With all of my patients, as they enter the third trimester, I discuss what their contraceptive plans are for after the baby is born.
Many smile a beautiful, blissful, glowingly pregnant smile and say, “Oh no. I don’t think we will ever use contraception again. Hopefully we will get pregnant again right away!”
Fast forward to their postpartum visit. A sleep deprived, exhausted new mom sits before me. Her first topic of conversation: contraception. While she is madly in love with her new baby, the thought of having another right away is a little overwhelming. She is not physically ready to go down that road again.
Some women are ready right away. I once had a women ask me at delivery when she could try for another baby. My answer, “Well, you at least have to wait for me to get the placenta out!”
The decision on when to try for your next child, obviously depends on many factors. Finances, age, personal goals and beliefs on contraception are just a few. I was recently asked on our FB page what the ideal timing between pregnancies is from a medical stand point. According to studies looking at pregnancy outcomes, it is best to conceive 18 months to 4 years after your last delivery.
I find it interesting that the ‘optimal’ time for conception of the next child is about 18 months since this is when children are truly at their most adorable. Full of toothy grins and giggles as they toddle around. This stage of ultimate cuteness entices people to have another baby. They then proceed to conceive before their child hits the ‘terrific twos.’ Which while adorable, at least in my house, is a challenging time.
Pregnancies conceived less than 18 months since the last delivery have an increased risk of preterm delivery and low birth weight. Pregnancy takes a lot out of your body, and it takes time for a woman to recover from the stress and for her nutrient supplies to get back to normal. The theory is that the body has not fully recovered at less than 18 months causing the baby’s extra risk of not growing as well (low birth weight). The risk of preterm delivery is further amplified in teens who conceive again quickly, since teens have often used their nutritional supplies on their own growth as well as their baby’s.
VBAC: Women who attempted a trial of labor after a cesarean section have an increased risk of uterine rupture if the pregnancies are less than 18 months apart.
Pregnancies conceived less than 12 months since the last delivery have an increased rate of placental abnormalities, such as placenta previa and placental abruption. Placenta previa is a condition where the placenta covers the opening of the cervix making vaginal delivery unsafe and increasing the risk of hemorrhage. Placental abruption occurs when the placenta begins to detach from the uterus before the baby is delivered. It can result in hemorrhage and fetal distress.
Pregnancies conceived less than 6 months from delivery have an increased rate of neural tube defects and autism. Neural tube defect is associated with low maternal folate levels, so most likely in pregnancies less than 6 months apart, the mother has not had time to fully replenish those supplies.
Pregnancies conceived greater than 4 years from the last delivery have an increased rate of preeclampsia, fetal growth restriction and cesarean section. It is unsure why this increased risk is seen other than the possible health changes in the mom over this time.
The actual ‘increased risk’ in each of the cases is statistically significant but overall low for the average woman. Take preterm delivery, the risk increase with conceiving early is 20%. For the average mom with no history of preterm birth, this changes her risk from 1% to 1.2%, which is negligible. However, a woman with a previous preterm delivery sees her risk go from 15% to 18%. These increased risks are most significant for those moms who already have risk factors for these conditions.
For the average healthy mom with no medical problems and a vaginal delivery, the increased risks of these complications with conceiving again soon are extremely low. Women with a cesarean section should wait 18 months for their scar to fully heal, especially if they desire a trial of labor (VBAC). Those with a history of pregnancy complications listed above are advised to wait the suggested interval before conceiving.