Bar Refaeli had a big announcement for her fans on Monday: She’s expecting her second child. “Something’s cooking…” the supermodel, 31, captioned a photo on Instagram that showcased her bare torso and slight bump. While Refaeli’s comments were flooded with messages of congratulations, some fans seemed…confused.
Refaeli had her first child, her daughter Liv Ezra, in August—a fact that several people pointed out. "Again???" one person wrote in the comments. "Didn't you just give birth?" another said. Still another wrote, "She just had her baby in, like, August!"
Refaeli has been open about wanting to have a big family. She told Hello! Fashion Monthly in August 2015 that she was excited to have kids. “I think this will be a decade of family. . . . I come from a family of four children,” she said. “A lot of [moms] could read this and think, ‘Yeah, try having one first.’ Hopefully, I’ll have a big family, but I’ll take it one by one.”
Refaeli’s small bump suggests that she’s at least a few months along—meaning, she likely got pregnant just three or four months after giving birth. A 1999 study in the New England Journal of Medicine cited by The American Congress on Obstetricians and Gynecologists found that waiting 18 to 23 months for a subsequent pregnancy (a measure known as birth spacing) dramatically lowers the risk of low birth weight and preterm birth. According to the March of Dimes, pregnancies that occur less than 18 months after birth are often associated with ongoing health problems such as developmental delay, asthma, and vision and hearing loss.
That said, women who do get pregnant in that time period are not destined to have a complicated pregnancy or bad outcome, Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “Many women have successful pregnancies [with shorter birth spacing], particularly if they’re low-risk and are careful with their iron and folate levels,” she says, adding that the range depends on the person and how difficult their first pregnancy was.
It's still possible to get pregnant soon after having a baby, even if you're breastfeeding.
Many doctors advise patients to wait to have sex again until they’re six weeks postpartum to allow the woman’s vagina, cervix, and vulva time to heal, so the six-week checkup is a good time to discuss bedroom action, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. "Because that is the time that a lot of women have not had sex yet and are unlikely want to have another child really soon, we advise protection immediately," she says.
If a woman is breastfeeding, she's producing prolactin, a hormone that stimulates milk production. Prolactin prevents ovulation-prompting pulsatile hormones from being released, Greves explains, which means it's harder for her to conceive (unless she has reproductive assistance).
If a woman isn’t breastfeeding, Greves says it doesn’t take long for her to ovulate again after giving birth (it can even happen five weeks postpartum) and getting your period isn't a reliable sign of ovulation because women ovulate before they get their period. Once a woman begins ovulating after giving birth, she has a higher chance of becoming pregnant again because her reproductive organs are still going back to their normal shape and size. “The cervix is open more as the uterus shrinks after giving birth, which facilitates easy entry of sperm,” Maureen Whelihan, M.D., an ob/gyn at the Center for Sexual Health & Education, tells SELF. “Plus, women are generally distracted by the baby, sleep deprivation, and family excitement that they forget the 'basics' about contraception.”
Back-to-back pregnancies can be physically and emotionally difficult.
While some women may want to have another baby again ASAP, Greves points out that back-to-back pregnancies can be hard on your body. “Consider the nutritional and emotional requirements for another pregnancy immediately after birth,” she says. Whelihan agrees. “I discuss postpartum contraception before the patient gives birth so we have a plan,” she says. The more popular choices include oral contraceptives and long-acting reversible contraception (LARCs) like IUDs. The minipill, a progestin-only birth control pill, is commonly recommended for breastfeeding moms who want backup birth control (some experts believe that estrogen, which is in combination birth control pills, affects milk production, although recent research has suggested this isn't the case, according to the Mayo Clinic). The implant can also be a good option for women who have a hard time remembering to take a daily pill, Greves says.
Streicher says doctors mainly worry about a woman's iron and folic acid levels—both of which can be depleted by pregnancy and breastfeeding, and are important for supporting another pregnancy. Women who have back-to-back pregnancies are also at a higher risk of preterm birth and having babies with a low birth weight, she says.
No matter what, do what's right for you and your family.
If you’re pregnant or just had a baby and know you want to wait awhile to have another, or are done having kids altogether, talk to your doctor about your options. He or she should be able to steer you in the right direction.
And, if you want to have kids back-to-back or if you get pregnant accidentally soon after having a baby, don't panic. "Yes, we make these recommendations and it's based on clear associations, but it doesn't mean that it's a terrible thing if a woman ends up pregnant," Streicher says. "If you’re planning to get pregnant sooner rather than later, keep up with iron supplements and folic acid—you really have to take care of yourself."
Correction: A previous version of this article gave the incorrect recommendation from experts on birth spacing. We've updated to include the industry-standard recommendation, as well as the underlying research to support it.
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This story originally appeared on Self.
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