SAM DEAN The Roanoke Times

Jo Ann Foster watches as her husband Scott Foster burps their son. Jo Ann, who has been bombarded with questions about her choice to become pregnant at age 50, said she will make it her mission to let other middle-aged women know they have options, too.

Photos by SAM DEAN The Roanoke Times

Jo Ann Foster, 50, and her husband, Scott, 53, enjoy a moment with their son, Kemper Scott Foster. Jo Ann carried Kemper, who was conceived with a donor's egg and her husband's sperm, and suffered a heart attack two days after returning home from the hospital after his birth.

Jo Ann Foster had embryos conceived with donor egg and her husband's sperm implanted.

Jo Ann Foster's daughter, Kaile France, 21, helps put the finishing touches on the nursery. When Jo Ann was hospitalized after her son's birth, Kaile got the opportunity to play mom, stepping in to help with feedings and diaper duty.

Photos by SAM DEAN The Roanoke Times

Jo Ann Foster, 50, smiles while listening to her baby's heartbeat during an ultrasound. Jo Ann was 48 when she asked her gynecologist about trying to conceive. "He said I was too old," she recalled. Jo Ann and her husband, Scott Foster, worked with a physician in Charlottesville and after three rounds of in vitro fertilization, Jo Ann learned she was expecting.

Jo Ann Foster waits for a doctor's appointment. Though Jo Ann quit smoking prior to her pregnancy, she still dealt with health complications. She had elevated blood pressure and had to modify her diet to combat gestational diabetes.

Forget the stay-at-home versus working mom battlefront. Of all the issues people love to judge mothers about, Jo Ann Foster's situation tops them all.

For nearly nine months, friends and strangers have bombarded her with questions: Why, at your age, would you want to become a mom again?

Why put your 50-year-old body through the swelling, the diabetes and other problems common among older pregnant moms?

And the rudest question of all: How can you carry someone else's baby?

The judgments gnawed at her, Jo Ann said, severing friendships and making it difficult to land a job.

When Kemper Scott Foster arrived on the planet June 9, it didn't matter that Jo Ann and her husband, Scott, had created him in a petri dish, an amalgam of Scott's sperm and another woman's egg.

It didn't matter that, days later, Jo Ann faced a complication that threatened to render Kemper Scott a motherless child.

What mattered to Jo Ann was that her baby boy was healthy and much doted upon, by his proud 53-year-old papa and his big sister, who is 21.

"How did you do it, and do you think maybe I could do it too?" a middle-aged hospital nurse wanted to know.

Finally, Jo Ann sighed. For nine months, that was the question she'd been longing to hear.

Rack Room romance

They met on match.com some five years ago.

They were both divorced, both lonely. When Scott Foster first turned up in her e-mail in box, it was a Friday night. Jo Ann was lounging in her pajamas, ketchup from a Whopper Junior smeared on her front.

Their first hour online did not portend a match made in heaven: He liked NASCAR and sports. A bit of an old hippie, she hated both.

He worked on railroad train cars, good with his hands; she was an administrative assistant, good with computers. He allowed his dogs to lie on the couch; she was a clean freak who couldn't stand the mess.

But somewhere in the ether, something clicked. It was her first foray into online dating, and she was armed with excuses about why they shouldn't meet later that night:

Said she was in her pajamas. "So ... get dressed and meet me for coffee!" he wrote.

Said she didn't drink coffee, or even beer. "How about some wine?"

"You're getting close," she conceded.

They met at a bar -- but not before Jo Ann called her girlfriend to report all she'd learned of Scott, in case she turned up missing.

She'd also spent a painstaking hour figuring out what to wear. Known to her friends as "the shoe queen," Jo Ann finished off her capris-and-top ensemble with her favorite lace-up sandals.

"Nice shoes," were the first words out of Scott's mouth.

The shoe queen was hooked. Within a year, they were married.

Feelings of failure

They vowed to work out their differences, even though Scott's a homebody, and Jo Ann goes stir crazy if she's stuck for more than a day in their north Roanoke County house.

