Help Me, Heidi! How Long Do I Need to Wait to Start Trying to Get Pregnant Again?

Hi! As someone who still suffers with bouts of raging baby fever (30-something years after the birth of my second and final baby), I hear you — and the insistent call of your uterus, longing to be refilled. 

Still, there are compelling reasons to put your uterus on hold, at least for several months — depending on who you ask, up to 18 months or longer. The World Health Organization suggests pushing the pregnancy pause button for a minimum of two years. But that longer recommended wait time reflects the fact that moms in many parts of the world don’t get the nourishment or health care their bodies need to physically recover from one pregnancy and prepare for another. It also reflects another WHO recommendation: that moms breastfeed babies for a minimum of two years, especially when other sources of nutrition are in short supply.

Back here in the U.S., where moms are less likely to be seriously nutrient-deprived and are more likely to receive regular health care, the guidelines are a little more liberal. American College of Obstetricians and Gynecologists (ACOG) recommendations give moms the yellow light (proceed with caution) on next-round baby-making at a minimum of six months (timed from delivery of one baby to the conception of the next), with a roundly preferred wait period of 18 months.

Getting pregnant again before the half-year mark happens, of course (whether on purpose or by “oops”) — usually with happy, healthy results. But research does show that bump-to-bump pregnancies can somewhat increase the overall risk of complications for mom and baby, including preterm birth and low birth weight. A short wait time between pregnancies can also reduce the chances of scoring a successful vaginal birth after a cesarean (VBAC). 

Are the numbers all that matter? Is timing really everything when it comes to the healthy spacing of pregnancies? Definitely not. Every woman, like every pregnancy, is different — which is why a conversation with your OB provider is a smart first step before you start your TTC engines. Together with your partner, you can discuss all of the following factors that may — or may not — impact your ideal wait time:

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• Your age. Do you have many more reproductive years ahead of you, or fewer, in which to add to/complete your family? Talk to your practitioner about whether your age should factor into your decision, perhaps fast-tracking your next TTC efforts. 
• Your fertility history. Was getting pregnant as easy as getting busy (without protection)? Or was it many months — or a year or more — before your baby-making mission was accomplished? Were you able to conceive naturally, or were fertility medications needed (or even bigger fertility guns)? Though conceiving your next pregnancy may be easier or more challenging than conceiving your last, you and your practitioner may want to discuss whether it makes sense to put extra time on your side and begin TTC sooner than later. 
• Your weight. Have you shed most of the weight from your last pregnancy, or are you still holding onto much of it (a far more likely scenario for the average mom at three months postpartum). Extra weight can weigh on your fertility — making getting pregnant again a heavier lift — but it can also impact the health of your next pregnancy, adding extra risks (including of gestational diabetes, preeclampsia, preterm labor, having a too-big baby, having a C-section). Your practitioner may recommend that you hold off on conceiving again until you close in on your ideal weight (gaining weight if you’re underweight, losing if you’re overweight). Another reason to wait until you’ve lost that baby weight (and more, if necessary): Studies show that moms who don’t take this step between pregnancies are likely to accumulate lifelong pounds with each, adding to associated risks of obesity, including Type 2 diabetes and hypertension, later in life.
• Your last pregnancy. Was it easy, breezy, a not-so-perfect storm of complications, or somewhere in between? While every pregnancy is different, even for the same mom, pregnancy history has a way of repeating itself — the good, bad, the complicated, the uncomfortable. Also important to consider: Have you completely recovered from your last pregnancy and delivery (experts call the first few months postpartum The Fourth Trimester for a reason)?
• Your general health. Do you have chronic conditions like hypertension, diabetes or thyroid disease that need managing? Medications that need to be tweaked before a next pregnancy? It’s best to check those boxes off your preconception to-do list before you get busy TTC. Something else to factor in: whether you’ve been faithful about continuing to take your prenatal supplement. If you haven’t, talk to your practitioner about what nutrients (especially folic acid) you may need to play catch-up on before you start TTC again.
• Your mental health. Did you experience depression, anxiety or another mood disorder during your last pregnancy, or have you struggled with any since delivery? Since some cases of postpartum mood disorders can show up later in the first year after birth, you’ll want to be sure you’re on a steady emotional course before you begin another pregnancy — and that any mood disorder is treated and monitored. Also think about whether you’ll be up to the physical and emotional challenge of nurturing another pregnancy while you’re still busy nurturing a young — and appropriately needy — baby. 
• Whether you’re breastfeeding. It’s definitely possible to continue breastfeeding during a next pregnancy — and, thinking ahead, to tandem breastfeed a newborn and an older baby or toddler. And many moms do, successfully. Others may encounter unexpected problems breastfeeding once they’re expecting. For one, breastfeeding while pregnant can be draining, literally. It can also be a pain during the first trimester, when nipple soreness and sensitivity are at their height. And while breastfeeding during pregnancy is generally considered safe, the contractions it can cause (that’s the oxytocin talking) can worry some moms, if unnecessarily. Also, while most babies don’t skip a breastfeeding beat while their moms are pregnant, a picky few may reject the slightly changed taste of the milk, especially once colostrum starts being produced (in the second half of pregnancy). And finally, some moms find their supply drops once they’re pregnant, making supplementing with formula necessary. The bottom line: If exclusive breastfeeding is in your long-term plans, you might want to think about tabling pregnancy at least until your baby has begun solids, and possibly until you’ve clocked in a full year of breastfeeding or more. 
• Your schedule and your partner’s. Sometimes, real life gets in the way of recommendations about baby-spacing, or even overrides them. These might include a partner who is about to deploy or is coming home during a limited window, or the demands of school or career schedules. 

The decision of when (and whether) to scratch that baby itch will ultimately be yours and your partner’s to make, in consultation with your OB or midwife. As you think on that decision, here’s another little something to think about — that little something you’re probably cuddling (or feeding, or changing) right now. I’ve said it before, and I’ll say it every chance I get: Stop and smell the babies … because they don’t stay that small and sweet forever!

Big hugs,

Heidi