence women ’ s decisions about the timing of motherhood, particularly among

younger women.

Factors Infl uencing Women ’ s Decisions About Timing of Motherhood Karen Benzies , Suzanne Tough , Karen Toffl emire , Corine Frick , Alexandra Faber , and Christine Newburn-Cook

CLINICAL RESEARCH

626 JOGNN Volume 35, Number 5

The recent trend toward delayed childbearing has shifted the focus of reproductive risk away from adoles-cent mothers toward mothers 35 years and older ( Carolan, 2003 ). After the age of 31, the probability of conception falls rapidly ( Dunson , Colombo, & Baird, 2002 ; van Noord-Zaadstra et al., 1991 ), and older women are more likely to require reproductive assistance to become preg-nant ( Tough, Toffl emire, Newburn-Cook, Fraser-Lee, & Benzies, 2004 ), with associated increases in multiple and preterm births with some types of reproductive assistance ( Tough, Greene, Svenson, & Belik, 2000 ). In Canada, there are a number of insured options for reproductive technologies. Currently, the most successful procedures, such as in vitro fertilization and intracellular sperm injec-tion, are not insured in many Canadian provinces.

Women who conceive in their late 30s have an increased risk for spontaneous abortion, regardless of obstetric his-tory ( Andersen, Wohlfahrt, Christens, Olsen, & Melbye, 2000; Smith & Buyalos, 1996 ). They are more likely to begin their pregnancy with preexisting chronic medical conditions, such as hypertension ( Barton et al., 1997 ), dia-betes ( Bobrowski & Bottoms, 1995 ), or other diseases ( Scholz, Haas, & Petru, 1999 ). The detrimental effects of smoking on birthweight increase with maternal age ( Bonellie, 2001; Tough, Svenson, & Schopfl ocher, 1999 ). Older fi rst-time mothers are at greater risk than their younger counterparts for induction of labor related to pre-eclampsia and postdates ( Scholz et al., 1999 ) and for caesar-ean delivery ( Gilbert, Jandial, Field, Bigelow, & Danielsen, 2004; Heffner, Elkin, & Fretts, 2003; Main, Main, & Moore, 2000 ; Scholz et al.). However, caesarean delivery is increasingly associated with maternal and obstetrician choice rather than medical indication ( Papapetros, 2001 ).

Births to mothers of ages 13 to 24 are associated with increased risk of preterm and low-birthweight delivery, and neonatal or infant death ( Fraser, Brockert, & Ward, 1995 ). Compared to infants of mothers in their 20s, more infants of older mothers are stillborn ( Fretts, 2001 ), born with congenital malformations ( Hollier, Leveno, Kelly, McIntire, & Cunningham, 2000 ), or born preterm ( Joseph et al., 2005; Scholz et al., 1999; Tough, Svenson, Johnston, & Schopfl ocher, 2001 ). The risk of preterm delivery increases with multiple gestation and occurs independent of assisted reproductive technology ( Pschirrer & Monga, 2000; Tough et al., 2001 ). Others argue that pregnancy complications may be increased among older mothers, but infant outcomes do not differ ( Prysak, Lorenz, & Kisly, 1995 ). In a retrospective chart review conducted in the U.K., more women older than 35 years were placed in a high-risk category than women aged 20 to 29 years ( Windridge & Berryman, 1999 ), but there were few ma-ternal age effects related to obstetric outcomes. While the older women received more assessments, such as ultra-sound, amniocentesis, and serum screening than their younger counterparts, the only difference in outcomes was

that fetuses of older mothers were more likely to have an irregular fetal heart rate. These results are consistent with a recent systematic review that suggests that the effects of older maternal age on preterm birth are exerted through preexisting chronic disease and assisted reproductive tech-nology ( Newburn-Cook & Onyskiw, 2005 ).