Still, after four years of marriage, it was obvious: Something was missing from Scott's life. Something huge. She saw it at the Little League games he umpired, at the rec-league basketball games he refereed.

Though he had been married twice before, he'd never had children of his own. When Jo Ann's daughter, Kaile France, left for college, the quiet was deafening.

She knew how her husband felt. When she married her first husband at 25, he'd already had twin sons of his own.

It had taken them five years to conceive Kaile, during which time Jo Ann used to stare at other women in the mall with children. "You feel like a failure," Jo Ann said. "Just seeing a pregnant woman at Kroger, I remember bursting into tears."

Early on in her marriage to Scott, tensions were mounting, they both recall. "Scott didn't have what he wanted in his life," Jo Ann said. "Right honey? You felt like, what ... a loser?"

Scott nods his head.

At her next checkup, she asked her gynecologist about having a child. "He said I was too old," said Jo Ann, who was 48 at the time.

But Jo Ann didn't feel too old, recalling back-to-back years as Kaile's elementary-school room mom. She remembered crying when Kaile graduated because there were no more school-party cupcakes to bake. "Her friends always saw me as the cool mom."

She refused to believe she was too old. By the time she left the doctor's office, she'd talked him into giving her a brochure with the name and number of an infertility specialist.

She waited on their front porch, paper in hand, for Scott to arrive home from work.

As soon as he got out of his truck, she waved the brochure. "We can too have a baby," she said.

Not the only one

Newswoman Joan Lunden did it. So did actresses Geena Davis and Holly Hunter, and a 67-year-old woman from Spain.

An increasing number of older women are having babies, most of them with the help of technology. In the past 10 years alone, the number of women 45 and older giving birth has more than doubled, with the Centers for Disease Control reporting 7,349 such births in the United States in 2007.

In 1982, before in vitro fertilization grew popular, the number of unassisted pregnancies was 1,236.

Leave it to the baby boomers, says Elizabeth Gregory, a University of Houston women's studies professor and the author of the 2007 book, "Ready: Why Women are Embracing the New Later Motherhood."

Not only did boomers come of age in a century where the average life span increased 30 years; they were also the first to enjoy the benefits of birth control and women entering the work force.

"Birth control changed the life narratives of women, which pushed people to the point where they're now like, 'OK, maybe we've waited too long,' " Gregory said. "That's what drives the fertility technology."

Some of Jo Ann's friends and family members were shocked to learn that she was going to a fertility clinic, offering, among other insights: Do you realize you'll be collecting Social Security by the time the kid graduates from high school?

But in Dr. Jim Holman's mind, "I don't think many infertility specialists in the country would bat an eye at someone who's 50 having a baby." Holman, a former Carilion Clinic administrator, now works for the Center for Applied Reproductive Science in Asheville, N.C.

While other countries have set upper limits on age for women who undergo assisted reproductive technology -- usually IVF and its various permutations -- the United States leaves it up to the discretion of doctors.

The first time Dr. Chris Williams met Jo Ann and Scott in his Charlottesville office, he explained that 50 was the upper age limit for his patients. Williams also advised the Fosters to use a form of IVF that would draw together Scott's sperm and the egg of a younger donor, which he would then implant into Jo Ann's uterus. Using a donated egg would significantly reduce the risk of miscarriage and birth defects, he said.

Scott borrowed nearly $50,000 from his 401(k) retirement fund to pay for the treatments and procedures. It would take three cycles, including one miscarriage, before Jo Ann learned she was pregnant with Kemper Scott -- the day before her 50th birthday.

"Jo Ann was very, very driven," recalled Williams, of the Reproductive Medicine and Surgery Center. "She was absolutely going to follow this through till it got done. If we'd have said no, she would have gone somewhere else."

Broke but determined

Though she had stopped smoking in preparation, complications arose early on. There were swelling problems, and Jo Ann had to modify her diet to combat gestational diabetes. She also had elevated blood pressure, which is why an echocardiogram was ordered early in her second trimester, to rule out heart problems.

Jo Ann became a weekly, sometimes daily visitor to the Roanoke office of Dr. Lynn Keene, the high-risk obstetrician who managed her pregnancy. She was there so often that the nurses and technicians even gave her baby a nickname -- Scooter -- because he moved around constantly in utero.

