Predicting the End to Grandparenthood?

The occasion of my 40th high school reunion, was a chance to reflect on two things: how my classmates and I have aged and how almost none of my high school friends have grandchildren. As we mingled and shared family photos, classmates were showing toddler and teen photos of their children; I alone was showing photos of my grandchildren.

Why the dichotomy?

The lack of grandchildren is explained by simple math. In delaying marriage and childbirth significantly, my generation of boomers has thought it natural to wait until 35 or even 40 to marry and start a family. Careers, freedom to travel, searching for the perfect soul-mate are some of the common reasons for delaying…settling down. With life expectancy for men at 76 and women at 81, the odds of having much meaningful time with your grandchildren are slim indeed, if your adult child follows your example and delays marriage to 35 or older. The disappearance of grand-parenting would be a great loss for American families.

There are some serious consequences to delayed childbearing in addition to missing out on grandparenthood and they are: augmented infertility, which leads to elevated multiple births, which leads to increased rates of pre-term births and C-sections.

If my high school classmate got married at age 35 and her child is waiting until 35 to have her first child, then we’re about 12 years too early to be seeing pictures of her grandchildren, because just about everyone at the reunion was 58 years old.

People are passionate about this topic. Comments from outraged readers to a column that I authored on the consequences of delayed child-bearing include: “Pushy, busy-body parents of grown children continue to nag and harass them into having children they don’t want…ever consider that spawning is not the end-all and be-all of marriage, let alone of life?” Another reader declared, “Parents need to butt out of their children’s lives and if that means they don’t get any grandchildren, so be it.”

Hmmm, do you think I touched a nerve? What did I say that produced these reactions? I said that when parents are approached by their married adult children who say they plan to delay starting a family in order to establish their careers, own a home, and have fun traveling, the parents should not keep their opinions to themselves and say, do your own thing. At the risk of seeming like meddlers, parents should warn their adult children in strong terms that there are serious consequences to the decision of delaying child-bearing.

In my book, Creating Your Perfect Family Size, I encourage couples to proceed slowly and thoughtfully with their family size decision. In short: as many or as few, as long as you think it through.

The scenario that most concerns me and repeats itself when I counsel older couples is as follows: In order to make up for lost time and because a couple has a pre-determined family size, couples who delay child bearing until age 35 or older, will have rapid-fire children that are barely 15 months apart. That’s detrimental for the Mom’s health, family well-being and most of all the parents’ marriage. A space of 2-3 years between children is most beneficial.

Seeing my grandchildren is an affirmation that my wife and I have done a pretty decent job of parenting, which is demonstrated by our adult children deciding to start their own families. I’m no expert after five years of grandfathering, but I believe that the end to grand parenting would leave an enormous black hole in our emotional universe.

Global "Burden" of Preemies (I Call it Tragedy) But No Mention of - Don't Delay

A new March of Dimes study found that over one million babies worldwide die each year because they are born too soon, according to the first report to estimate the "global burden" of premature births.

Liz Szabo in USA Today states: “The preterm birth rate in the USA is especially high: 12.7% of all babies are born early, according to the March of Dimes. That rate has increased 36% in the past 25 years, partly because of an increase in elective cesarean section, an increase in older mothers and the growing use of assisted reproduction, which increases the risk of twins, triplets and higher-order multiple births, the report says.”

She added, “Doctors can do far more to save preemies than they could only a generation ago but they still have no reliable way to prevent preterm birth. At best, doctors can delay delivery by a day or two — just long enough to give women drugs to mature their babies' lungs.”

Discussion in Szabo's article only addresses medical solutions. Was I off-base when I suggested that parents should tell their adult children not to delay starting a family? In a May 2008 post, I suggested that these trends are sequential: delayed marriage, delayed child birth, infertility, increased multiple births, and increased number of pre-term births. I believe that we need more than a drug-related medical solution to this mammoth global tragedy.

Care to discuss?

Multiple Births Dilemma: Newsweek "My Turn"

With increased fertility treatments, the U.S. birthrate of twins has more than doubled in the past 30 years and the number of triplets has increased significantly. Parents often face a horrific decision.

Somewhat overlooked, are the surges of neonatal deaths, developmental disabilities, as well as other long-term problems. (I have described the consequences of delayed childbearing in several previous blog posts.)

