Pregnancy in your 40s: why aspirin shouldn’t feel like a tick-box exercise

“Patient care should never be a ‘tick-box’ exercise when it comes to being pregnant in your 40s.”

There are moments in life when you realise how much of modern healthcare has been reduced to form-filling. My pregnancy at 40 was one of them. The midwife ticked a few boxes and suddenly I was labelled ‘high risk’. No one likes to be reduced to two data points, age and BMI, least of all when you’re carrying a small human inside you.

It began innocently enough. A midwife suggested I take low-dose aspirin from week 14 until delivery. My first reaction was part irritation, part fear. I felt healthy. My blood pressure was low, I was taking folic acid, and I exercised. Why was I being handed a packet of pills before anyone had even asked how I felt?

The science – and the scare stories

The explanation, when it came, was calm and logical. A daily 75mg dose, about a quarter of a standard aspirin tablet, could reduce the risk of preeclampsia, a condition that raises blood pressure and floods the urine with protein after 20 weeks. Research suggests women classed as high-risk who take low-dose aspirin reduce their risk of preeclampsia by around 24 per cent and their chance of preterm birth by 14 per cent. Promising numbers, if you can look past the panic induced by Google.

Preeclampsia is not something to shrug off. It can cause seizures, stroke, and organ failure. It can kill. Yet, once I got home, I did what any overthinking midlife mum might do, I went online. Within five minutes I’d read about miscarriage risks, growth problems, and placental abruption. By bedtime, I was convinced that one tiny pill could blow up my entire pregnancy. Information may be power, but it’s also a very effective way to terrify yourself at 2am.

The kitchen table debate

Back home, my husband and I staged our own medical symposium over a cup of tea. Should I take it or not? I was already experiencing mild heart palpitations and breathlessness. The scientist in me said yes. The worrier in me said absolutely not. Eventually, I went with the experts, and perhaps a touch of maternal instinct. Better a tiny tablet than the looming risk of preeclampsia.

Once I began, the anxiety eased. So did the palpitations. I can’t prove the aspirin worked, but I never developed preeclampsia, didn’t swell like a water balloon, and stayed on my feet until just before my son arrived. Sometimes, good medicine is also good psychology.

We need more human care

My experience taught me something far beyond the chemistry of aspirin: people need people, not just checklists. The NHS midwives I met were brilliant once the conversation went beyond the boxes. But that first appointment, that quick flick through the notes, was chillingly impersonal. It felt as if my age had entered the room before I did.

If I’d been 39 with a BMI of 30, I might have been waved through as ‘normal’. Yet the statistics don’t care about nuance. I’ve known younger women who suffered preeclampsia, some of them seriously. Perhaps a conversation, or a daily pill might have changed their outcomes. We’ll never know.

Being pregnant in your 40s isn’t a crime, nor should it be treated like a medical anomaly. It’s a chapter of life that deserves empathy, not paperwork. Sometimes the smallest pills and the simplest conversations make the biggest difference.

Further reading: NHS: Pregnancy complications