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I'm obsessed with all things periods, pregnancy, pelvic floor and helping women just like YOU to navigate all of life's major milestones!
Preparing for a subsequent pregnancy is a whole different ball game compared to first time around.
There will be days where you wonder why on earth you want to add another little bundle to your family! How will you ever manage another one? Are you ready? Are they ready for a little brother or sister? How can you spread the love between more than one?
I know I swing from “yes absolutely” to “no way” a few times a day!
Preparing for baby number two, three and beyond certainly seems to involve a lot more mental gymnastics than first time around, but the physical preparation should be the same.
But it’s often not.
It doesn’t matter whether your first child is 1 or 5 or 12, being a parent means you no longer come first. Which means your health and by extension your fertility can take a real hit.
While I understand this is a generalisation, many couples who are planning ahead for baby #2 (and beyond) still have a young child. So in this episode I’m particularly talking to those women who might have a 1 or 2 or 3 year old, and are preparing to get pregnant again. And now that I’m on the other side of pregnancy and mum to a 1 year old myself, when I’m ready to try for #2, I recognise that my preconception journey isn’t going to look as idyllic as it did first time around.
I speak with so many women who have already experienced pregnancy and had no trouble conceiving first time around, and they’re concerned about secondary infertility because things are looking different when trying for baby number 2. Secondary infertility is a whole other episode in itself, but addressing some of the things I will be discussing in this episode may assist you if you’ve been given that diagnosis. I will say, and if you’ve listened to Episode #47 – Why I NEVER Use the Word “Infertility” about my thoughts on the use of the word infertility, I strongly believe that barring some exceptional circumstances, if you can conceive naturally once, then you can conceive again.
But there are absolutely factors that make it a little more difficult second or third time around, whatever time you are up to, and that’s ultimately because you are already caring for a tiny human and that in itself is a full time job on top of everything else you have going on. And this is something that you obviously didn’t have to take into account first time around. So let me dive into the specifics here so you understand more clearly what I’m talking about.
Whether you choose to breastfeed, pump and bottle feed, or use formula straightaway, your menstrual cycle will still be impacted after giving birth, and you cannot possibly expect it to return to your version of normal straightaway when you consider everything your body has gone through over the past nine months.
It is completely normal to experience bleeding, called lochia, for several weeks after giving birth. It contains blood, mucus and uterine tissue and this is how the body and the uterus recovers after birth, and you will experience this even if you have had a C-section.
After this initial postpartum bleeding, milk production and lactation will influence the return of your fertility. Milk supply is a supply and demand process, so if you do not breastfeed or lactate, then your milk supply will reduce quickly, and you may experience ovulation and menstruation within a matter of weeks.
Milk production, called lactogenesis, is controlled by hormones and the endocrine system. As baby stimulates the nerve endings of the nipple, the hormone prolactin triggers milk production and the hormone oxytocin causes the “let-down (milk ejection) reflex”. Cells around the alveoli of the nipple contract and squeeze milk through the ducts of the nipple.
After birth, the sudden drop in progesterone (after placenta is delivered) allows the hormone prolactin to stimulate milk production. This occurs 30-40 hours after birth. Within this time, milk is produced in copious amounts. For the first 3-5 days, colostrum is produced. This is a yellow-coloured, high-protein milk that provides immune protection, nutrients and developmental support for baby. Mature breastmilk, also called transitional milk, may not be produced until 2-3 weeks after birth. The composition of this breastmilk does not change much during lactation until milk production is reduced or ceased, but its composition can change in response to feeding. Milk supply generally takes around 6-12 weeks to be fully established. Milk production works as a supply and demand process, where production will continue indefinitely for as long as milk removal continues.
Nipple stimulation from suckling regulates milk production according to baby’s needs. Suckling also initiates hormonal changes to support lactation and suppresses the function of the ovaries to prevent future pregnancies until lactation is complete. This is why many women do not menstruate until they stop breastfeeding. This is called lactational amenorrhea.
It is thought that, after a period of time, milk production stops being driven by hormones and ultimately becomes a supply and demand process only. This is why some women will ovulate and have their menstrual cycles return even though they are still breastfeeding. This is thought to be at around six months which is why the first six months of breastfeeding is considered to be pretty safe for birth control, as long as you are feeding on demand and following some other rules as well.
When your fertility will return after having a baby is highly variable, even for the group of women who do breastfeed longer-term. Some women might see a return in their period once solids are introduced and breastfeeding frequency reduces, others when they start pumping more frequently, rather than feeding on demand; and for others, they will need to wean completely. Ultimately, you do not know how your body will react, and it might even vary between pregnancies, so breastfeeding is definitely a factor to consider if you are preparing for baby number two, and your cycle still feels like it hasn’t returned to your version of normal. With that said, some women are able to breastfeed throughout a pregnancy and feed a toddler and a newborn at the same time, which I think is incredible. So it’s very variable.