A fertility life span perspective about the factors that infl uence women ’ s decisions about the timing of childbear-ing would provide useful information to counsel women during their reproductive years. This study is unique in that the perspectives of women across the fertility life span, including those without children, are explored. The philo-sophic perspective of symbolic interactionism ( Blumer, 1969 ) and an ecological framework ( Bronfenbrenner, 1986 ) guided this study. Symbolic interactionism focuses on the nature of social interaction and how a woman defi nes and gives meaning to a given situation. That is, the meaning of motherhood interpreted by the woman determines her de-cisions. The ecological framework provided an organizing structure to understand the complexity of factors that may infl uence decisions at the individual, familial, and societal levels. Factors interact across levels to infl uence women ’ s decisions about the timing of motherhood.

Method

This study was conducted to inform a larger quantita-tive survey. The purpose of the larger study was to conduct a population-based telephone survey to determine factors related to delayed childbearing and to assess whether women were aware of the risks. The joint university – health research ethics board approved the protocol. A conve-nience sample of women between 18 and 50 years in a large Western Canadian city was recruited. Through word of mouth, obstetrician clinics, parenting classes, and post-ers in public places, women willing to discuss their deci-sions about when to start a family were asked to participate. A research assistant contacted all women who expressed an interest in the study to invite them to take part. There were 116 women who expressed an interest in the study; 78 were deemed eligible after screening and were invited to take part.

The primary method of data collection was focus groups, which were held in the evening at a central location (uni-versity communication laboratories) and lasted from 1 to 1.5 hours. Thirty women who participated in the focus groups received parking passes with their letter of invitation. Student nurses provided child care on site if women chose to bring their children; fi ve women used the child care. Two women accepted reimbursement offered for in-home child-care. The secondary method of data collection was indi-vidual telephone interviews offered to 15 women who wished to participate but were unable to attend a focus group. Women were interviewed once. Consent was obtained prior to participation.

September/October 2006 JOGNN 627

Participants Participants were grouped by age and childbearing sta-

tus: group A, women older than 35 years with a child ( n = 11); group B, women 30 to 35 years with a child ( n = 9); group C, women who were currently pregnant ( n = 8); group D, women older than 30 years without children, not pregnant ( n = 5); group E, women aged 20 to 30 years without children, not pregnant ( n = 6); and group F, women aged 20 to 30 years with a child ( n = 6). The size of the group had no effect on the depth of women ’ s re-sponses. However, the depth of conversation in focus groups where mothers brought their children was affected by occasional interruptions by the child care providers. The total sample included 45 women. Most were Euro-pean Canadian, with a range of age of 20 to 48 years and completed education (high school to graduate degrees). Most were married at the time of the interview, four co-habited with a male partner, and fi ve were single. Occupa-tions ranged from “ stay-at-home mom ” to professional.

Design For this qualitative study, a sociodemographic ques-

tionnaire and a semistructured interview guide with ques-tions adapted for each group (with children and without children) were developed. The interviewer was a doctor-ally prepared maternal-infant nurse, with prior experience in conducting focus groups. The interview guide began with general questions about broad social factors that in-fl uenced women ’ s decisions about the timing of childbear-ing, such as “ What factors at work or school infl uenced your decision to start a family? ” Interview questions and subsequent probes then moved to more specifi c factors, such as “ What personal factors infl uenced your decision to start a family? ” Finally, women were asked whether or not they were satisfi ed with their decisions. Women re-sponded to and expanded upon each other ’ s words as they shared their experiences. One woman was referred to a crisis counseling service after she shared emotionally dis-tressing personal information. She declined the referral.

All interviews and fi eld notes were audiotaped, tran-scribed verbatim, and checked for accuracy. Any informa-tion that might identify a participant was deleted from the transcripts. Nonnumerical Unstructured Data Indexing Searching and Theory-Building Revision 4 software was used to manage the data. Data analysis was an iterative process conducted concurrently with data collection. After careful reading and concentrated engagement with each transcript, a coding scheme was developed based on themes that emerged from the data. A theme is a simple expression of what a data segment is about ( Tesch, 1988 ). Themes were labeled if they were recurring and essential to women ’ s decisions. Themes were compared across groups to iden-tify commonalities and uniqueness depending on women ’ s ages and whether or not they had children. The research

team refl ected on potential sources of bias in expressing themes, clarifi ed meaning and relationships among themes, and reached consensus about fi nal themes. An audit trail included both theoretical memos that documented investi-gator refl ections and insights and process memos to docu-ment actions and decision paths in the study.

