family planning
Sex and relationships

Family planning – getting it right

Having another baby may be the last thing on your mind now that you’re a mum. But you could become fertile again before you know it.

Another baby

There’s no perfect time to have another baby. And, even with careful planning, you can’t always control when conception happens.

However, understanding the risks and benefits associated with timing your pregnancies too close together or too far apart can help you make an informed decision about when to grow your family.

Whether you’re thinking about getting pregnant for the first time or you already have children, it’s important to think about family planning and your reproductive goals. Knowing whether you do or don’t want to have children in the next few years can help you and your partner choose appropriate contraception – such as birth control pills, contraceptive injections or implants, or an intrauterine device (IUD). Family planning can also help you determine when you might begin preconception planning, which is sometimes recommended up to a year in advance of getting pregnant.

family planning

After your first child is born, family planning takes on new meaning. Having another child will change your family’s lives. Are you and your partner ready to take care of a newborn again? How will your other child or children react to sharing your attention with a new baby? It’s also important to consider the timing of your pregnancies. While you and your partner might have preferences about how close in age you’d like your children to be, some studies show that spacing pregnancies too close together or too far apart can pose health risks for both mother and baby.

What’s the best interval between pregnancies?

To reduce the risk of pregnancy complications and other health problems, limited research suggests waiting at least 18 to 24 months but no more than five years after a live birth before attempting your next pregnancy. However, further research is needed to determine whether the effects of birth spacing on maternal and fetal health differ between developed and developing nations.

Still, choosing when to have another baby is a personal decision. When planning your next pregnancy, you and your partner might consider various factors in addition to the health risks and benefits, including your health, age, fertility, relationship, how many children you have, how many children you hope to have, access to health care, child-rearing support, and social and economic circumstances.

Until you make a decision about when to have another child, be sure to use a reliable method of birth control even if you’re breast-feeding. Once you feel ready to get pregnant again, ask your health care provider for guidance.

How soon can I have sex again?

You can have sex as soon as you and your partner feel ready to. Some people find it takes a while to feel ready, both physically and emotionally. If you have had stitches, then these are usually dissolvable so will not need removing. If you are having any discomfort from these then you should see your doctor or midwife. Some women find they need to use some vaginal lubricant if they feel drier than normal.

 

What are the risks of spacing pregnancies too close together?

Limited research suggests that a pregnancy within 12 months of giving birth is associated with an increased risk of:

  • The placenta partially or completely peeling away from the inner wall of the uterus before delivery (placental abruption).
  • The placenta attaching to the lower part of the uterine wall, partially or totally covering the cervix (placenta previa), in women who previously had a C-section.

family planning

A pregnancy within 18 months of giving birth is associated with an increased risk of:

  • Low birth weight.
  • Small size for gestational age.
  • Preterm birth.
  • Uterine rupture in women who attempt vaginal birth after a C-section (VBAC).

Some experts believe that closely spaced pregnancies don’t give a mother enough time to recover from the physical stress of one pregnancy before moving on to the next. For example, pregnancy and breast-feeding can deplete your stores of essential nutrients, such as iron and folate. If you become pregnant before replacing those stores, it could affect your health or your baby’s health.

What are the risks of spacing pregnancies too far apart?

Research suggests that long intervals between pregnancies also pose concerns for mothers and babies. A pregnancy five years or more after giving birth is associated with an increased risk of:

  • High blood pressure and excess protein in your urine after 20 weeks of pregnancy (pre-eclampsia).
  • Slow or difficult labour or delivery (dystocia).
  • Pre-term birth.
  • Low birth weight.
  • Small size for gestational age.

It’s not clear why long pregnancy intervals are linked to health problems for mothers and babies. Some experts believe that pregnancy improves uterine capacity to promote fetal growth and support, but that over time these beneficial physiological changes disappear. It’s also possible that maternal age or unmeasured factors, such as maternal illnesses, may play a role.

What are the different methods of contraception?

When you choose a method of contraception you need to think about:

  • How effective it is.
  • Possible risks and side-effects.
  • Plans for future pregnancies.
  • Personal preference.
  • If you have a medical condition, or take medicines that interact with the method.

Contraceptives can be divided into short-acting, long-acting and permanent; unless you are planning to have another baby in the next year or two, then you should consider using a short-acting contraceptive.

Condoms and diaphragms are safe, whether or not you’re breastfeeding. If you used a diaphragm before having a baby, this might need to be refitted. An IUD (intra-uterine device) is another possibility. See your doctor if you’re interested in this. Choose a contraceptive method as soon as you decide not to breastfeed. In this case, you have a lot of choice, including the combined pill or an implant such as Implanon.

More like this:

Top tips to boost your fertility
All you need to know about fertility
Are you super fertile?

Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.

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ASK LOUISE

Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….