Deciding When to Start Trying…Again!

Toddlerhood
Written By Sophie Smith

If you’re already pregnant again, click here for practical tips on the transition to two (e.g. preparing your older child, managing birth logistics)


Optimal Spacing

  • Your ideal gap between kids is a complex personal question but here are some spacing considerations

  • Advantages of having them closer:

    • The newborn stage is fresher in your mind, so less re-learning to do

      • Mine were about 2 years apart and I feel like I still remembered the early months quite well

    • The siblings will be able to play together on a similar level pretty early on

    • You will be out of the phase of diapers and complicated sleep/feeding schedules sooner, and thus able to all do different kinds of activities/vacations together sooner

    • Parenting is very physically demanding and our bodies aren't getting younger; same goes for grandparents - nice to maximize the years that they are able to be active and involved grandparents

  • Advantages of having them further:

    • You get more focused time to enjoy your first child before feeling your attention split - the early toddler years are so amazing!

    • Your older child will be more mature - sleeping/eating better, safer around your newborn, potty trained, etc.

      • Anthropological evidence suggests that for most of human history, children were spaced 3-4 years apart, in part because this put less of a strain on resources and maternal health

    • Less likely that the kids will be super competitive with each other later on since there will be a wider gap

  • Also consider how many kids you want in total and what spacing you would need to reach that number by age 40 (when female fertility starts to really drop)

    • If you want to go much beyond that age, it’s of course possible, it just might take longer or require IVF

Physical Considerations

Conception

  • The official guidance is that you should wait at least 6 months, and ideally up to 12-18 months, before getting pregnant again, so your uterus can fully recover from the first pregnancy - shorter intervals are associated with increased risk of adverse birth outcomes like preterm delivery (source)

  • Breastfeeding can act as a natural check on getting pregnant too soon, since it inhibits ovulation for some amount of time

    • Technically still possible to get pregnant even if your period hasn’t returned (since you could get pregnant after the very first ovulation, before your first period) so consider birth control if you want to avoid that small chance

    • Opt for progestin-only birth control pills (sometimes called the “mini-pill”) since they won’t affect your milk supply, unlike the typical combination pill that includes estrogen.  IUIs are also safe.

    • Some women are able to get pregnant while still breastfeeding, and may even end up “tandem nursing” where they continue to nurse their toddler alongside their newborn

      • Breastfeeding while pregnant is generally safe for low-risk pregnancies, but the composition and taste of your milk will change as you approach your due date, which might affect the nursing habits of your older child

  • If your first child still isn’t sleeping well and thus neither are you, this could impact your fertility, as could other forms of stress - and let’s be real, toddlers can be very stressful at times!

    • Even if you got pregnant quickly for baby #1, don’t be surprised if it takes a little longer for baby #2 due to the above, plus the fact that you are that much older

Pregnancy

  • Your first pregnancy is a pretty good indicator of what you can expect for your second in terms morning sickness severity and fatigue levels - but chasing a toddler around while pregnant can certainly heighten these symptoms

  • For a complication you had during your first pregnancy, the chances it will recur depend on the condition and its severity, but here are some approximate recurrence figures (from Emily Oster’s new book “The Unexpected”):

    • Hyperemesis Gravidarum: 15-25%

    • Gestational diabetes: 50%

    • Preeclampsia: 10-50%

  • Talk to your doctor about whether there are any measures you can take this time around that could mitigate the issue (e.g. starting prescription meds for nausea sooner, low dose aspirin for preeclampsia)

Birth

  • If you had a pre-term delivery with your first, you have increased chances of pre-term delivery with your second (15-30% chance) (Oster, The Unexpected), though it depends on the cause of the first pre-term birth; similarly, if you delivered post-term with your first, you are more likely than average to do so with your second (but still only a 15% chance) (study)

  • You can expect a much shorter labor - on average, 50% shorter “first stage” of contractions and 75% shorter pushing - though of course unexpected situations can always arise that were different than your first (source)