Mark Evans, an Obstetrician and medical geneticist, described the procedure known as selective reduction in a recent Newsweek, My Turn. "This is accomplished - usually at 3 months gestation - by reducing the number of fetuses down to a manageable number, usually two."

What does selective reduction accomplish? A woman who is pregnant with quadruplets, has a 25% chance of losing all of her babies, but she can decrease the loss rate to about 5% by reducing to twins.

Question: How would you and your spouse respond to your doctor if he/she recommended selective reduction?

In Truth, Didn't We Create Octomom?

With our glorification of bizarre behavior, Raina Kelley correctly makes the point that we dare the emotionally needy to shock and appall us; then we slam them.

Kelley raises some solid issues in her recent essay in Newsweek.

She labels it as beautiful and exasperating, that our democracy gives people the freedom to have as many children as they want. She describes money and how having lots of it really does make the work-home balance thing a lot easier. And on the ethical question (described in an earlier blog post) of how many embryos should be transferred to a woman, Kelly states, "While the cost of IVF is usually mentioned, most of these experts conveniently forget to mention how few states force insurance companies to pay for IVF treatment."

She concludes that Octomom should be a warning to us that by sensationalizing her, "We're inviting more trivialization of the most sacred aspects of humanity."

How about you, have you had enough of those large family reality shows?

Delayed Childbearing Consequences: Parents Warn Your Adult Children by Dr. Alan Singer

Encourage Children to Start a Family Sooner than Later (First of two parts) was published on 9/5/08. Click here to read it in the Home News (while the link lasts).

Consequences to Delayed Childbearing (second of two parts) was published on 9/19/08. Click here to read it in the Home News (while the link lasts).

You can also read Parts 1 and 2 from my earlier blog post by clicking here (This link will remain).

These columns have generated more debate, by far, than any other topic I have blogged about. Stay tuned for a future column that will describe the irate emails I received.

Parents-Tell Your Adult Children: Don’t Delay Childbearing by Dr. Alan Singer

Attribution: Journalists have permission to reproduce this column in full or in part, provided they attribute authorship to Dr. Alan Singer and this website www.FamilyThinking.com

Click here to see Dr. Singer's YouTube video on this column

Too many parents approach issues in their adult child’s life with the unspoken rejoinder, close your mouth and open your wallet. Parents often give no advice, even when they have serious concerns. Thirty years as a family therapist and 28 years as a father, have taught me that parents should voice their opinion to their adult child about two specific issues: getting married and not waiting numerous years before having children.

The Domino Effect
In recent years, the trend of delaying marriage has caused a domino effect on other trends which have a significant emotional cost for families and an enormous financial cost to society. The dominos are: delayed marriage—delayed childbearing—augmented infertility—elevated multiple births—increased rates of pre-term births and caesarian sections. My goal in this column is to describe these decisions to delay marriage and childbearing and the resulting consequences. I will offer some suggestions that parents might use in dealing with their adult child.

Of the 4.1 million births registered in the U.S. in 2005, 37 percent were born to unmarried women (CDC). Some of the reasons that couples cohabit include: convenience, economy of savings, preparation for the marriage commitment, and apprehension about the high divorce rate. But these couples are actually practicing non-commitment. Even if they eventually marry, they have less satisfying marriages and higher divorce rates than spouses who did not first live together (National Marriage Project). If the unmarried biological parents go their separate ways, where does that leave the children?

If I am perhaps describing your adult child, don’t you want the best possible family environment for your grandchild? Wouldn’t you consider voicing your opinion to your son or daughter, knowing the irrefutable research finding: the best environment to raise children is two biological parents in a low-conflict marriage? You might respond that you don’t want to “meddle” or times have changed and it’s not like the old days when parents spoke their minds. My response mirrors a recent mass e-mail: don’t be so open-minded that your brains fall out.

Adult Children Do Listen
Please don’t misunderstand me: Parents should not tell their grown child everything on their minds. But, in matters that are crucial for their well-being, they must speak up. My three decades of research into family size decisions have shown that adult children are aware of and appreciably influenced by the attitudes of their parents. One of my own survey research findings is the importance of family-of-origin family size as a predictor of total family size. The decisions our parents made about family size tend to have a significant impact on our own decisions.

