And importantly, how many babies are you planning?
All of these things matter when trying to decide when to have your next baby.
In this episode we even talk about our own journey and the factors we considered to help us decide when to try for another baby.
Brigid: [00:00:36] Well, welcome everyone. This is episode 42 and we've called this how long to wait between babies and why?
Dr Pat: [00:00:44] Good morning, everyone. We're back here in the studio recording some more episodes.
It feels good.
Brigid: [00:00:48] It does feel good. Doesn't it? And this has been asked lots of times on our DMS. So yeah, I love it.
People are so great at spending the time to write as a DM and I'm going to actually read one. So I'm going to say this is from Daisy. It's not really, but I like Daisy. Okay. So hi, Brigid and Dr. Pat. I just wanted to thank you so much for your amazing podcast. I had an elective induction back in March. And I think I listened to your podcast on inductions about 10 times before my actual induction date, it was so informative and made me feel so comfortable and confident going into it. My induction was about 10 hours long start to finish, and my beautiful baby girl was perfect.
Thank you so much again for helping this first time mum and I can't wait to continue to learn more before we plan our second baby. There you go. And I thought that that was a good one to read out because this is kind of all about second and subsequent babies. And, you know, in an ideal world, we'd all like to be planned about when our babies come, but it doesn't always work that way.
And actually there's about more than half of pregnancies in Australia are unplanned.
Dr Pat: [00:01:54] I read that somewhere recently in the context of the debate about whether, whether you should have to identify obstetrics as something you want on your private health insurance. Because we as obstetricians think that it's just, it's part of health care and getting pregnant part of health care.
So you shouldn't have to have special cover for obstetrics. Yeah. Mostly because half pregnancies are unplanned. Right.
Brigid: [00:02:16] I read that too. That was in relation to, there are some health conditions that you can don't have to wait for the waiting period.
Dr Pat: [00:02:24] Yeah, There are a few, like some of the funds will say that they'll waive a waiting period on psychiatry.
Yeah. Because you couldn't have predicted that you were going to get a psychiatric problem. Well, and we would argue obstetrics is just the same. Most of the time, we couldn't have predicted that you were going to become pregnant and the waiting time system is inherently unfair
Brigid: [00:02:46] I couldn't actually find out whether that unplanned bit was your first, because I would imagine a lot of people are a little bit more planned for their second and subsequent babies
Dr Pat: [00:02:53] yeah. Maybe, maybe they, maybe their life circumstances are different, but not everyone. It's just not possible. Like we were in a bit of hurry.
Brigid: [00:03:01] that's right. Well, why were we in a hurry Pat?
Dr Pat: [00:03:04] We were trying to fit another baby in before we got to old.
So that's part of it. Isn't it.
Brigid: [00:03:10] Yeah. So we had our third when I was 39 and then six months later, I was pregnant with our fourth and nobody, like, we thought we'd start trying because it might've taken, you know, a year or something for a 39, 40 year old to get pregnant. But here we are.
And we're going to talk about why sometimes having that time gap, you don't get a choice sometimes when you, when you're aging, it is what it is.
But I did want to talk about probably the most planned person I've ever come across. And that's my sister. So Maureen, she is a school teacher. And so is a husband and they've got four children all grown up.
In fact, we've got one with us at the moment, staying in this COVID locked down and it’s just delightful. Maureen has four delightful kids, but all super planned where she had all of them in the school holidays.
Dr Pat: [00:03:59] Oh, that is fantastic.
Brigid: [00:04:00] Isn't it? But you know this whole idea about when to have your next baby, we're going to be talking about the physical part of that, the medical part of that, but it's, it's big planning your next baby.
Dr Pat: [00:04:13] Yes it depends on things like financial considerations, the woman's plan to come in and out of the workforce or whether she wants to go out of the workforce once and come back in once when the family's finished. The couples age, mostly a woman's age and overall desired family size.
Brigid: [00:04:31] Yeah. And you don't know how you're going to cope mentally too from having one, your first, who knows, you know, you may not be mentally able to cope with another baby within a certain frame. So between my first and second, it was about that mental coping. I couldn't even start to think about having a baby until about that I was mentally ready.
So two and a half years between the first and second. And, and that to me at that time was about right.
Dr Pat: [00:04:59] Yeah. That's nice to start with a plan, but you might need to experience having one before you can really know, whether you want yes, exactly. Oh this is so complicated. I often, you know, you know, infertility or subfertility type consultation, I'll say to people, how many babies do you want?
