It is estimated in studies that 25–40% of pregnancies are unplanned. These unintended pregnancies can occur shortly
after child birth, and are associated with adverse outcomes, including low birthweight babies, preterm delivery and postnatal depression.
If birth to conception interval is less than 18 months (short inter‐pregnancy interval), then this increases the risk of adverse outcomes in the pregnancy.
The article aims to stress the importance of using effective contraception as soon as possible after childbirth, so as to avoid complications associated with short interpregnancy interval and unintended pregnancies.
Return of fertility after child birth
This varies among women and depend on whether the woman is breastfeeding or not. Breastfeeding delays the resumption of fertility after childbirth and the length of the delay is related to the frequency and duration of breastfeeding
A review of studies by Jackson and Glasier showed the average time to first menstruation in nonlactating women ranged from 45 to 64 days postpartum. While the time to
first ovulation varied from 45 to 94 days postpartum.
Before 21 days after child birth, the risk of pregnancy is very low even among women not breastfeeding. Available data indicate that few non breastfeeding mothers will ovulate before 6 weeks postpartum, and that many first ovulations
may have compromised fertility.
A small number of women may experience a fertile ovulation as early as 25 days postpartum. Studies shows that younger women may return to fertility more quickly than their older counterparts.
A woman who is exclusively breastfeeding and whose menses is yet to return, has less than a 2% chance of pregnancy during the first 6 months after childbirth. However, waiting for first menses increases the risk of pregnancy,
because ovulation usually comes before menstruation.
How effective is breast feeding in preventing pregnancy?
A method of natural family planning based on the temporary effect of breast feeding in preventing pregnancy after child birth is called lactational (related to breast feeding) amenorrhoea (cessation of menses).
For this method of preventing pregnancy to work, the following 3 conditions must be present
o The baby must be less than six months old
o There must be no return of menses
o The baby is exclusively breast feed. The baby receives no other liquids or food, not even water.
The time between feeding should no be longer than 4 hours during the day and should not be longer than 6 hours at night.
If the above conditions are met, lactational amenorrhoea is about 98% effective in preventing pregnancy. Return to fertility in exclusively breastfeeding women occurs much later in the period after child birth.
When is the right time to get pregnant after child birth?
The time interval between one pregnancy and the next, whether short or long interval can affect the outcome of the subsequent pregnancy.
The time interval between child birth and the next pregnancy should preferably be atleast 18 months. WHO report on birth spacing recommended
an interval of at least 24 months after live birth before attempting the next pregnancy. After miscarriage the recommended miniumum interval should be atleast six months in order to reduce risks of adverse outcomes
Women with short intervals between pregnancies may not have enough time to recover from the stress of pregnancy. Maternal nutrients especially folic acid may not have been replenished before the subsequent pregnancy.
This is a particular problem in developing countries. In this areas poverty and malnutrition is common and majority of women breastfeed, adding a burden on already depleted nutrient stores.
A significant number of women, will resume sexual activity before 4 weeks after child birth, and some of those women will be fertile. Safe, effective, and timely postpartum contraception is necessary to prevent unwanted pregnancies
in these women.
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This information is for educational purpose only. It is not meant to replace your professional medical advice. Your doctor knows more about your conditions that we do.