In fact, reliance on the advice of parents has been described in the National Survey of Student Engagement (2007) which questioned 313,000 randomly selected college students. The survey revealed that young adults follow the advice of both parents more than twice as much as they listen to friends. So, if your son or daughter informs you that he/she wants to live together with a “significant other” for a few years, possibly even have a child or two, don’t respond with that 1960’s expression, do your own thing.

The First Two Dominos
Couples, who do choose to marry, are waiting longer to do so. According to the Census Bureau, between 1970 and 2000, the median age at first marriage for women increased by 4.3 years to 25.1 years; for men the increase was 3.6 years to 26.8.

In tandem with the later age at first marriage, is the decision to delay childbearing. The mean age of mothers in the U.S. was 24.6 in 1970 which increased to 27.2 in 2000 (CDC). Approximately 20% of women wait until after 35 to begin having children (www.ASRM.org). Consider that birth rates for women 35-39 and 40-44 years (which have risen steadily in recent years) each increased 2% in just one year, 2005 (CDC).

Why do these delays occur? Education and career, which are positive trends, are important factors in women’s decisions to delay marriage and motherhood. From 1970 to 2000, the percent of women having completed four or more years of college nearly tripled and the female labor force participation rate increased by 39% (CDC 12/11/02). The availability of contraception allows couples to delay childbearing while strengthening their relationship, establishing careers, and amassing enough assets to settle down for a secure and comfortable future. But how emotionally secure and financially comfortable are they going to be down the road? Will their marital bond be able to withstand the stress imposed by infertility, multiple births, and pre-term infants?

Infertility
The decision to delay comes with consequences that take their toll on spouses and society. The miscarriage rate (34%) is triple for women 40-44, compared to those ages 20-29 (10%). The risk of having a Down Syndrome child increases from one in 1250 for a 25 year old mother, to one in 30 for a 45-year-old mother (ASRM). Infertility, the next domino, affects 7.3 million people in the U.S., representing 12% of the women in the reproductive age population (CDC). A healthy 30 year old woman has a 20% chance each month to get pregnant; a healthy 40 year old woman has a 5% chance each month (ASRM). Secondary infertility, which can follow the birth of one or more biological children, is more prevalent than primary infertility. The emotional toll from the long-term inability to conceive a child can be devastating to spouses. Common feelings include: frustration, jealousy, anger, isolation, sadness and guilt. Self-image and self-confidence are affected as well.

Frequent visits to physicians interfere with careers and regardless of which spouse has the physical problems, most of the tests and treatments focus on the woman’s body. People typically assume that infertility is the woman’s fault and that adds to the stress (Abby, Andrews and Halman. Journal of Marriage and Family, May 1992). The financing of infertility treatments is considerable. Each in vitro fertilization cycle costs more than $12,000 with many couples requiring multiple cycles. The total cost for all types of fertility treatments exceeds $3 billion per year.

Remember when your child was young; you didn’t want to spoil her by giving her everything she asked for at the mall. But you knew which gift she really wanted and you waited for the right occasion to give it. Now, imagine your feelings of helplessness, when your adult child wants nothing in this world more than to parent a child. You can be supportive and optimistic, but there is no department store that sells what you wish you could buy.

Multiple Births
The huge number of couples undergoing fertility treatments has tipped another domino, multiple births. About 45% of Assisted Reproduction Techniques pregnancies result in twins and 7% in triplets or more (March of Dimes). The birth rate for twins in the U.S. rose steadily between 1990 and 2004, climbing an average of 3% annually for a total increase of 42% since 1990, and 70% since 1980. “Two related trends have been closely associated with the rise in multiple births over the last two decades: the older age at childbearing (women in their thirties are more likely than younger women to conceive multiples spontaneously) and the widening use of fertility therapies” (CDC 12/5/07).

Increased fetal risks include: higher chance of miscarriage, birth defects, and the mental/physical problems that can result from a premature delivery. Fetal mortality rates are higher for a number of groups, including: women who are 35 and over, unmarried women, and multiple deliveries. “Twins are 5 times and triplets are nearly 15 times more likely than singletons to die within a month of birth” (CDC 12/5/07). Maternal risks include high blood pressure, diabetes, and hemorrhaging”. Multiple gestation is associated with more depression, lack of sleep, financial difficulties, and marital discord (ASRM).

One method of reducing the risks is Multi-fetal Pregnancy Reduction. When there are four or more fetuses present, the number is reduced to one or two. This technique is used in an effort to increase the likelihood that the pregnancy will continue.