Eight months into the pregnancy, Jo Ann felt so tired that she had to take two naps a day. She couldn't wear many of her favorite shoes; her feet were too swollen.

The hardest thing about the pregnancy was losing her temporary job as an administrative assistant; she blamed that on missed work due to doctor appointments. When she interviewed for other jobs and disclosed her pregnancy, she was never called back.

"Nobody wants to hire me because I'm pregnant and 50. Financially, it's killing us," she said.

In her 35th week, she was hospitalized because the fluid in her placenta had gotten dangerously low, putting her at risk of a stillbirth. She was released after a few days with the goal of staving off the birth for two more weeks.

For the last six weeks of her pregnancy, she had only been able to sleep in the wingback chair of her living room. Lying flat made breathing difficult, she said. The former size-6 woman now weighed more than 220 pounds.

Before the C-section began on June 9, Jo Ann thought she was having a panic attack. It felt like she was suffocating. "She has a tendency to choke, and it scares her," Scott said, adding that she was given extra anesthesia to help combat the anxiety.

At 7 pounds and 9 ounces, Kemper Scott was born healthy and without incident, with his father looking on.

The next day Jo Ann was groggy, but she was also joyful and ebullient, nursing the baby and calling him "precious." She was still very swollen and sounded congested when she spoke.

"Ain't nobody in the world gonna tell me there's not something of her in that boy," Scott said proudly.

As they left the hospital, Kaile pushed the baby while a nurse wheeled Jo Ann to Scott's car.

It was a picture-perfect, if not quite typical, hospital departure scene. They never imagined they'd have to return so soon.

'I'm dying'

Two days later, Jo Ann was even more swollen. She couldn't walk from one end of the dining-room table to the other.

"I'm dying," she told Scott.

He wanted to take her to the emergency room, but she insisted on holding out for her Monday morning doctor's appointment.

Within hours, her chest and arms were so heavy that she could no longer hold the baby. "Call the rescue squad," she said.

Here's how doctors described what happened: Sometime during the tail end of her pregnancy -- no one can say for sure why or when -- Jo Ann's heart muscle weakened and wasn't pumping properly, exacerbating the fluid buildup and, three days after the birth, causing a heart attack.

In younger, healthier women, the fluid buildup goes away postpartum on its own. The complication is so unusual even among older moms that both Holman and Williams said they had never had it happen to a patient before.

"The protocol hasn't developed to deal with people my age," Jo Ann said days later. "I don't blame anybody, just myself. I should have read more and been more persistent about knowing what could happen."

"I should have pushed harder too," Scott said.

But they focused on the baby instead. "My worst fear was always that he'd end up in the NIC [neonatal intensive care] unit -- not that I'd end up on the cardiac ward," she said.

Months earlier, before attempting the IVF procedure, they made sure that Kaile and Scott's younger sister supported the pregnancy. The two agreed to jointly raise the child in the event that anything happened to the couple.

Now, Kaile was already getting the opportunity to play mom, taking the night shift while Scott did feedings and diaper duty during the day.

The three visited Jo Ann daily in the hospital's cardiac-care unit, where nurses -- unaccustomed to seeing babies -- fussed over him and begged to hold him for a spell. One even asked for Dr. Chris Williams' phone number, saying she was thinking of having a baby, too.

When a middle-aged phlebotomist came in to draw blood, Jo Ann told her story again: about the IVF and egg donor; about how here she was -- 50, and just now having her second child.

"Oh, you're a crazy lady," Colleen Andrus said, smiling as she inserted her needle. "But I bet you're gonna have a ball. He'll keep you young."

Even though she still has a heart procedure ahead of her, Jo Ann agrees. She's making it her personal mission to make sure other middle-aged women know they have options, too.

Heart attack or not, she has proof that her decision was right: Her son weighs almost 9 pounds now, rarely cries and looks just like his father, who likes to show him off to waitresses at the nearby Waffle House.

"I will recover from this, and to have him in my life only makes me want to get better quicker," Jo Ann said.