Results

Themes emerging from the data are organized accord-ing to the ecologic framework ( Bronfenbrenner, 1986 ) and include individual, familial, and societal factors (see Figure 1). While the specifi c themes are presented as dis-crete for purposes of the research, factors were invariably interconnected. Illustrative examples are provided in the women ’ s own words. Pseudonyms were selected by the researchers to protect women ’ s identities.

Individual Factors Independence. Women who decided to have their chil-

dren later in life were more likely than women who had their children earlier to stress the importance of establish-ing independence through education, secure employment, and fi nancial stability. Catherine who was in her late 30s without children stated:

My mom always stressed that I needed to support my-self and be independent. I went and got a practical de-gree and got a career started. It wasn ’ t until I fi nished my degree that I was even able to consider getting mar-ried, so there was a lot of pressure [about getting an education] there.

Family Motivation. Some women were quite clear that having children was important in their life. Susan who was in her early 30s with an infant said:

I knew I wanted a big family … more than trips, more than material stability, or having a big house, or a new truck. What I wanted in life was a family.

FIGURE 1 Factors that infl uence women ’ s decisions about childbearing.


For Judy, who was older than 35 years with an infant and had delayed starting a family to achieve education and career goals, family motivation did not seem as important.

If it ended up that we didn ’ t get pregnant, it wasn ’ t go-ing to be a really big thing for us. Our children are very important to us, but if it didn ’ t work out, that would have been all right for us as well.

Readiness. Women who delayed childbearing reported feeling ready for motherhood because they had satisfi ed personal goals. Sarah who was in her mid-30s with a child said:

You [have] got a much better parent now, than if I would have been in my 20s. I am very satisfi ed [with my life] I wouldn ’ t change anything, I saw the world, had a great career, and now I have a little one.

This statement was supported by another woman in her early 30s who wanted to make certain that she was ready to have children and would not feel like she was missing out on anything once she decided to have children.

Projecting the Life Plan. A recurring theme for women of all ages, with and without children, was how they had projected a mental plan for their life by integrating their intended age at childbearing with their child ’ s life transi-tions. Kelly in her early 20s without children said:

I ’ m scared of having a kid at 30 or any later because if I have a kid, I want two or three so I ’ m going to have kids until I ’ m 35. I will be 60 when the last kid is out of the house, and that scares me!

The Biological Clock. The impact of declining fertility on decisions about childbearing was a recurring theme for most women older than 30 years. Pat who chose single parenthood and insemination by donor sperm stated:

I ’ ve always wanted a child and time was ticking by and I fi gured my eggs were getting pretty wrinkly and I had to do something, otherwise … when the right man does come along into my life they [eggs] might be dried right up and might not work anymore.

Women were confi dent that, if they needed it, repro-ductive technology would be available to assist with con-ception whenever they decided to bear a child. Sheila who was older than 30 years without children stated:

Women are having babies later because of technology, fertility technology that allows us to kind of extend our fertility period, where before we couldn ’ t, you know?

Yet, most women had not considered the biological risks of delaying childbearing, such as multiples and pre-term birth, and still favored achieving education, career, and other personal goals before starting a family.

Chronic Health Problems. Chronic health problems were related to infertility across the fertility life span. One

woman who had a life-threatening illness in her early 30s was concerned that she would never have a child but eventu-ally did. Sanchia who was an immigrant to Canada stated:

I was married when I was 24 years old, but had health problems. We tried so hard for 12 years until fi nally we have a girl. The idea of not having a child was so sad. Just thinking that when I get older, [I would be] so lonely with nobody. When you can ’ t [conceive], you feel like something is missing.

Stable Relationship. A stable relationship was critical because women did not want to raise a child on their own. Several women reported failed long-term relationships, in-cluding marriage, before they found a stable relationship they deemed suitable for childbearing and childrearing. Sarah stated:

I was married before and it just didn ’ t work out, and I lived with somebody else and that didn ’ t work out … fi nally I met the right fellow so that ’ s when we started our family, and I was into my 40s by then.