And the couples sort of look at each other and they'll invariably say we'll be grateful for one. Yeah. And I say that's not the question. Forget your fertility issue. How many babies do you want in your secret heart? You know, what's your vision. Yeah. And then we, of course we work to try and get that vision number.
Yeah. But if someone's 22 and wants two babies, when we've got the much smaller problem, then someone is 38 and wants four.
Brigid: [00:05:40] Yeah, yeah. Exactly. You know, you'd have to be pretty planned for that. And there are tough decisions. Do you ever get that situation where you ask that couple and they have different answers?
Dr Pat: [00:05:49] All the time.
Brigid: [00:05:52] Really? Uh, I could imagine one! When I met you it was zero more babies. Wasn't it?
Dr Pat: [00:05:58] Well, but yours. Yeah. Yours. So the, yeah, so sometimes the, perhaps the woman might be more likely to cough up her dream number and the bloke might say, let’s have one? See how we go,
Brigid: [00:06:10] Alright. So I want to talk though medically, because we could wax lyrical all day on how a family goes, but you know, we're here about the medical side of things,
Dr Pat: [00:06:21] the inter pregnancy interval.
Brigid: [00:06:23] Yes. Is that a term
Dr Pat: [00:06:24] think it is. It's in the books. I've never used it. I just used it just then. That was the first time.
Brigid: [00:06:29] Yeah. Cause when I did my research on Google, once again, you love it. When I do that, the term inter pregnancy interval came up a lot.
Dr Pat: [00:06:34] Yeah. It's obvious what that means. I'm not sure it's in everyday clinical use
Brigid: [00:06:38] no.
What do you say? Gaps?
Dr Pat: [00:06:40] Just the gap. Yeah. Yeah. And people do ask about safe gaps in it. It comes up most seriously in the caesarean section discussion because we want to give people, some sensible advice about. How long it should be between two caesarean sections or between one Caesarean section and a subsequent attempt at a vaginal birth.
And the problem that we've got is that there's really mixed data about how long it should be.
Brigid: [00:07:11] Well, the world health organization has a recommendation. Doesn't it?
Dr Pat: [00:07:15] I think they say it should be 18 months between the births, at least not 18, but at least 18 between the births, which would mean that you were, weren't becoming pregnant again for nine months after a Caesarean section.
Now for most people, that would be fine because they weren't trying to become pregnant again the first nine months, but it might be relevant to somebody who was already 40, for example.
Brigid: [00:07:40] And the thing that I have about the world health organization recommendations is it it's for the whole world. So we're comparing first world medical systems to third world.
And I could imagine their making that also for a third world condition. So yeah. Yeah.
Dr Pat: [00:07:56] So there's a lot of their recommendations are for following in developing countries with low levels of health care, less money per person spent and so forth. So we have to factor that into recommendations made by overarching bodies like that.
Brigid: [00:08:12] You talked about Caesarean section, but are there other risks if you have your babies too soon, too close together?
Dr Pat: [00:08:19] Well, let's go through some of them. I mean, one of them, for example, if you wanted to get pregnant again, straight away might be, how does that impact on breastfeeding? Yes. So, uh, I've looked after several women over the years who have breastfed right throughout the second pregnancy, and it's certainly possible for the milk to keep coming.
And then they've only really tried to wean the first baby when they had to breastfeed a second baby full time
Brigid: [00:08:40] or tandem fed. Yeah.
Dr Pat: [00:08:43] Yeah. It can definitely be done, but you'd need some spare, but it would be for the most highly motivated person, but you might be able to.
Yeah, it's just not wean that first baby completely until the second baby needed all or most of your breast milk, which can be done by motivated people. But for other people it's not possible. Like when the new pregnancy comes the milk will stop.
Brigid: [00:09:06] Me, I'm putting my hand up. That's exactly what happened.
And I remember feeling so devastated because you know, breastfeeding, I've talked about it before, but my breastfeeding journey hasn't been all that easy and I've been determined to continue it, even though it was difficult and stressful. However, I managed to get Sully, the third baby until about, I dunno, six or no, it must've been more than that.
Maybe seven or eight months. And then just went, you know, this is too much of a struggle. I was already two months pregnant and my breast milk was just gone. Yeah, yeah, yeah. Which was so sad. But
Dr Pat: [00:09:38] otherwise we would have gone longer
Brigid: [00:09:41] Yes I knew that was it, finished.