We’ve talked so far about the physiological, and the hormonal reasons as to why your fertility may be different after having a baby, which in turn would impact your ability to conceive. Now let’s talk about other factors that can make it more difficult to conceive next time around and this can all tie in with postnatal depletion. And this applies to anyone who is a mother of a child of pretty much any age.
For anyone who has been through it, pregnancy is hard. It is an enormous, physical, mental and emotional strain, and as we transition from pregnancy to motherhood through labour, this in itself is exhausting. We don’t really get time to recover from it properly before we are thrown into caring for a newborn that needs us literally 24/7. Throw in the increased nutritional demands of breastfeeding and recovering from a major event like labour and birth, it is absolutely no surprise that those first months and years leave us feeling like we have nothing left in the tank.
During pregnancy, our baby has been taking everything it needs from us; all of our essential nutrients, this is why preconception preparation, and being in the best possible state of health first time around is so important. It’s not just for getting pregnant, it’s for getting us through the pregnancy, feeling energetic and healthy and thriving and most importantly, it’s for helping us to get through those first months and years in the postpartum period, where we are incredibly sleep deprived and at the beck and call of our tiny squishy bubs at all hours. This inevitably leads to deficiencies in nutrients that we need to help us to recover and get through this time. This is known as postnatal depletion and it is a combination of the physical, emotional, mental and hormonal depletion that mums experience in this postpartum period that leaves them feeling exhausted. More than just fatigue, symptoms are what we commonly refer to as Mum brain: brain fog, low energy as well as the constant self-doubt, frustration, overwhelm and stress.
Dr. Oscar Serrallach in his book The Postnatal Depletion Cure believes that over 50% of mothers will suffer from some degree of postnatal depletion, and he suspects that our busy lifestyles, our desire – and the pressure – to do it all, and increasing age of motherhood means that women are taking longer to recover from pregnancy and birth, and are not receiving the support that other cultures might traditionally receive around the world. And we can still be in post partum depletion 10 years after giving birth.
But for some incredible reason, even though it is, all insanely hard, there is something that has us going back and doing it all over again.
So regardless of whether you have started trying, and you’re struggling and your concerned that you might be experiencing secondary infertility, whether the idea of having a brand-new baby is bringing back those clucky feelings, or you’re ready to start chapter 2 of the preconception journey, here are some things to keep in mind. And they are what I consider to be the 4 pillars of fertility: nutrition, exercise, sleep and stress. And funnily enough, they are all impacted heavily when we already have a little one to chase around.
So this is where we need to start on our initial preconception journey, but it is so incredibly important to think about these things when you are already in the trenches of motherhood and can quitter easily forget to eat multiple meals in a row. Many women get away with more the first time around and still manage to conceive with no trouble, but when we are potentially battling more irregular menstrual cycles, and we are not in our highest state of health, conceiving might be more difficult this time around; pregnancy might be more difficult this time around and recovery from a second pregnancy and birth can increase your chances of postnatal depletion.
So, let’s look at each of these four pillars of fertility, and what you can do to get yourself in the best possible position for conceiving this time around.
Let’s begin with nutrition. It is essential that we are getting all of the nutrients we need to rebalance our hormones, regulate our menstrual cycles, and optimise ovulation to keep us feeling good and to stave off post natal depletion and obviously to help us to conceive again. We know that nutrition is essential for physical and mental health, and for immunity. During the post natal period, to combat that depletion of nutrients and ensure we are getting what we need to maintain our health and support the return of our fertility, we need to focus on getting enough iron. We lose iron stores through blood loss during pregnancy and birth, with breastfeeding. We get this through red meat, liver, as well as through leafy green vegetables. Next is Vitamin B12 for red blood cell production, DNA production, for energy. DHA, an omega 3 fatty acid, for helping with mum brain, reducing brain fog, as well as reducing inflammation and the risk of post partum depression. Then we have choline, which is just as essential as folate, but often not talked about as much, and finally vitamin D, for immunity (also at risk when we are so tired and depleted), for supporting our brain and nervous system and preventing depression and anxiety. We can get Vitamin D through the sunshine, as well as from fatty fish, liver and eggs.
This is why it is recommended to continue taking a high quality prenatal supplement in that post partum period, especially if you are breastfeeding. Speak with a naturopath or a nutritionist or a practitioner that can support you to identify where you are deficient and to get access to a high quality supplement that you can use in addition to a wholesome nourishing diet to give your body what it may be lacking.
