Almost 39 weeks ago, Kristine Casey set out on an unusual journey to help her daughter and answer a spiritual calling.
Her goal was achieved late Wednesday when she gave birth to her own grandson at age 61.
Casey, possibly the oldest woman to give birth in Illinois, served as a surrogate for her daughter, Sara Connell, who had been trying for years to have a baby. Connell and her husband, Bill, are the biological parents of the child Casey carried, which grew from an embryo created from the Chicago couple's egg and sperm.
Crying and praying, Connell and her mother held hands as Finnean Lee Connell was delivered by cesarean section at 9:47 p.m.
When the baby let out a cry, "I lost it," said Sara Connell, the first family member to hold him. "It's such a miracle."
The doctor who delivered Finnean said there wasn't a dry eye in the crowded operating room.
"The surgery itself was uncomplicated, and the emotional context of this delivery was so profound," said Dr. Susan Gerber, obstetrician and maternal-fetal medicine specialist at Northwestern Memorial Hospital.
Childbirth remains a rare event for post-menopausal women, but the number of such births has risen in recent years due to wider use of in vitro fertilization and other assisted reproductive technologies. According to state health department records, the oldest woman to give birth in Illinois was 58 when she had her baby in 2006. But data on births after 2008 are not yet available.
Older women face greater risks during pregnancy and delivery, and experts say many women would not be good candidates.
"It's going to be more risky for somebody who's got underlying conditions," said Dr. Alan Peaceman, chief of maternal-fetal medicine at Northwestern Memorial Hospital, one of Casey's doctors. "Because of that, we recommend that patients have a cardiac evaluation."
The Connells decided in 2004 to try to have a baby, but Sara, now 35, soon discovered she wasn't ovulating. After undergoing infertility treatment at the Reproductive Medicine Institute in Evanston, she got pregnant but delivered stillborn twins, and later she suffered a miscarriage.
Casey's previous three pregnancies her last was 30 years ago went smoothly, resulting in three daughters. After Casey retired in 2007, she filled her time walking, meditating, taking classes and socializing with friends. But she felt she had a deeper calling.
"At the beginning of 2009," she said, "I decided for once in my life to take some time to think about my life and find something that seemed right for me where there was no pressure to do a specific thing."
During a visit to Chicago she lives in Virginia Casey participated in a workshop led by Connell, a life coach, writer and lecturer on women's empowerment. In one class exercise, she used pictures cut from a magazine to create a collage depicting a life's goal. One picture grabbed her attention: an ostrich with an expression of wonder and joy.
Casey wanted to experience the exuberance captured in the picture.
Around the same time, a walking partner mentioned a story she had read about a post-menopausal woman who gave birth.
"I thought, 'Wow, three of the happiest days of my life were giving birth to my daughters,' and I thought I could choose to do this for someone I love," Casey said.
Casey later wrote a letter to the Connells offering to be Sara's surrogate.
"I found something that would make me feel like that ostrich," she wrote. "What do you think of this?"
She suggested that they forget about it if they found the idea repulsive.
"I won't do this just to make me happy because, believe me, I could find other things to do," she remembers writing, laughing at the recollection. At the time, she was 10 years past menopause.
Several months later, the family discussed the idea with experts at the Reproductive Medicine Institute, where they had sought help six years earlier. The couple said they had considered adoption but preferred to have a biological child.
"The idea of having a family member being open to doing this for us was so extraordinary for us," Sara Connell said.
Bill Connell said he appreciated his mother-in-law's offer, though he didn't think it was doable at first. Any further reservations evaporated when he saw she was serious, he added.
"I just wanted to make sure the science was there," he said. "I didn't want us to subject ourselves to another very risky, possibly devastating, scenario. Infertility is one thing, but putting your mother-in-law in danger kicks it up to another level altogether."
At first, Casey's husband also wondered if it was even possible for his wife to have a baby in her 60s. Then he worried that a pregnancy could jeopardize her health or even her life. But he set aside most of his concerns after she cleared medical tests and doctors gave a thumbs-up.
"What made the difference for me was when Kris said it was a calling from deep within herself," Bill Casey said. "You can't get any more compelling than that."
Casey underwent multiple tests to evaluate her medical and psychological health, as required by Illinois law on surrogate births. The family also drew up a mandatory legal agreement.
The risks of genetic abnormalities were low because Connell's egg would be the one fertilized. But if any such issues were detected later, Casey said she and the Connells agreed that she would carry the baby to term regardless.
Then she took hormones to prepare her uterus for pregnancy. She got pregnant on the second cycle of in vitro fertilization with an embryo transfer.
"If you give the uterus hormones, it will act like a young uterus," said Dr. Carolyn Coulam, a reproductive endocrinologist at Reproductive Medicine Institute. Coulam's oldest patient was in her late 60s at the time she had a baby. She lived in another state.
"It usually is a function of the age of the egg, not the uterus, whether or not the pregnancy will be successful," Coulam said.
Still, some fertility programs have age limits for gestational surrogates. At the University of Chicago Medical Center the upper limit is 55, said Dr. David Cohen, chief of reproductive medicine.
"The issue comes up because as a woman gets older, the risks she takes in pregnancy clearly go up everything from high blood pressure and diabetes to premature delivery and infant death," Cohen said. "So one has to be clear about what those risks are."
The medical center evaluates cases involving older surrogates in an ethics consultation.
"It's not written in stone," Cohen said. "One is left with deciding each case individually, and those decisions are made after a very serious discussion with everybody involved. I personally would not throw stones at somebody who decided to go ahead in this situation as long as she clearly understood her risks."
Peaceman described Casey's health as excellent throughout her pregnancy, but he emphasized: "It takes a significant commitment to be a surrogate in any circumstance. To take on this type of physical burden at this age is not anything anybody should take lightly."
After her C-section, Casey had a complication with her kidneys.
"After delivery, her urine output was lower than we expected and there was no discernible cause," Gerber said. "We wanted to be extra careful, given her age, so we gave her close attention. With relatively little intervention, it turned around."
Josephine Johnston, a research scholar at the Hastings Center, a bioethics research institute, had no ethical objections to the idea of a 61-year-old having a baby, as long as she had undergone a thorough medical and psychological evaluation.
"It seems like an unquestionably loving and generous thing for a family member to do," she said.
"It's a great story to tell the child," Johnston added. "It's one of those situations where outsiders might wonder if it's OK or healthy. But the experience of that child and his family will be that it's good. If they treat it as good, it will be experienced that way."
Casey, who has a quick wit and laid-back manner, plans to return to her Virginia home with her husband in about two weeks, where she is ready to adopt a more conventional grandmother role. Finnean is her first grandchild.
"From the very beginning, the moment I've wanted is the moment the baby is in their arms," she said at her daughter and son-in-law's home weeks before the birth. "I've been clear since after my third child that I didn't need to have any more children, and as much as I will be delighted to be a grandmother, I don't want to take a baby home."
Sara Connell said she was grateful for her mother's loving, generous spirit and what she called "her special gift."
"It grew beyond the two of us having a child," Connell said. "It was about the closeness with my mother, and our family having this experience that was unique and special."
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