Motherhood at or beyond the edge of reproductive age is a new aspect of what clinicians previously referred to as pregnancy in the "older gravida." With the implementation of infertility treatment, the boundary between "old" and "young" no longer exists. Currently, three types of old mothers are seen in the physician's office: those who accidentally conceive, those who still have fertilizable oocytes for assisted reproduction, and those conceiving with assisted reproduction after egg donation. In the United States alone, the 2001 rates for births to women aged 35-39, 40-44, and 45-49 years rose 30, 47, and 190% compared with 1990. Specifically, there were about 5,000 births to women > or = 45 years. Generally, the majority of the published studies have been unanimous about the special, and perhaps the super-cautious attitude required for the older mother, an approach that translates to higher rates of peripartum interventions. This is despite the fact that although some complications may occur more frequently in older mothers as a result of accumulated prior diseases, there is no direct evidence that older age per se complicates either gestation or parturition. In contrast, the risks for the fetus-neonate depend on the source of the oocytes and relate to the mode of conception. Also, older age has an advantage of better perinatal outcome of twins and triplets. Despite many unanswered questions, clinicians should exercise an unbiased approach and be prepared for the challenges and potential complications related to patients who are older than those seen in the past. The "unnatural" connotation of a pregnancy at an advanced maternal age should be accepted as a consequence of the combined effect of social changes and medical progress and not as a counter-evolutionary phenomenon.