Preparing for baby number two Q&A

Are you thinking about growing your family and having a second child? To help you understand if your body is ready for another pregnancy, Dr Ian Currie Consultant Gynaecologist at BMI The Chiltern Hospital in Buckinghamshire, shares his expert advice on what to expect and how to prepare for your next pregnancy. 

Dr Ian Currie

I suppose it depends what is meant by recovery. From a medical perspective, the physiological changes that have occurred during pregnancy have diminished by 6-12 weeks post-partum and the uterus will have returned to a normal post pregnancy size by then. Menstruation would usually start at this point when the normal hormonal cycle starts.

However, women have different labours, and are also delivered in different ways - normal, forceps, ventouse, caesarean. Therefore, their recovery can be immensely varied.

If a pregnancy is normal and the delivery is uncomplicated, physical recovery improves month after month. It’s the sleepless nights that are usually the most troublesome. Also, many women breastfeed and this can place the body into an oestrogen deficient state for several months thereby suppressing periods.

Delivery following medical intervention usually delays recovery even if there are no complications. If anaemia or infection occurs, this can have a profound effect on not only dealing with the physical and mental aspect of having a new baby, but also the body’s recovery from the complication. Damage to the perineum is common following a first delivery and suturing is often required. Even after ‘healing’ has taken place the perineum can be very sensitive and tender for several months in some cases. However, if pain is severe it would be advisable to get a referral to be checked.

 

Dr Ian Currie
There is no set time from a physical perspective. Breastfeeding can suppress ovulation which has historically created intervals between pregnancies. Having seen many women over my career, I can honestly say that it’s not the actual physical traumas of pregnancy that delays a woman considering baby number two, but rather the fatigue that is caused by looking after a newborn baby.

Dr Ian Currie
The physical demands on a woman’s body from pregnancy are enormous and should not be underestimated. Ideally, preparation should involve getting into the best of health. Eating healthier and optimising your weight go without saying, but from a medical viewpoint, checking you’re up-to-date with cervical smears, as well as ensuring you’re taking folic acid supplements and are not anaemic. Many women see a gynaecologist privately and have an infection screen (swab, urine test), cervical smear and ultrasound to check all is well. Although this is ideal, it is certainly not mandatory.

Dr Ian Currie
Vaginal delivery damages the pelvic floor. As a urogynaecologist I see lots of ladies with bladder incontinence and prolapse issues following childbirth. Many women are naturally anxious about how their body has changed, but many suffer with stress incontinence and a much weakened pelvic floor. Exercising the pelvic floor on a daily basis throughout pregnancy and after delivery is essential to maintaining good strength of the muscles. Carrying out pelvic contractions 40 times a day, usually in blocks of 8 or 10 is usually recommended.

In my practice, we assess pelvic floor strength and will use dedicated pelvic floor physiotherapists who are skilled in getting the best out of the pelvic floor to assist in teaching.

Studies using repeated MRI scans of the pelvis after vaginal delivery have shown that it takes up to three months for the pelvic floor to start approaching some sort of normality again. However, the ligaments and muscles will never return to the original pre-pregnancy state.

Dr Ian Currie
Surgery can usually be in two forms.

The perineal trauma from an assisted delivery, such as a forceps, can be more traumatic than the tears from a normal vaginal delivery. There is usually more bruising and swelling. Keeping the area clean and dry is essential to avoiding infection. Usually, the midwife will check to make sure progress is heading in the right direction.

Caesarean section is another form of surgery and is a major operation. Obviously looking after a baby after undergoing surgery is difficult in itself. The blood loss will be greater in this surgery so there is greater potential to become anaemic. Also, if the caesarean was an emergency, this is often after the woman has gone through a long labour. She may have endured all the trauma and exhaustion from a vaginal delivery, and then will have to undergo a major operation. There is also the possibility of the abdominal muscles separating, which would require exercise and potentially physiotherapy to build back up.

Dr Ian Currie
As mentioned, the cycle will normally return from six weeks onwards if not breastfeeding. When a woman is breastfeeding she suppresses her oestrogen. This can cause vaginal dryness and can hinder getting back to a normal sex life even if stitches have all healed.

Dr Ian Currie
My top recommendations for pregnancy would be:

  • Maintain a healthy weight. Complications in pregnancy and delivery increase as body mass index increases
  • Eat healthily and avoid excesses particularly alcohol
  • Optimise any medical conditions to make sure you’re in the best shape possible
  • Exercise regularly and also in pregnancy. Take advice on types of exercise but aqua-aerobics is excellent
  • If you have really heavy periods get a haemoglobin check to make sure you are not anaemic
  • Take folic acid supplements
  • And above all, enjoy your pregnancy!

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