Sheila, who was older than 35 years without children, spoke about “ missing the boat ” when her long-term rela-tionship ended:

Towards the very tail end of the relationship, I began to have inner pangs about missing this opportunity. I ’ ve been separated 10 years, and the horizon is totally dark. Stepchildren are a possibility, but somewhere along the way it [childbearing] hasn ’ t been a monumental issue and the reconciliation is obviously taking place. There may have been a pang there at some point, but I ’ ve missed the boat.

Familial Factors Familial factors including partner readiness, economic

stability, and family origin play a role in women ’ s deci-sions about childbearing.

Partner Readiness. The decision to start a family was mutually negotiated with a male partner. Tanya, who was in her early 30s, wanted to have had children several years sooner but was waiting until her partner was ready.

I was ready before he was. He was so nervous about his own. This [child] was going to be his 24 hours a day. He couldn ’ t just go and play and give it [child] back. We couldn ’ t go out for a movie and dinner that we ’ ve been used to, there ’ s going to be this other person [child]. We got the dog the year before to break us in.

Financial Stability. Financial stability in the family was a recurring theme for women in the older age groups. Susan who was in her 30s with children said:

We had a house. My husband was working on his [pro-fessional designation], so we waited until he had done


that exam and both had good jobs. [We waited] until we were fi nancially secure to try to kind of give me the choice of going back to work or not.

In contrast, Anne, who was in her early 30s, stated that fi nancial stability had less infl uence on decisions about the timing of childbearing than the age of her partner.

It had nothing to do fi nancially. It was his age, not my age. He is 7 years older than me and he said he didn ’ t want me having babies when he was in his 40s. He wanted to do it while he was in his 30s.

Family of Origin. Women acknowledged that they had more choices than their mothers ’ generation about child-bearing and spoke about the differences in raising children today versus in their families of origin. They noted that families are geographically more distant today than in past. A few of the younger women without children were waiting to start a family until they achieved career and fi nancial goals and could move closer to their family of origin for childrearing support.

For some women older than 35 years, their families of origin had given up hope that they would ever have chil-dren and were surprised when a pregnancy was announced. Pat, who had been in a failed long-term relationship and decided to raise a child on her own, said:

As soon as I was 30, [my mom] gave up all hope. When I told my mom, I said mom you better sit down, I got some big news. Even before I got anything out of my mouth she said, “ You ’ re pregnant! ” She told me it was about time and that I should have done it ages ago!

For some women, family origin expectations for grand-children were implicit and were alluded to through com-parisons with other family members who already had children. For Tanya, expectations from her family of ori-gin were explicit and resulted in good-natured disagree-ments about the timing of childbearing.

I had a lot of pressure from my family to start having kids. “ We want to be grandparents! ” But I didn ’ t really let it get to me, because I knew I was going to be out here [Western Canada] and they were going to be in Eastern Canada.

Family of origin infl uences included women ’ s percep-tions of the consistency of their timing with the timing of their own mothers ’ childbearing. Sabrina, who was in her early 20s without children, was planning to have her chil-dren soon because that timing was consistent with her mother ’ s. While acknowledging the challenges of simulta-neously raising young children and launching a career, she hoped that her decision to start a family in her 20s would result in having independent adult children while she and her husband were still young and healthy, with maximum earning potential to enable them to enjoy life.

Societal Factors Societal factors include the social acceptability of de-

layed childbearing, divorce rates, and social policy. Social Acceptability of Delayed Childbearing. In her

mother ’ s generation, Kathleen believed that childbearing among older women was not as acceptable as it is today.

In our mother ’ s generation if you showed up at the playground and you were the 50-year-old mom with the 4-year-old, everybody ’ s eyebrows would have gone up and it wouldn ’ t have been nearly as acceptable.

A recurring theme for women older than 35 years with children was that childbearing at an older age was becom-ing more common and that older mothers were becoming the norm. Lynne said:

When I take my daughter to the playground now, it seems like most parents seem to be this age [over 35] or at least the people that we run into seem to be a lot older. I think it ’ s very common.