Next is exercise. And I want to be careful with this one because there is so much pressure to bounce back after having a baby and I know from experience fitting in any kind of physical activity and exercise is incredibly difficult. I do also recognise has this can be a huge stress relief and enjoyable activity for many women, so I’m not going to say don’t do it. So let’s replace the word exercise with movement, because it’s about moving your body, not about losing weight and getting back to a pre-baby body. If you are overdoing exercise when you were already in a depleted state, this physical stress will further impact your fertility and your cycle, just like it would at any other time of life. Throw in the increased energy requirements of breastfeeding, lactation and literally producing the milk that feeds your child and you likely won’t need to do as much movement as you think to be active. Walking with a pram is the very best form of movement that I can recommend. It gets you outside of the house, which is challenging in itself, it gets you vitamin D, it boosts your mood and you get the added benefit of movement without intense, physical exertion. So yes we need movement ,we need to move our body but we do not need to exercise like we may have done pretty baby. Yoga and stretching is fantastic for those sore tired muscles when you’re holding baby constantly, you’re feeding in funny postures and it’s movement with relaxation.
The next one on the list is sleep. And I laugh to even mention it because I have never known sleep deprivation like I know it now as a mother. I remember those early newborn days where I would wake up in a panic searching the bedsheets for the baby, because I thought I had fallen asleep feeding, I would wake up and not know if I was in bed or in the feeding chair, and every time I went to have a nap. I would fall asleep instantly and deeply and these are quite possibly the greatest naps I’ve ever had in my life. Fast forward and I now have a 14 month old and I’m still sleep deprived. We bed share, and while this wasn’t ever the plan initially, getting up and walking down the hallway every couple of hours to settle a baby that is a terrible sleeper isn’t sustainable and bed sharing was the way to get the best quality sleep for me.
We all know the saying, “sleep when baby sleeps”, but it is so much easier said than done when the house is a mess, you need a shower and something to eat and you don’t want to spend those few hours of alone time asleep. This took me far too long to appreciates, and admittedly, I now mostly use nap time to work, but closing your eyes and resting during nap time, even if baby is next to you, can help you to make it through the afternoon and into the night.
While this is incredibly difficult if you have a baby who won’t take a bottle or is breastfeeding exclusively, splitting the nights between you and your partner can help you to get a few more hours of uninterrupted sleep. This is a strategy to consider when your child is a little older but still needing some love and support overnight. I know this is easier said than done because this is something that we have really struggled with in our house, but getting a few hours of sleep when you’re not having to listen out for a crying baby makes all the difference.
I’m not going to say any more about sleep because it’s still a sensitive topic for me. But huge shoutout to Fiona from Mama Matters who has the best approach to sleep and parenting that I have encountered on my many searches and falls down the Google rabbit hole. I cannot recommend her work more.
It sounds ridiculous even saying it out loud, that we worry about a messy house in the postpartum period. Anyone who comes to visit virtually expects a messy house when you have little kids, and yet more time spent at home means you want to be spending it in a clean environment. When I was pregnant, I read the book The First 40 Days about that beautiful period of rest during what is often called the fourth trimester, and I loved the idea of a mother being able to recover from birth and transition into motherhood with the support of her family. Unfortunately this is not the reality for many of us, and it is so common that new mums feel overwhelmed and unsupported. Managing stress is essential for hormone balance, for optimal ovulation and for our overall health at all stages of life. But its effects can be more significant if you’re already dealing with all of these other factors on top of a cycle that is trying to normalise and recover. I’ve talked about managing stress a lot on this podcast already and we do a deep dive into some specific ways to manage it in Episode 5 – Stress and Your Menstrual Cycle: Why Your Period is Irregular and Your Hormones Are Haywire (And What You Can Do To Fix It) and these are all still applicable now.
It’s saying no to visitors when you need a rest. It’s saying no to leaving the house when it all feels too hard. It’s letting the washing build up for a week because you just need a break from it. It’s getting in a cleaner to help take some of that burden. This is something I have promised myself when we move house in a couple of months. I refuse to let our brand new house that we have been building for over a year now get messy and grubby because we don’t have the time to clean it properly, because I know that this is something that I will feel stressed about. It feels excessive, it feels like a luxury, but it’s something that I truly see the value in.
Finally support, feeling supported is a huge one. By your partner, by extended family and friends, even staying in touch with those who were in your mothers group long after the more formalised sessions are over. These are still people in your local community going through the exact same thing as you, so lean on them, share your experiences, have a whinge. We cannot possibly do this all alone.
I don’t often talk about motherhood and post-partum life on this podcast, because I know most of you listening aren’t there yet. But I’m hearing more and more from women who are already mothers who have found me because they’re struggling to conceive second time around after having no issues the first time. And it’s my reality as well. I’ve shared a lot lately about my wonky post partum cycles, both thanks to breastfeeding and a certain virus that has definitely impacted my cycle. And I’m starting to think about how to make time for preconception preparation and start prioritising my health and my fertility, now that my cycles are back and not as simple as they were pre pregnancy.
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