616 JOGNN © 2007, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to cur- rent research, primigravidas over 35 tend to be edu- cated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women re- lated to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort. JOGNN, 36, 616-623; 2007. DOI: 10.1111/ J.1552-6909.2007.00197.x Keywords: Advanced maternal age—Delayed childbearing—Maternal psychosocial aspects—Maternal risk—Tailoring maternity care Accepted: May 2007 An increase in rates of delayed motherhood after age 35, both in the United States and internationally (Aliyu et al., 2005; Carolan, 2005; Newburn-Cook & Onyskiw, 2005), presents challenges for maternity nurses. Women older than 35 years of age tradition- ally have been considered at risk for adverse mater- nal and infant outcomes as a function of the interaction between age and health history. However, many older women may not be at increased risk. Furthermore, a health care provider’s judgment of a pregnant woman’s level of risk may not match her self-perception or the perceptions of her family. A low-risk woman may view herself as medically high risk and desire all the intervention possible, or she may expect a low-intervention birth but arrive in labor with abnormal findings requiring medical intervention. The challenge for the maternity nurse is to tailor nursing care to meet the biological and psychosocial needs of healthy and at-risk women over 35 years old who present for labor, delivery, and postpartum care. A “one size fits all” approach to care is inade- quate. The nursing assessment is the first step in providing tailored care to a woman of advanced maternal age (AMA). Tailoring care requires under- standing a woman’s expectations, the values she has placed on her childbirth experience, and her adap- tation to impending motherhood. Holistic patient- centered care facilitates patient satisfaction (Brown, 1992; Redman & Lynn, 2005). This paper reviews the research evidence of risks faced by older child- bearing women and provides maternity nurses with updated information and examples of nursing care tailored to meet the psychosocial needs of mothers over age 35. Health Outcomes of Births to Older Women Childbirth Rates and Outcomes After Age 35 Since 1990 (Center for Disease Control [CDC], 2006), birth rates in the United States for women between 35 and 39 years of age increased by 43% and those aged 40 to 44 experienced an increase in birth rate of 62%. Table 1 presents the number and CLINICAL ISSUES Tailoring Peripartum Nursing Care for Women of Advanced Maternal Age Patricia Dunphy Suplee, Katy Dawley, and Joan Rosen Bloch