Younger women with children argued passionately against societal perceptions that early childbearing had robbed them of opportunities for education and the acqui-sition of material things. Women who were in their late teens or early 20s when they had their fi rst child perceived that society saw them as “ bad mothers ” simply because they were young. Andrea who was younger than 25 years with children stated:

I ’ m so tired of people thinking that we [younger moth-ers] are incompetent or incapable in some way. When you watch the news or listen to the radio, most of the bad mothers that you hear about are young moms. There is a really negative expectation in society of young moms. I ’ ll do anything to dispel that myth!

Another young woman reported that nurses insinuated that her life had been ruined by an unplanned pregnancy. All younger mothers argued the contrary. They were clear about commitment to their children, as well as the chal-lenges of fi nding ways to be a good parent. They agreed that age was not nearly as important to decisions about starting a family as “ where you are in your life and who you are as a person. ”

Divorce Rates. For some women, decisions about the timing of motherhood were infl uenced by their knowledge of current divorce rates. Tanya who was in her early 30s with children stated:

The divorce rate is 50%. You have to look after your-self, and if you ’ re not ready to look after yourself, I don ’ t think I should be bringing little people into the world.

Policy. A new federal policy ( Treasury Board of Canada Secretariat, 2003 ) that provides yearlong parental benefi ts infl uenced decisions about the timing of motherhood for a


few women. Tanya who was in her early 30s with a new-born said:

We waited for the year-long maternity benefi t to come into play and now my employer has a 2-year leave that I have taken. I think that ’ s really important and there [are] droves of women getting pregnant now because of that year-long maternity thing, just everywhere you turn.

Another woman in the same group challenged the im-portance of parental benefi ts and indicated that she and her partner would have had children regardless of the op-portunity to take a “ year off now and then. ” Some women were ineligible for parental benefi ts because of insuffi cient hours in a position or contract work. Sarah who was in her late 40s said:

I didn ’ t get any maternity benefi ts. My boss was phon-ing me when my daughter was a week old wanting to know when I was coming back to work. I went back when she was 3-1/2 months old. I got no benefi ts any-time, because I was a contract worker. It made no dif-ference to me.

In summary, women across the fertility life span en-gaged actively in decisions about the timing of mother-hood. Most women described a life plan that included establishing independence through postsecondary educa-tion and a career, and then starting a family. Most older women described a readiness for childbearing that in-volved having satisfi ed their desires for travel and personal fulfi llment, a stable relationship, and fi nancial stability. The younger women argued that age at childbearing had limited infl uence on their readiness to undertake mother-hood and strongly objected to negative societal percep-tions of younger mothers. All women were aware of the decline in fertility with age, and some older women had used assistive reproductive technology in order to achieve a pregnancy. Partner readiness and family of origin were less infl uential in women ’ s decisions. Women believed that current societal expectations for personal independence before childbearing makes older motherhood more ac-ceptable and normative for their generation. New federal policies about parental benefi ts were important to a few but not all women.

Women believed that current societal expectations for personal independence before

childbearing makes older motherhood more acceptable and normative for their generation.

Discussion

Interviews with women with and without children, across the fertility life span, provide evidence that decisions about the timing of motherhood are infl uenced by multiple and complex interrelated factors. The fi ndings are discussed according to the ecological framework, beginning with indi-vidual factors, followed by familial and societal factors.

Clearly, women in our study valued independence and worked to achieve it through education and career attain-ment. These fi ndings are supported in other Canadian re-search that suggests that women who delay marriage and childbearing are concentrating on education and careers ( Dion, 1995; Drolet, 2002 ). The fi ndings extend this re-search by suggesting that societal expectations for fi nan-cial independence and women ’ s concerns about increasing divorce rates may underlie the pressure to achieve educa-tion and career goals. However, there is evidence that de-laying childbearing does not guarantee higher wages in the labor market ( Meyer, 1999 ) and serves to undermine the myth that motherhood and career success are incompati-ble. The concept of family motivation is similar to other fi ndings that suggest valuing of family, rather than moti-vation to be a parent may underlie decisions about parent-hood (Dion, 1995). That is, the valuing of family may be more important than the potential role-related benefi ts, such as having “ someone who needs me ” ( Dion, 1995 , p. 328).

