When should you have another baby? An OBGYN’s take on pregnancy timing
If you’ve got a little one at home and you know you want more children, you may be wondering when is the best time to try and conceive a sibling. The most obvious answer is whenever you want! If you feel healed, rested, and supported, you’ve finished breastfeeding and you’re ready to try again, go for it! On the other hand, if you’re feeling like one is enough for now and making siblings is the lowest priority on your to-do list, take as much time as you need! However, if you want some evidence-based guidance on when to have more children or are looking for ways to prevent pregnancy in the postpartum period, read on!
When is too soon?
According to the World Health Organization (WHO), a pregnancy interval (defined as time from a live birth to conception of the next pregnancy) of less than 6 months is associated with worse maternal and infant health outcomes. Pregnancy intervals of less than 18 months are associated with increased risks of infant mortality, low birth weight, and preterm birth. The WHO subsequently recommends waiting 24 months after a live birth before trying to conceive.
This recommendation from the WHO comes with a few caveats: first, this recommendation has not been updated since 2005! Second, most of the data informing this recommendation is based on research in low-middle income countries where poor nutrition, insufficient medical care, and other socioeconomic factors may be impacting recovery between pregnancies. Data on pregnancy spacing from higher income countries such as the United States is less certain; most studies report some increased risk of preterm birth/adverse infant outcomes with a pregnancy interval of less than 6 months, however beyond 6 months the risks are less clear.
What if you had a C-section with your first pregnancy?
One of the main concerns with pregnancy after a cesarean section is the risk of uterine rupture during labor, which is a very dangerous complication. This risk is <1% in most women who labor after a single prior C-section, however a short interval pregnancy can increase this risk. If you had a C-section, it is recommended to wait at least 18-24 months before conceiving again to allow the uterus time to heal.
Is it possible to wait too long?
Age is just a number and taking care of your physical and mental well-being takes priority over getting pregnant! However, risks of many pregnancy complications (e.g. gestational diabetes, preeclampsia, preterm birth, low birth weight infants) increase with increasing maternal age, and fertility decreases with increasing age (most notably after age 35). Regardless of age, some data suggest that waiting longer than 5 years to get pregnant again is also associated with increased pregnancy risks such as preeclampsia and arrested labor.
How can you prevent getting pregnant again after giving birth?
Preventing pregnancy after childbirth can be tricky! It may take a few months for your cycles to return to normal after birth, so fertility awareness methods that rely on a regular menstrual cycle may be inaccurate and relying on them may lead to accidental pregnancies. Lactation can help prevent pregnancy; however this method alone is only effective if you are within 6 months postpartum, exclusively breastfeeding (not supplementing with any formula/introducing other foods), and have not yet gotten a period. Estrogen-containing birth control methods should be avoided in the first 6 weeks postpartum regardless of breastfeeding status due to the increased risk of blood clots in this period. Additionally, estrogen methods will reduce milk supply in those who wish to breastfeed.
Luckily, there are many types of birth control that are safe for postpartum and while breastfeeding! Reversible methods include progestin-containing birth control (pills, injections, implants and intrauterine devices), non-hormonal birth control such as the copper IUD, and barrier methods such as condoms. If you’re certain you never want to conceive a child again, you can consider permanent options such as a bilateral salpingectomy (removing the fallopian tubes). Many of these options can even be started in the hospital right after birth!
The bottom line here is that there is no absolute best time to have another child, and no single best way to prevent another pregnancy after childbirth. These decisions require taking into consideration your personal health, goals, situation, and support system. Of course, if you are thinking about getting pregnant or wanting to avoid pregnancy you should discuss this with a health care professional.
Dr. Jacquelyn O’Sullivan
Obstetrics + Gynecology (OBGYN)
She speaks medical Spanish and basic Portuguese. When not at work, she can be found running, hiking, climbing, or skiing.
Sources:
- Report of a WHO technical consultation on birth spacing: Geneva, Switzerland June 13-15, 2005. https://www.who.int/publications/i/item/WHO-RHR-07.1
- Ahrens, Katherine A., et al. “Short Interpregnancy Intervals and Adverse Perinatal Outcomes in High‐Resource Settings: An Updated Systematic Review.” Paediatric and Perinatal Epidemiology, vol. 33, no. 1, 24 Oct. 2018, https://doi.org/10.1111/ppe.12503.
- Tessema, Gizachew A., et al. “Interpregnancy Intervals and Adverse Birth Outcomes in High-Income Countries: An International Cohort Study.” PLOS ONE, vol. 16, no. 7, 19 July 2021, p. e0255000, https://doi.org/10.1371/journal.pone.0255000.
- Adily, Pejman, et al. “Inter-Pregnancy Interval and Uterine Rupture during a Trial of Labour after One Previous Caesarean Delivery and No Previous Vaginal Births: A Retrospective Population-Based Cohort Study.” EClinicalMedicine, vol. 80, Spring 2025, p. 103071, pubmed.ncbi.nlm.nih.gov/39902314/, https://doi.org/10.1016/j.eclinm.2025.103071.
