Child Spacing: How Close is Too Close?

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Never before have women had so much control on family planning and child spacing. We can space our pregnancies to suit our needs. And many women want to have their babies as close together as possible.

Brittney Walker from Phoenix, Arizona, had two back-to-back difficult pregnancies. Her sons are 13 1/2 months apart, and while the second pregnancy was especially hard, she is now thankful that things worked out the way they did. "My boys are best friends now, and I think they'd be lost without each other," Walker says. "I plan on having the next two almost as close as these guys! I will just try to prepare myself better next time."

Walker feels the hardest part of having her children so close together is that she didn't have time to prepare herself physically for the challenge. "My body had not had time to re-develop the back and abdominal muscles that are necessary to carry a baby comfortably," she says. "I was very tired because my reserves were depleted, and I was always dehydrated between nursing and growing a new baby."

How Close is Too Close?

Mavis Schorn, a certified nurse-midwife at West End Women's Health Center and an assistant professor at Vanderbilt School of Nursing, says that generally, studies have shown 18 to 23 months apart is ideal spacing. "Spacing seems to adversely affect pregnancy more significantly if it is less than six months or greater than five years," says Schorn. "The very closely spaced pregnancy (less than one year) has an increased risk of low birth weight and/or preterm birth."

Schorn says there may also be increased stress on the family that includes the following:

• Economics (increased cost of another baby, missed work, healthcare costs)
• Interpersonal issues (between a couple, worries about the effect on the previous child)
• Nutritional depletion (i.e., increased incidence of anemia)

Mom's Physical Health

Women who wish to have their children close together should space them more than a year apart and take care between pregnancies to increase their own health and stamina. This takes more time for some women than for others.

"There is not a magic date as to when a body is recovered," says Schorn. "Most women are physically doing well by six weeks after birth, but it takes more time to lose their pregnancy weight, increase their exercise strength, improve their body tone (abdominal and pelvic floor muscles particularly), and begin or increase sexual activity.

Nutritional Needs

Nutrition is a big part of recovering from your first pregnancy and preparing for your second. Schorn says there is an increased need for iron to help replace the iron lost from bleeding during and following birth. This is best obtained from an iron-rich diet that includes animal sources (meat and fish) and vegetable sources (spinach, lentils, avocados, oats, wheat germ, brewer's yeast, dried beans, and peas), certain seaweeds available in health food stores, dried fruit, and nuts.

"Iron from animal sources is used more efficiently compared to vegetable sources," says Schorn. "Foods high in vitamin C increase iron absorption, so citrus fruits and other foods high in vitamin C increase absorption. Protein is needed for tissue repair." According to Schorn, calcium intake also should be increased during pregnancy and increased even more postpartum for as long as the woman is breastfeeding.

This becomes even more crucial if there were complications during the first pregnancy. "For example, a woman who is very overweight and had diabetes during pregnancy may be advised to postpone the next pregnancy to work on improving her health first," says Schorn. "If the pregnancy was difficult because the woman did not like the effects of pregnancy on her body, psychologically it might be better to postpone pregnancy until she really is ready to go through pregnancy again. If there are issues between a couple, they may want to work on that before adding another child into the mix. The answer to this question is that it is very individual depending on what made the first pregnancy 'difficult.'"

Emotional and Mental Health

Dr. Karen Perkins, an OB-GYN for Mercy Medical Center in Baltimore, believes the decision to have back-to-back pregnancies also should focus on the emotional and mental health of the mother. "Usually the concern is with maternal well-being," Dr. Perkins says. "If moms have problems with their prior pregnancy and have not recovered physically or nutritionally, then there could possibly be a risk of miscarriage early on with the current pregnancy as well as problems with Mom adjusting to the changes/dynamics in her family."

Dr. Perkins says the time depends on the maternal status and how healthy and adjusted she was during the first pregnancy. "On average we counsel patients to think about all aspects of the family to determine an interval that they can manage," she says.

Spacing your children close together has many rewards. Just remember to take care of yourself physically and emotionally during and between each pregnancy.