The fi nding about the importance of readiness to start a family is somewhat consistent with those of others who re-ported that women older than 40 years who have children are more patient and understanding, more relaxed, ready to settle down, and possess life experiences ( Berryman, Thorpe, & Windridge, 1995; Dion, 1995 ). Additionally, mothers older than 35 years may be more satisfi ed with parenthood, less stressed, and report better family functioning than their nondelaying counterparts ( Garrison, Blalock, Zarski, & Merritt, 1997 ). However, younger women in this study also reported the idea of readiness for motherhood and argued that readiness to start a family was less related to age than personal values and beliefs about motherhood and family. Similarly, criteria for their planned pregnancies in another small sample of adolescents living in group homes included fi nancial stability, serious relationship with a boyfriend, and ability to legally hold a job ( Montgomery, 2001 ). Except for the very youngest adolescent (14 years) in Montgomery ’ s sample, adolescent mothers wanted to do well for their child and valued the stability a baby would bring to their lives. Together, these fi ndings suggest that there are similarities in readiness to start a family between older and younger women.

Women ’ s projection of their life plans related to the timing of motherhood appears to be a new concept that could not be located in the literature. While intention to act is commonly associated with health-related behaviors such as smoking and exercise, it may be that similar intention underlies projection of the life plan. If so, health


promotion approaches may be useful to inform women about the risks of delaying childbearing.

Similar to others ( Tough et al., in press ), women in this study were aware that fertility decreased with age but were unaware of the rapid decline in fertility after 35 years and risks associated with reproductive technology (for a review, see Hansen, Bower, Milne, de Klerk, & Kurinczuk, 2005 ). Women who delay childbearing into their late 30s may en-counter fertility problems that leave them involuntarily child-less, such as in the case of female academics who chose to delay childbearing until their careers were established ( Kemkes-Grottenhaler, 2003 ). It is important to note that childlessness is not a negative outcome in the lives of many women. In this study, most of the older women without chil-dren were satisfi ed with their lives and had directed their en-ergy toward career and personal goals. The fi nding is consistent with others who found that women aged 40 to 46 years dis-engaged from the goal of childbearing ( Heckhausen, Wrosch, & Fleeson, 2001 ) and in contrast to investigators who report signifi cant distress for women with infertility and involuntary childlessness ( McQuillan, Greil, White, & Jacob, 2003 ).

Women expressed satisfaction with their decisions. How-ever, if they had to do it again, the women older than 35 years would have started their families earlier. This fi nding is in contrast to research that suggests that older mothers are more satisfi ed with their parenting experience than younger mothers ( Ragozin, Basham, Crnic, Greenberg, & Robinson, 1982 ). Similar to other fi ndings ( Aquilino & Losch, 2005 ), while they may not have intended to become pregnant, younger women in this study were adamant about their commitment to their children and parenting. Social support from family and close friends was important to their success. The fi nding is consistent with a British study of adolescents where the majority of pregnancies were unplanned but wanted ( MacLeod & Weaver, 2003 ). Many of MacLeod and Weaver ’ s participants were in stable relationships, felt supported, and adjusted well to their pregnancies.

With regard to familial factors, a stable relationship was infl uential in women ’ s decisions about the timing of moth-erhood. This fi nding is similar to that of Dion (1995) who reported that stability and security in the spousal relation-ship infl uenced the timing of childbearing for currently pregnant women. However, increasing maternal age and the urgency to have a child may supersede the need for a stable relationship ( Heckhausen et al., 2001 ), as demon-strated by one woman in this study who chose to bear a child on her own. Partner readiness was infl uential in wom-en ’ s decisions. Other researchers (Dion) found that older women ’ s decisions about the timing of childbearing were shared with a partner. In this study, decisions about the timing of childbearing included a period of preparation for the parenting role, which may be an ideal time to counsel women and their partners about pregnancy. The infl uence of the family of origin was surprising in a society where independence and choice are highly valued. In a recent in-

tergenerational study, there was a strong positive associa-tion between mothers and daughters ’ parity and desirability of pregnancy suggesting that mothers have a role in passing a favorable attitude toward childbearing to their daughters ( Pouta, Järvelin, Hemminki, Sovio, & Hartikainen, 2005 ).

