Why did being pregnant at 40 mean talking about aspirin?

There is something unsettling about being pregnant at 40 and discovering that your date of birth has become one of the most interesting things about you. I didn’t feel old and I didn’t feel medically fragile. I exercised, my blood pressure was low, I took my folic acid and I was getting on with the business of growing a baby. As far as I was concerned, I was a healthy pregnant woman who happened to be 40.

Then came the risk assessment. Age, medical history and BMI were noted, boxes were ticked and suddenly we were talking about pre-eclampsia and low-dose aspirin. I remember looking at that little yellow packet and wondering how we’d got there. I wasn’t ill. I felt well. Why was I being asked to take medication every day when, from where I was sitting, there didn’t appear to be anything wrong with me?

That was the question I needed answered. Because when you’re pregnant, particularly at 40, the words “increased risk” have an ability to drown out almost everything said afterwards.

There was good medicine behind the recommendation, even if I didn’t immediately appreciate it. Pre-eclampsia is a pregnancy complication associated with high blood pressure and, in some cases, signs that organs such as the kidneys or liver are not working properly. It can become serious for both mother and baby, which is why identifying women who may be at increased risk matters before they become unwell.

Low-dose aspirin can be recommended during pregnancy to reduce that risk. Current NICE guidance lists several factors clinicians should consider, with being 40 or older classed as one moderate risk factor. Others include a first pregnancy, a gap of more than 10 years between pregnancies, a family history of pre-eclampsia, multiple pregnancy and a BMI of 35 kg/m² or above at the first appointment. One high-risk factor, or more than one moderate risk factor, can lead to aspirin being recommended.

Being 40 does not, by itself, mean every pregnant woman should be taking aspirin. Looking back, I can also see something I struggled to understand at the time: I wasn’t being told something was wrong with me. My maternity team was looking at factors associated with what might happen later and trying to reduce that risk before it became a problem. It sounds like a small distinction, but when you’re pregnant and frightened, it is an enormous one.

Within minutes, a sensible question about a tiny daily tablet had turned into an online tour of practically every frightening pregnancy complication imaginable. I read about bleeding. I read about placentas. I discovered complications I hadn’t known existed half an hour earlier. By bedtime, that innocent-looking yellow packet on the kitchen table had acquired the emotional weight of an experimental drug trial.

Pregnancy does things to rational thought. Give a worried pregnant woman a search engine late at night and she can achieve amazing levels of catastrophising before midnight. The irony, of course, is that I had never had access to so much health information, yet I wasn’t feeling better informed. I was more frightened.

That experience taught me something I have carried with me ever since. Information and understanding are not the same thing. I had plenty of information. What I didn’t have was context, particularly context about my pregnancy, my risk and why a clinician believed aspirin might be useful for me.

My husband and I did what couples do when neither has an obstetric qualification but both have opinions. We made tea and discussed it. I was already experiencing occasional palpitations and breathlessness, which made me nervous about adding medication. The rational part of my brain understood the preventative argument perfectly well. The anxious part regarded the yellow box with considerable suspicion.

Eventually, evidence won and I followed the advice. Once I began taking the aspirin, the tablet itself hadn’t changed, but my relationship with it had. Instead of seeing it as evidence that there must be something wrong with my pregnancy, I began to see it for what it was: an attempt to reduce the chance of a complication developing later.

I did not develop pre-eclampsia, although I can’t tell you aspirin prevented it. My experience is one pregnancy, not a clinical trial, and maybe I would never have developed the condition anyway. What I can say with certainty is that understanding the recommendation changed how I felt about taking it.

For years, I thought this experience was an example of healthcare becoming a tick-box exercise. I’m less convinced now. Maternity care needs checklists, risk assessments and systems that help clinicians identify patterns before a woman becomes seriously unwell. A seemingly impersonal box on a form may represent years of evidence about which pregnancies are more likely to develop complications.

The problem comes when the checklist becomes the conversation. There is a considerable difference between hearing, “You’re high risk because you’re 40,” and hearing, “Your age is one of the factors we consider because it is associated with a higher risk of certain complications, so let’s talk about what that means for you.” One feels like a label. The other feels like healthcare.

We shouldn’t pretend age is irrelevant in pregnancy because it isn’t, and women deserve accurate information about how risk changes as we get older. But acknowledging statistical risk is not the same as treating every woman over 40 as a medical problem waiting to happen.

At 40, I was still me. I had my own blood pressure, medical history, fitness, family history and pregnancy. I also had a lot of questions.

Pre-eclampsia usually develops from around 20 weeks of pregnancy, although it can also occur after birth. Routine antenatal appointments matter because raised blood pressure and protein in the urine can be detected before a woman necessarily feels unwell. The NHS advises seeking medical help immediately if symptoms develop including a severe headache, vision problems such as blurring or flashing lights, pain below the ribs, vomiting or sudden swelling of the face, hands or feet.

Knowing that now also exposes the flaw in one of my strongest arguments at the time: but I feel perfectly healthy. Feeling well was reassuring, but it couldn’t tell anyone what might happen several months later. Annoyingly, medicine had a point.

If I met the clinical criteria and my midwife or obstetric team recommended it, yes. But I would ask better questions. I would want to know which risk factors applied to me, why aspirin was being recommended, what benefit we were trying to achieve, what dose I should take, when I should start and stop, and whether there was any reason it might not be suitable for me.

I once worried that asking too many questions made me a difficult patient. Age has cured me of that concern. Asking questions is not the same as rejecting medical advice.

For years, I thought this was a story about being prescribed aspirin because I was pregnant at 40. It isn’t. It is about what happens when statistical risk meets the woman sitting on the other side of the desk.

Medicine necessarily deals in numbers: age, blood pressure, BMI, dosage and probability. Patients experience those numbers rather differently. We experience healthcare through conversations, glances, explanations, worries carried home and, occasionally, a small yellow packet sitting rather accusingly on the kitchen table.

My midwives were right to assess my risk. I was right to want to understand it. Those two things were never in opposition, although at the time they sometimes felt as though they were.

Keep the evidence. Keep the risk assessments. Keep the boxes if they help clinicians spot something that might otherwise be missed. But once the boxes are ticked, look up from the form and talk to the woman sitting in front of you. Pregnancy in your 40s may mean more conversations about risk, more monitoring and, for some women, preventative treatment such as low-dose aspirin. None of that needs to make a woman feel as though her age has become more important than she is.

Did somebody explain why it was being recommended, or did you leave the appointment and find yourself searching for answers at home? I’d love to hear what your experience was like.

This article describes my personal experience and is not medical advice. Aspirin is not suitable for everyone. Speak to your midwife, GP or obstetric team before starting or stopping medication during pregnancy.

Occasional stories, experiments, discoveries and questions from Saffron & Cyrus.