Did you just have a baby?

Is it your first baby?

Are you Done with your postpartum blues?

Now back home, after all the celebrations of inviting the new member in the family, your mind will be throbbing with the question of when and how you are going to have the next one. One common question that every couple after the first pregnancy with a newly born first child asks their doctor is “When can we have our next baby?” In other words, the couple is trying to figure out how long they need to adopt a family planning method so that they can have an adequate period of space between the two children.

What is birth spacing?

But what exactly is birth spacing? It is nothing but the time interval between a live birth and the next pregnancy. This is technically referred to as birth-to-pregnancy interval. Though there are various birth-to-pregnancy intervals suggested, there are universal guidelines developed and adopted by the World Health Organization that keeps in mind the multicultural landscape of maternal health. World Health Organization in 2007 recommended a minimum interval of 24 months between a live birth and the next pregnancy.

Why do you need birth spacing?

Before delving into the methods of spacing births, it is important to understand why it has to be done in the first place. Maternal, infant, perinatal, neonatal and child health are intricately linked with birth spacing. Premature deliveries and babies with low birth weight are associated with shorter birth-to-pregnancy interval.

During pregnancy, delivery of the baby, and the subsequent events, there is a profound effect on the physical, cognitive and emotional health of the mother. It takes time for the mother to adjust to the new life, regain her health, and lose those extra pounds gained during pregnancy. In addition, the emotional and cognitive restructuring that takes place in the mother during this phase requires time to settle. Furthermore, there are various social issues, like neglect of the first child, when the birth spacing is very less.

Maternal morbidity and mortality

Adequate spacing is required for a healthy pregnancy outcome. Spacing should be ideal- it should not be too long or too short. Too less (< 12 months) and also too long spacing (>75 months) is associated with maternal mortality. The chance of preeclampsia is high when the birth-to-pregnancy interval is higher than 59 months. A longer interval is also associated with a higher risk of other maternal morbidities. Longer intervals pose a higher risk than smaller intervals. Also note that very short intervals are associated with miscarriages, still birth and induced abortion.
Effects of birth spacing on perinatal, neonatal, infant and child health

Another important reason to consider birth spacing is the health of the subsequent child as well as the well-being of the first child. The first child usually faces neglect when it is followed closely by another newborn. The neglect can be nutritional with the mother stopping lactation early due to pregnancy, or the neglect can be emotional where the child feels insecure about his / her position in the family when the parents’ attention shifts suddenly to the next child. This has profound negative impact on the cognitive development of the first child as he/she grows up.

The newborn of the shorter birth-to-pregnancy interval faces a unique group of problems. These can be divided into mainly four stages: perinatal (around the time of birth up to seven days after birth), neonatal (up to one month after birth), infant (up to one year after birth) and childhood. Premature births, low birth weight, and death of the fetus are associated with shorter intervals. In some cases, small size for the gestational age is related to intervals lesser than 18 months. Neonatal mortality is the least when the interval is around 27 months, whereas shorter intervals are more common in neonatal deaths. For infants and children, mortality rates and nutritional deficiencies are higher in shorter intervals of less than 18 months.

How long to wait for the next child?

As stated, a minimum duration of 24 months of birth-to-pregnancy interval is suggested. This consensus was reached after several rounds of discussion and technical consultation with various stakeholders. Two years of breastfeeding is required for optimum growth of the child was taken into account to decide this interval. Two to three years is ideal while three to five years is considered to be more beneficial.

What are the methods of birth spacing?

Birth spacing can be achieved through family planning methods that should be decided after a consultation with your physician. The method has to be chosen after evaluating a number of factors including maternal health, long-term or short-term goals, the motivation of the couple, intelligence and education of the mother, affordability, etc.
Male condoms are the most preferred short-term and cost-effective way of avoiding pregnancy while enjoying sex. Hormonal contraceptives for women that act on the ovulation cycle are popular among women. There are also long-term methods like intrauterine devices that help in birth spacing.

Summing up, birth spacing is a planned behavior that requires careful consultation with your physician and spouse, as it has health and well-being implications for you, your baby and your first child.