Pauline is a 34-year-old newlywed and full-time banker. Three months into her marriage, she became pregnant. She was diagnosed with placenta previa, a condition where the placenta is lowlying, and which causes intermittent bleeding with a risk for premature delivery. In her third trimester, she was required to be on bed rest for the duration of her pregnancy. Luckily, she delivered a healthy baby boy with no untoward complications.
However, Pauline’s long confinement had taken an emotional and mental toll on her. Aside from coping with the rigors of new motherhood, she now had to face the demands of her job after a long absence. Despite initially wanting three children before she turned 40, she and her husband decided to wait another three years before having a second baby; they wanted to focus on the challenges of raising their first born simultaneously with their respective careers.
Dr. Rose Cheng, an OB-GYN specializing in perinatology or high-risk pregnancy at The Medical City, talks to HealthToday on why couples decide to practice birth spacing or planning a pregnancy that deliberately allots a specific time interval between the births of siblings.
Healthy mom, healthy baby
Pauline’s story is common. Couples are frequently delaying subsequent pregnancies for various reasons. “A mother’s physical, emotional, and mental health are better when pregnancies are timed,” Dr. Cheng says. They enable her to manage her time better especially if the nature of her work calls for it. Spacing gives mothers who had difficult pregnancies and/or strenuous deliveries time to regain strength. It also allows the uterus of those who underwent CS delivery to heal and recover.
Another major concern for families is financial burden such as the costs of visits to the pediatrician, vaccinations, and education. Spacing children enables parents to live within their means. “Supporting one child at a time also allows parents to allocate a budget for other needs such as nutrition and recreation,” Dr. Cheng adds.
Options for better spacing
“There are no hard and fast rules when it comes to optimal time interval between pregnancies,” Dr. Cheng says. Factors that affect the decision to have another baby include maternal age, financial capacity, personal preferences, and the general health status of the mother. Likewise, the health and wellbeing of the older child have to be taken into consideration.
“In general, as long as all is well, two- to three-year intervals would be okay,” she says. Birth spacing can be achieved in a number of ways, all of which involve forms of contraception:
· Lactational-amenorrhea method or LAM
This is one of the more popular forms of contraception for mothers who have just given birth. Breastfeeding provides a natural way of ensuring birth spacing by causing amenorrhea or an absence of menstruation, thus inhibiting ovulation. However, for this method to work, breastfeeding must be done, day and night, on demand, with no interval of more than six hours between feedings. “LAM provides protection for up to six months after delivery,” Dr. Cheng states. The risk of pregnancy increases after six months, necessitating a shift to other methods of contraception.
· Fertility awareness methods or FAM
These natural methods of contraception are often employed by couples with concerns or religious beliefs that prevent them from practicing other forms of contraception. FAM includes the rhythm or calendar method. With an effectiveness rate of only 80 to 87 percent, the rhythm method can be used only by women with regular menstrual cycles. It requires abstaining from vaginal sex during the woman’s fertile period. “This method relies a lot on proper technique, determination and self-control for both partners,” Dr. Cheng emphasizes. More often than not, FAM is recommended in conjunction with other methods to increase its reliability and effectiveness.
· Coitus interruptus
Popularly known as the withdrawal method, this involves the interruption of sexual intercourse when the male withdraws his penis before ejaculation. It is probably the oldest form of contraception but is the least effective. Failure rates are estimated to be as high as 25 percent. “This method is deemed more effective when partnered with LAM or the rhythm method,” Dr. Cheng advises.
· Barrier methods
Condoms, diaphragms, cervical caps, or sponges are some of the barriers that prevent pregnancy. Condoms, especially, are very reliable in spacing births because they are effective 97 percent of the time. Dr. Cheng says, “For barrier methods to work, couples need to know how to use them and be motivated and consistent in their usage.” Diaphragms and cervical caps are considered about 95 percent effective. Wait four to six weeks after delivery to use a diaphragm to allow the uterus to go back to its normal state.
· Hormonal contraceptives
To date, these are the most effective means of birth spacing available. They come in the f orm of pills, injectables, transdermal patches, and implants. These devices can be used from six weeks after giving birth and onwards, or until after the baby is weaned off breastfeeding, whichever comes earlier. When used properly, they afford the best protection from unwanted pregnancy. In addition, their side effects have been known to control acne, lighten and shorten the duration of bleeding during menses, and reduce dysmenorrhea.
However Dr. Cheng cautions, “The downside for using hormonal contraception is the threat of blood clots, stroke, and heart attacks.” Usage can also lead to a higher risk of breast cancer in susceptible women. Therefore, it is crucial to consult your doctor before using hormonal contraceptives.