The increasing social acceptability of older motherhood identifi ed by women in this study stands in sharp contrast to fi ndings from a qualitative study of American mothers aged 30 years and older ( Dobrzykowski & Stern, 2003 ). They de-fi ned their central variable as out of sync with the mother ’ s world. Women in the current study normalized childbearing among women older 35 years and did not perceive the phe-nomenon as out of sync for their generation. In Canada, new parental benefi ts that extend the total period of maternity and parental benefi ts from 25 to 50 weeks came into effect in December 2000 ( Treasury Board of Canada Secretariat, 2003 ), prior to data collection for this study. Contrary to expecta-tions, the new parental benefi ts had minimal infl uence on most women ’ s decisions. Hyatt and Milne (1991) , who con-ducted a maternity benefi t policy study in Canada between 1950 and 1986, reported a small positive impact of benefi ts on fertility. Their fi ndings are inconsistent with those of the others who report limited effects of maternity benefi ts on fer-tility rates. In an analysis of Canadian maternity benefi ts prior to the implementation of the new policy, Phipps (2000) re-ported that childbearing behavior was not signifi cantly infl u-enced by the availability of maternity benefi ts. Similarly, paid maternity benefi ts did not have a great infl uence on women ’ s decisions about the timing of childbearing in Germany ( Kemkes-Grottenhaler, 2003 ). Rather, social changes with regard to male participation in childrearing, and employment policies about part-time work and support may be more im-portant. These fi ndings are consistent with our study where mothers were challenged to fi nd employment that was com-patible with their experience and skills, yet with fewer hours and more fl exible time to allow them to care for their children.

Limitations While an attempt was made to recruit a diverse group of

women, participants were primarily well-educated European-Canadian women. Sample characteristics limit the transfer-ability of fi ndings to other populations and contexts. The specifi c manner in which spousal relationships exert their in-fl uence on women ’ s decisions is unclear. Additional research about the perspectives of male partners and their infl uences on decisions about the timing of motherhood is required.

Nurses caring for women across the fertility life span need to discuss childbearing plans and the impact of maternal age on fertility.


Implications

Consistent with recommendations ( Strobino, Grason, & Minkovitz, 2002 ), nursing practice guidelines need to ac-knowledge the infl uence of social contexts that affect wom-en ’ s health generally, not just during pregnancy. Nurses caring for women across the fertility life span need to discuss childbearing plans and the impact of maternal age on fertil-ity. Nurses need to be sensitive to women who chose early childbearing and recognize that they may feel out of sync in this generation. Women who require assistive reproductive technology or who begin pregnancies with chronic health problems are more likely to have multiple and/or preterm births. Policy decision makers must be cognizant of the need for additional high-risk obstetric and neonatal health services when societal norms encourage women to delay childbearing in favor of completing education and establishing a career.

Acknowledgment

Suzanne Tough was funded by the Alberta Heritage Foundation for Medical Research.

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Karen Benzies, RN, P H D, is an associate professor at the Faculty of Nursing in the University of Calgary, Calgary, Canada.

Suzanne Tough, P H D, is an associate professor at the Depart-ments of Pediatrics and Community Health Sciences in the Uni-versity of Calgary, Calgary, Canada.

Karen Toffl emire, MSc, is a research associate in the Decision Support Research Team, Alberta Children ’ s Hospital, Calgary, Canada.

Corine Frick, RN, MN is the director at the Alberta Perinatal Health Program, Calgary, Canada.

Alexandra Faber, MSc, is a medical student in the Trinity College Dublin, Dublin, Ireland.

Christine Newburn-Cook, RN, P H D, is an associate professor at the Faculty of Nursing in the University of Alberta, Edmonton, Canada.

Address for correspondence: Dr. Karen Benzies, RN, P H D, Fac-ulty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4. E-mail: [email protected] .

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