Dr Pat: [00:09:42] Yep. So that's one consideration. And then I guess the next one is just coming, you know, one of the real determinants of how well pregnancy is going to go is how healthy you are at the start coming in. Yep. So, you know, anyone who's listened to any of our other podcasts will know how passionate we are about in particular, in the, in the setting of a planned pregnancy, that before we actually get pregnant, we go to the local doc and we get some advice on drugs, alcohol, and smoking.
We get a plan to reduce body weight, and we get optimum management of any preexisting. Health issues. Yeah. So if we've got a thyroid issue, we get it spot on before your pregnant. So if you get pregnant again, very quickly after one baby, we may have missed an opportunity to come into that second pregnancy in the best nick we can.
Brigid: [00:10:29] Yeah. And I think my problem was that I was a little depleted, so my iron. levels were always pretty well monitored, even in my third and fourth pregnancy. But what do you think is, is that a thing, like, are you,
Dr Pat: [00:10:42] I think it's a thing that you could definitely come in depleted although, something that could be managed with supplementation, but yeah, absolutely.
If you had a whole pregnancy of your baby stealing your iron and then you're already low and then you breastfeed, and maybe you're going to have a great iron intake and then get pregnant again, you'd be coming off a low base. Yeah.
Brigid: [00:12:12] Another thing that I had was I had some pelvic pain during my third pregnancy, which during my fourth pregnancy, because I think it was so soon after I remember having to be monitored and treated by the physio pretty regularly and wear the supportive belt, which made me feel like I was trussed up like a chicken.
Dr Pat: [00:12:32] Yeah. So same thing, I guess, if there was a longer gap, you would have more of an opportunity to address that more of an opportunity for the physios and the Pilates people and the weight reduction and all the things that help settle musculoskeletal pain down
Brigid: [00:12:45] yeah. Oh, and when you say weight reduction, if you've gained weight in your first pregnancy and then you're pregnant sort of soon after I would imagine that that's just sort of all adding up
Dr Pat: [00:12:58] cumulative.Yeah. Women can gain a lot of weight in their childbearing years by gaining some per pregnancy and not taking it off again in between. And weight control is a challenge for all of us. I'm not pretending for a moment that it's easy, but the key to not winding up very overweight when your last babies, born is dropping some of it off between each pregnancy.
Brigid: [00:13:16] Yeah. Which is kind of tricky to do if you're pregnant again. And so, Pat so far we've been talking about the problems or the what can happen, the physical aspects to the mum, but is there a problem for the baby if you've got too shorter gap between pregnancies?
Dr Pat: [00:13:32] Yeah. So for the babies, it's difficult because the data is a little mixed and definitely deficient.
There've been a couple of well publicized studies that have looked at this, and they've certainly looked at a large number of women in the studies, but there, there were too many confounding factors,
Brigid: [00:13:51] no confounding. What does confounding mean?
Dr Pat: [00:13:53] confounders, uh, factors that might complicate the results of a study where the thing that you find might be explained by something completely different, other than.
The thing you're looking at. So for example, in this study that the, of the Canadian study that looked at babies born close together in age, they suggested that the second baby might be more likely to have growth restriction and it's tempting to conclude that's because the babies are closer together, but further analysis might show that those women who had their babies close together there might've been a higher rate of smokers.
Yeah, right. For example. Yeah. And the smoking would more than, more than adequately explain the growth restriction and it would be potential statistical mistake to assume that it was just because the babies were born closer together
Brigid: [00:14:41] yeah. Because there's, there's others that show that there's really no link.
Dr Pat: [00:14:45] Yeah. Yeah.
Yeah. The first thing, if you, if you do a really good study and think you found a link between thing a and outcome B, it has to be repeatable. So someone else has to be able to yeah. Do the same thing and find the same result.
Brigid: [00:14:58] And of course we're talking about pregnancies that have resulted in a live beautiful baby, but I'm assuming it's different advice that you would give to people who have had miscarriage or maybe a second term baby loss or something like that.
Dr Pat: [00:15:11] I think we might've talked about that in the miscarriage podcast. That's very much a matter of being emotionally ready? Yes. Let's talk about first trimester miscarriage for a moment. It's pretty fast. People are resilient and if they've got it in their heart to have a baby, it's amazing how quickly they will return their efforts to that.
Yeah. Yeah. So I kept, you know, if any of my patients have a first trimester miscarriage, I see them in two weeks to make sure that they're part of the majority of women who will soldier on from that incredibly well and not the smaller group who need immediate, psychological or psychiatric support.
