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Sara Toups was 44 – old enough, she figured, that any chance of pregnancy was long behind her. … A growing share of Americans are opting to start parenthood later in life, having their first children in their late 20s, 30s and even 40s.

People like Toups – who live in cities with large hospitals and research institutions – have an advantage in finding appropriate pregnancy-related medical care, noted Karen Guzzo, a sociologist at the University of North Carolina at Chapel Hill who studies family formation and birth patterns. OB-GYN care is already difficult to find in large swaths of the country, particularly more rural areas. And then there’s finding a physician comfortable caring for older patients, and who can make sure those patients feel adequately treated.

USA Today