Remember when you taught your child decision-making, such as which friends she could invite for a sleepover or how she should spend her hard earned allowance. Did you imagine that one day you might be giving support to your child in her decision to proceed with multi-fetal pregnancy reduction?

Pre-Term Babies
More than half of twins are born pre-term and approximately half of twins and almost all higher order multiples start life with a low birth weight. Data from 2005 indicates the premature birth rate is continuing to rise, with more than 525,000 babies or 12.7% born prematurely (March of Dimes 12/5/07).

Preemies tend to encounter these difficulties: low birth weight, breathing problems, underdeveloped organs, risk of infection and risk of cerebral palsy (NICHD). Researchers, writing in the New England Journal of Medicine (1/17/02) concluded, “Very low birth weight participants had a lower mean IQ; educational disadvantage associated with very low birth weight persists into early adulthood.” And the emotional toll? Preemie families face a stressful new world. Parents may only enjoy a brief encounter with their baby before she is whisked away to the NICU for weeks, even months. And the financial toll? More than $26.2 billion per year. “Direct health care costs to employers for a premature baby average $41,610—15 times higher than the $2,830 for a healthy, full-term delivery. Additional costs to employers in lost productivity average $2,766” (March of Dimes, Cost to Business).

Remember when you taught your child patience, such as waiting for a mail-order gift to arrive or standing in line at Disney World. Now, imagine how you may need to give strength to your child as she waits patiently for her baby to come home after months in the NICU.

Caesarian Sections
The last domino is the soaring number of caesarian deliveries (1.25 million per year). The current c-section rate of 30.3 percent is triple the 10.4% c-section rate of 1975 (ACOG Stats and Facts 2007). Mothers of multiples are more likely to have c-sections and a growing number of doctors and patients are scheduling c-sections for their own convenience. The cost of a c-section ($13,441) is twice that of a vaginal delivery, with the national total exceeding $17 billion per year (ACOG). And the human price tag? Risks for mothers include: anesthesia, increased bleeding, chance of infection and blood clots in legs, pelvic organs, and lungs. Risks for the baby are inactivity from the anesthesia and possible breathing problems (March of Dimes).

Conclusion
The trends described above are not small blips on the radar screen; they are continents. They are years in the making and would take a major upheaval to reverse by even a percent or two. My real hope is that these trends will not continue to increase. I also hope that with the catastrophic divorce rate in the U.S. hovering at 50%, not one more marriage will succumb to the marital stress caused by these trends. But as long as parents are either too shy or too worried to put in their two cents, these emotionally devastating and costly trends may continue to surge.
Remember how it took courage to sit down with your pre-teen and explain the birds and the bees? Summon that courage again and tell your adult children your opinions on the importance of marriage and the timing of children.

Remember when your child was in grade school? You soccer moms and side-line dads, who ran yourselves ragged in your minivans because violin, astronomy, chess, swimming and painting weren’t enough—you also insisted that your child go to Math camp. Didn’t you believe that all the hyper-parenting was in your child’s best interest so that she would have the best chance to succeed in life? Do you want to see your adult child go through the frustration, pain and sometimes grief from the trends described above? And the possible negative consequences for your grandchild?

Final Thoughts
It is vital to remember the "context" that a parent would have this discussion with an adult child. You cannot just spring this topic on your grown child out of nowhere. You need to communicate and demonstrate the values of marriage and parenthood to tweens and teens, long before they are ready to be independent. Second, you have to convey to your grown children that you are willing to help them raise their children, to the extent that you are able. You cannot simply give lip service to the trends and consequences described here; you need to step up to the plate and offer your services and resources. Be willing to put your time, energy, and money where your mouth is, not only for the personal joy of bouncing a grandchild on your lap, but so your grandchildren can reap the benefits of significant contact hours with YOU....their grandparents. Don't you want to help your adult child start a family while you are young and have the energy and health to be helpful in addition to joyful? So please don't be cheap. Your offer to help your children financially in the early years of marriage can make all the difference in the world to a young couple who is determined to be self-sufficient. I’d like to change the rejoinder to open your mouth and open your wallet too.

When your newlyweds tell you they are in no hurry to start a family, will you be prepared to respond? Children do respect the opinions of their parents, and truly need to hear them.

Please comment on this column at DrAlanSinger@aol.com