And when I see those couples at two weeks after miscarriage, it's amazing how often.They tell me that it still hurts, but it hurts less than it did a week ago. And they're ready to turn their attention to trying again.
Brigid: [00:16:03] Yeah. So that's a, that's a totally different sort of example. And of course, if there's been baby loss at any time, it's sort of the mental again, the mental readiness
Dr Pat: [00:16:12] yes. Yeah. And that's a more complex issue, but if we're talking about a baby born at term, when we have the next one.
Yeah. And honestly, I encourage people not to worry a huge amount looking for data on that. Even if you look at some of the data that's been gathered on, what's the perfect age gap between your kids, for their developmental, social development and so forth. I think even that. It has to be taken with a grain of salt.
A lot of the time, like our youngest two are very close in age. They're terrific friends. They are each other's primary playmate and yeah, it would be different and perhaps not as good if they were further apart
Brigid: [00:16:54] and it is beyond the scope of our podcast in general, but it does come down to parenting doesn't it. The kids take your lead. Yeah. That's for future us. I mean, when we do like the parenting podcast. No, thank you. Go to Maggie dent. She is excellent about all these things. All right. So we've talked about when the gap is too short, but what about if the gap is long, like, you know, like me in between our second and our third, the gap was six years was, you know, am I like, is it like I'm birthing my first?
Dr Pat: [00:17:28] Yeah. It's an interesting question. There's a feeling in obstetrics that it's a risk factor if it's been a long time since your previous baby. And I guess the typical situation is the couple who thought they were done and then five or six years later, they go “no we'll have our more”. Or more commonly a new relationship.
So we will, for example, in the, in the labor ward of a public unit in the morning handover, if someone's laboring away and we were handing over from the night team to the day team, we'll say, this is Mrs. Jones having a third baby, but it's been seven years since the last baby,
Why is that relevant? Because she might behave a bit more like somebody having their first baby, if there's been a long gap and that's potentially something that we might just want to know about to monitor how that labour was going out for the rest of the day. I actually think the gap is it's not so relevant. It's more just that if it's been six years in someone last had a baby, then by definition, they are six years older and it's probably more relevant that she's just, it's not so much the gap.
It's just, she's older than she was. So some of the things that we know. Where age comes into it and more likely to be relevant to the post-gap pregnancy.
Brigid: [00:18:41] Yeah. Yeah, yeah. Yeah. Good. All right. Well, I don't know. We have we given any answers, like,
Dr Pat: [00:18:47] No, there aren't any answers now.
So this is one of those situations where I really do say to people don't worry too much about that. Have that next baby when you're ready.
Brigid: [00:18:56] When you're ready. When you're, when your family's ready, when you're. Discussed it, when you're you feel like your body's ready? You're mentally ready.
Dr Pat: [00:19:04] Yeah. It's one of the reasons why as obstetricians, if all things are equal and the works out financially and all that sort of things, we like couples to have their babies with enough time to have the family size they want to have.
Yeah. And it's another reason to make a sensible contraceptive choice. Yeah. So that, for example, if you've got another baby planned in 12 months, then that may well alter your contraceptive choice compared to if you've got another baby planned in three years.
Brigid: [00:19:33] And actually we've done a few podcasts now, haven't we?
So there's a contraceptive podcast that we would recommend you go back to listen to. And I'm not sure what number that was. Oh, there we go. Number 12, what contraception can you take to help protect your fertility, but we've also gone into what contraception to take between your babies. Sure. Yeah, because you know, you're trying to protect your fertility as well, if that's what you're choosing to do.
And I think another point that we made in this is, you know, your baseline, making sure that you're healthy, really sort of looking at starting that next pregnancy. In the best nick, we talk about that a fair bit, the best nick as you possibly can yet. So if that is it, you're worried about, you know, your vitamin reserves or how, how you went after the first pregnancy is to go back to your GP and have those baseline tests, see what your iron stores are like and your thyroid function and, and then bat on, but everyone who's not Australian, bat on, Oh no,
Dr Pat: you carry on.
Brigid: Yes. All right, everyone. Well, thanks for listening. And if you feel like it, why don't you hop onto our iTunes podcast and give us a five star rating? That would be great. Wouldn't it Pat and maybe a DM or a podcast write a review. And so we can read it and know what it is that you're liking about the podcast and what you want to hear more of.
Dr Pat: [00:20:49] We love hearing from everyone. Thanks for listening.