  • Perineal tearing is less likely and less severe - 3rd and 4th degree tears occur in 7% of first births, but only 2.7% of later births; if you had tearing in your first birth, you do have a slightly higher risk of recurrence than someone who did not (Oster, The Unexpected)

    • Some women who experienced 4th degree tears in their first pregnancy may opt to have a C-section to avoid risk of recurrence

  • If you had a C-section for your first, you’ll have to decide whether to have a planned C-section for baby #2, or attempt a Vaginal Birth After Cesarean (VBAC), also called a Trial of Labor after Cesarean (TOLAC)

    • Only ~20% of women who had one previous C-section will try for a VBAC (source) - among these women, the success rate is around 70% (source)

    • The reason for your prior C-section impacts your chances of a VBAC:

      • Lower likelihood of success: small pelvis/large baby, failure for labor to progress (Dystocia)

      • Higher likelihood of success (non-recurring reasons): Fetal position (i.e. breech/transverse), fetal distress caused by cord issues

      • Here is a calculator where you can see your predicted VBAC success rate based on a number of factors (age, birth history, BMI) 

    • Benefits of VBAC:

      • Recovery from a vaginal birth is typically faster and easier than C-section

      • If you’re hoping to have more than two children, there’s a good argument to try for a VBAC because the scar tissue from multiple C-sections can lead to complications in subsequent pregnancies

    • Risks of VBAC:

      • The biggest risk is uterine rupture, where the C-section scars tear during labor, but this is thankfully rare, occurring in less than 1% of cases where the previous C-section was a “transverse incision” which is the most common type

      • An unsuccessful VBAC would mean an unplanned or emergency C-section, which can be more stressful and a bit riskier than a planned C-section (plus you’re tired from having attempted the vaginal delivery for however many hours)

    • Benefits of Planned C-section

      • More predictable timing, which is useful for figuring out childcare for your older child and general peace of mind

      • Can use spinal block for anesthesia, which may be faster acting and easier to administer than an epidural, which is often used if already placed during the attempt at vaginal birth (but both are highly effective and allow you to remain conscious); definitely better than an emergency C-section where general anesthesia would be required

      • No vaginal injury/tearing

    • Risks of Planned C-section

      • Recovering from C-section surgery is especially challenging when you have a newborn and a toddler, especially if the toddler is young and might not understand how careful to be around your wound area

      • Multiple C-sections can lead to complications in subsequent pregnancies

Mental Considerations

  • Gearing up emotionally to go through pregnancy and the newborn phase again is no small task - perhaps you finally feel like you have a handle on this parenting thing, and now you’re about to blow it all up!?

  • You may also be wondering - is having two kids going to be twice as hard? Is it more than twice as hard, or are there “economies of scale” that make it less hard?

  • Obviously, the answer to this will depend on your specific kids, how easy sleepers/eaters they are, etc so it’s impossible to know since you haven’t met the future one yet!

  • But in general, I believe it’s less than twice as hard and here’s why:

    • You are a more experienced, knowledgeable parent, so you aren’t dealing with the same levels of anxiety or overwhelm as the first time around. While every baby is different and new challenges will arise, there’s a baseline level of confidence you’ll bring that will make it much easier.

    • Your life is already mainly oriented around your child, so going from 1 to 2 is less of a fundamental shift in your priorities and identity as 0 to 1 probably was

      • Plus, you already have most of the gear, so you don’t have to do all that research and purchasing

    • Once they hit a certain age, your baby and older child will entertain each other! This is the best, both because it’s beautiful to watch and it relieves you of the work of playing with them constantly! 

      • This started for us once the baby was around 15 months and older one was approaching 3.5 years, and would last 5 - 10 glorious minutes; by 18 months there could be 30 minutes stretches of unsupervised play together

Sophie Smith
Next

Transition to Preschool