Obstetric challenges include not just obstetrics challenges of delivery but a whole myriad spectrum of factors that ultimately decide the outcome of that pregnancy to increase the happiness quotient in the women's life or not. Here the challenges faced by the woman and the doctor are discussed in detail. The accompanying talk is available at https://www.youtube.com/watch?v=MVcEdq55o30

1. Obstetric Challenges
in Midlife
Dr. Asha Jain
MD, DNB, MNAMS,
FICOG, FICMCH
Dr. Asha Jain 1

2. Dr. Asha Jain
MD, DNB, MNAMS, MBA
asha@drasha.in
š Director – SMSA Raipur
š Medical Director – CPRS Raipur
š Elected Member – CGMC 2020-24
š Secretary – IMA Raipur 2019-21
š President – ROGS 2018-20 2020-22
š President – Rotary Club
Raipur North 2019-20
Dr. Asha Jain 2

3. Flow of
Presentation
š Define Challenge
š Define Midlife
š Ethical Issues
š Life Expectancy Issue
š Fertility Issues & Preconception
management
š Coexisting medical issues
š Counselling with due consent
š Unveiling of medical issues on late
contraception
š Pregnancy Specific Challenges
š Sleep Disturbances
š Financial and familial Issues
Dr. Asha Jain 4

4. Challenge
“Challenges” refer to experiences that require great physical or mental effort and
determination that test one’s strength, skill, or ability.
Stressor is a stimulus or threat that places real or perceived demands on the body, emotions,
mind, or spirit of an individual.
The word challenge, used in this study, is a word embroidered with strength and courage,
allowing for the possibility that all challenges may not be perceived as stressful or appraised
as negative
Thomaset al. Women's Midlife Health (2018) 4:8 https://doi.org/10.1186/s40695-018-0039-9
Dr. Asha Jain 5

5. Definition of Midlife
š At present, between 40 and 65 year is considered as the most acceptable definition for
mid-life in medical literaature
š Both upper and lower limits of age need to be defined if we consider mid-life in relation to
fertility.
Erikson EH, Erikson JM. The life cycle completed
(extended version) New York: W.W. Norton &
Company; 1998.
Jindal UN. Mid-life fertility: Challenges & policy
planning. Indian J Med Res. 2018;148(Suppl):S15-S26.
doi:10.4103/ijmr.IJMR_647_18
Dr. Asha Jain 6

6. Jindal UN. Mid-life fertility: Challenges & policy planning. Indian J Med Res. 2018;148(Suppl):S15-S26.
doi:10.4103/ijmr.IJMR_647_18
1. Definition of midlife in relation to fertility
2. Increasing age of pregnancy
3. Increasing demand for fertility services
4. Agerelated decline in fertility
5. Do Indian women lose fertility early?
6. Overestimation and fertile lifespan
7. Artificial extension of fertility
8. Higher failure rates of all kinds of treatments
9. Third party reproduction
10. Maternal risks
12. Impact on health and longevity
13. Perinatal morbidity and mortality
14. Welfare of the offspring
15. Use of experimental and costly
treatments
16. Fertility issues of the ageing male
17. Age cut-off for fertility services
Dr. Asha Jain 7

7. Ethical Issues
To be or not to be
that is the question.
Hamlet - Shaksepear
Dr. Asha Jain 8

8. Life Expectancy Issues
Dr. Asha Jain 9

9. Fertility Issues &Preconception
Management
Dr. Asha Jain 10

10. Older women wanting to have children
have more options today than ever before.
If conceiving naturally isn't possible, women
can pursue assistive reproductive
technologies, such as in vitro fertilization, or
IVF, and the use of donor eggs
Dr. Asha Jain 11

11. Counselling with due
consent
Dr. Asha Jain 12

12. Unveiling of medical issues on
late conception
Dr. Asha Jain 13

13. Pregnancy Specific Challenges
Dr. Asha Jain 14

14. Pregnancy
Specific
Challenges
PIH/HT GDM/DM
Obesity
Abruptio
Placentae
Preterm
Labour
Coagulation
Autoimmune
Disorders
Psychiatric
Issues
Dr. Asha Jain 15

15. Midlife Crisis
OCCURRENCE OF THE MIDLIFE
CRISIS HAS TURNED OUT TO BE
MYTH; RESEARCH SHOWS 10-20%
OF PEOPLE ACTUALLY
EXPERIENCE IT (LACHMAN, 2004;
WETHINGTON, 2000)
ALTHOUGH SOME CONSIDER IT
HUMOROUS AND THE FOCUS OF
JOKES, MOVIES, AND TV SHOWS
NEGATIVE REPERCUSSIONS
FROM PROMOTING THE CRISIS
AS NORMATIVE INCLUDE
IGNORING MENTAL OR
PHYSICAL HEALTH PROBLEMS
WHEN ATTRIBUTING THE
SYMPTOMS TO A MIDLIFE CRISIS
(LACHMAN, 2015).
Dr. Asha Jain 16

16. Labour
Vaginal
Abdominal
Dr. Asha Jain 17

17. Intra/Postpartum
PIH
DM
Cardiac Events
Dr. Asha Jain 18

18. Practical Postnatal Problems
Care of new born
Care of Infant Child, adolescent,
adult, and elderly
Dr. Asha Jain 19

19. Sleep Disturbances

20. Financial
Issues/Loss
of Income
Dr. Asha Jain 21

21. Familial Issues
š More Divorces
š Loss of Partner in Midlife
š Loss of elderly parent
Dr. Asha Jain 22

22. Conclusion
š Most Pregnancies in Midlife have a
happy ending
š Preconception management is a must
š Failed contraception needs to be
taken care of
š Pregnancy is high risk and proper
counselling and consultation is needed
š Preconception Genetic Testing has
definite positive role in ART with single
embryo transfer
š Pregnancy will require high alert from
both Doctor and Patient
š Role of Obstetrician does end with
discharge of patient
Dr. Asha Jain 23

23. So,
Happy Practice, Happy Midlife, Happy
Motherhood and Fatherhood

24. Thank you!