"An older heart doesn't have the same strength to accommodate that volume as a young heart does. The older blood vessels also don't have the same elasticity so the risk of getting high blood pressure is clearly higher."
But age isn't always the best indicator of maternal suitability, Cohen notes, and "someone at 61 might seem healthier than another person at 49. Thankfully, in this case, everything worked out fine."
At first mention, the idea of a grandmother giving birth to her own grandson sounds like a genetic nightmare, but because the Connells contributed the egg and sperm, the risk of genetic abnormality was actually quite low. From an emotional or even ethical standpoint, however, this arrangement might still raise concerns.
Is it ethical to put an elderly mother at increased risk of complications by allowing her to be a surrogate? Would carrying a grandchild that is then handed over to the biological parents create psychological turmoil in the grandmother?
Surrogacy in any case can be ripe with emotional complications as gestational mothers become attached to the child during pregnancy and may be less willing than expected to part with the child, even though it is not biologically theirs.
Even if the surrogate is no stranger but a family member, such as a sister, there might be similar attachment issues. In this case however, grandmother surrogacy might actually be one of the least complicated scenarios for surrogacy, notes Dorothy Greenfeld, a clinical psychologist who counsels patients at the Yale Fertility Center.
"I don't see it as particularly emotionally complicated," she says. "She's probably so overjoyed to be able to do this for her daughter."
Given that Casey was already going to play a somewhat maternal role in the child's life as his grandmother and that she is no longer at mothering age (and less likely to want to raise the child as her own), the situation is less complicated than others, she adds.
Indeed, Casey told the Tribune, "From the very beginning, the moment I've wanted is the moment the baby is in their arms. 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."