How soon did you want to get pregnant after your previous child? For some, it’s a while. For me, I was ready after 4 months after my first!
But I am so glad that I have been ecologically breastfeeding, because it has prevented my fertility from returning until 15 months postpartum after my first, and going on 18 months now with my second.
Today, we’re going to talk about ideal child spacing, which is God’s design for a healthy mother, baby, and future baby. Technically, ideal child spacing will only work naturally when the mother ecologically breastfeeds AND consumes adequate amount of healthy food. Understandably, if you are not able to ecologically breastfeed or if your fertility returned, you can still achieve ideal child spacing with safe birth control, Natural Family Planning (NFP).
What is child spacing?
Child spacing is the length of time between a birth and conception of the next pregnancy.
What is the ideal child spacing?
Conceiving a baby within 18 – 50 months, after a previous birth, is ideal to have a healthy, full term baby and a healthy mother.
What are the risks of inadequate child spacing?
A total of 67 studies (11,091,659 pregnancies) found increased risk of preterm birth, LBW (low birth weight), and SGA (small for gestational age) with spacing shorter than 20 months and longer than 60 months.
For both fetal and early neonatal death, the highest risk was for spacing shorter than 6 months and longer than 50 months.
For spacing shorter than 6 months, there was a 40% increased risk of preterm birth, a 60% increased risk of LBW, and an approximately 25% increased risk of SGA.
Infants spaced longer than 59 months faced a 20% to 43% increase in risk of the 3 adverse perinatal outcomes.
The largest study done in the US to help identify factors that may put children at risk for ASD (autism spectrum disorder) found that children conceived outside of the 18-59 month range had a significantly increased risk of ASD.
Seven studies (involving 1,140,210 children) found that the linkage is unique to only ASD, as there was no linkage found between birth spacing and having children with other developmental disabilities.
The linkage was also not explained by unplanned pregnancy, an underlying fertility disorder in the mother, or high blood pressure or diabetes during pregnancy.
Other studies linked conception under 18 months with significant increased risk of developmental delay (3 studies; 174,940 children) and cerebral palsy (2 studies; 19,419 children).
What is the reason for the adverse outcomes in child spacing under 18-20 months and over 50-60 months?
Mothers conceiving under 18 months have nutritional depletion, reproductive system damage, and postpartum stress.
Short intervals between pregnancies and periods of lactation worsen the mother’s nutritional status because there is not adequate time for the mother to recover from the physiological stresses of the previous pregnancy before she is subjected to the stresses of the next. This results in depletion of maternal nutrient stores, which results in the increased risk of adverse perinatal outcomes. Nutrient deficiencies, seen in short birth spacing, can also lead to postpartum depression.
Although many micronutrients normalize shortly after birth, several maternal depletions remain for months and even years. Stores of several nutrients may need to be replenished during the postpartum period.
Poor maternal nutrition is associated with:
- iron deficiency: can lead to low birth weight
- folate deficiency: can cause neural tube defects and increases risk of fetal growth restriction
- calcium deficiency: increases the risk of hypertension during pregnancy and also contributes to bone demineralization
- Vitamin D deficiency: increases risk of preeclampsia, gestational diabetes mellitus, and other specific conditions of certain tissues in pregnant women. Vitamin D also plays an important role in bone metabolism through the regulation of calcium homeostasis.
Studies show that pregnant women are below 35% from the RDA (dietary reference intake) for these key nutrients. This follows them into the postpartum period, where the ingestion of key nutrients, which were below recommended levels during pregnancy, actually decrease, along with fiber, vitamin E and C.
The extra nutrient intake needed to cover exclusive breastfeeding for 4 to 6 months is substantially greater than that needed to cover the entire pregnancy.
Although there are not conclusive studies done on why conceiving after 60 months from last birth causes adverse outcomes, researchers find that the mother’s body becomes primed for birth during the earlier pregnancy, with enlargement of the uterus and an increase in blood flow to the uterus, and these benefits decline over time.
What steps can we take for ideal child spacing?
- Breastfeed ecologically: refer to my post on ecological breastfeeding for how it works as an effective contraception.
- If that is not possible or fertility returns, implement NFP (Natural Family Planning).
- DIET OVER SUPPLEMENTS! I cannot emphasize this enough! Breastfeeding substantially increases the demand for energy, protein, and minerals such as calcium. Multivitamin-mineral supplements do not provide energy or protein, and they provide little calcium.
- It is important to consume a well balanced diet and a wide assortment of nutritious foods postpartum to help meet increased nutrient needs. This will not only help nourish and replenish your body, but will also prepare your body for fertility and pregnancy. If you do conceive sooner than expected while breastfeeding, increase your caloric intake to support your breastfeeding and pregnancy needs, while continuing to consume healthy, nutrient dense food. A healthy body works for you, not against you. It will do what it needs to, to protect your pregnancy and you.
- Find a supportive group of women on the same journey as yours. It’s hard to wait for the optimal time to have another baby when you see people around you announcing pregnancies! Your support group will remind you to slow down, focus on nourishing yourself and current baby, and will celebrate with you when the time comes for a new pregnancy.
Check out my resources page for some of my favorite resources on nourishment and fertility.
New England Journal of Medicine (1999;340:589-94)
PMID: 10066193
PMID: 29164825
PMID: 27244802
https://ct1.medstarhealth.org/content/uploads/sites/118/2015/09/Birth-Spacing-JAMA.pdf
Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition Services in Perinatal Care: Second Edition. Washington (DC): National Academies Press (US); 1992. 2, Nutritional Concerns of Women in the Preconceptional, Prenatal, and Postpartum Periods.
https://chiro.org/pediatrics/ABSTRACTS/Nutritional_Factors.shtml
PMID: 18614735
https://res.mdpi.com/d_attachment/nutrients/nutrients-12-01325/article_deploy/nutrients-12-01325.pdf
