According to the CDC, there were 3.61 million babies born in 2020 in the United States. 31.8% of these births were delivered by cesarean section, 112,437 sets of twins and 2,738 groups of triplets were born, and the fertility rate was 56 births per 1,000 women between the ages of 15 to 44. Though these numbers speak for themselves, it makes one wonder about the intricacies of fertility. Of those 3.61 million born in 2020, a little over half of those births were the first child born to a mother; and as the data continues, we observe that as the number of children born to one mother increases, the overall birth rate decreases, indicating that while some choose to have more than one, less and less families are deciding to have multiple children. While there are many factors that contribute to this phenomenon, there is also the consideration of postpartum fertility as well. Below, we address and answer a few of the most frequent questions women might have about the ability to conceive again, post-birth.

How does having a child affect my fertility?

There’s no singular answer to this question–everyone and their reproductive journey is unique. Conversely, we all start on a similar path. When female babies are born, they are likely to have 1 million eggs existing in their ovaries. Unlike males, females are born with all the reproductive cells that they will ever have, and the number slowly decreases over time. By one’s first menstrual cycle, this number has already dropped significantly–to about 300,000. As life takes its course, women will ovulate roughly 300 times as the number of eggs in reserve continues to drop.

With these numbers in mind, you might be able to deduce that one of the most limiting factors to fertility is age. By the age of 30, a woman will have around 100,000 eggs; 35 comes, and this number may be reduced to 80,000; by 40, 10,000. Research also shows a slight correlation between quantity and quality of eggs produced: as the quantity of eggs decreases, so does the quality.

Alongside age, fertility can be affected by complications during a previous birth that either impacted your physical or mental health, causing you to have a harder time becoming pregnant again. Or, you may have had a perfectly healthy birth and experience secondary infertility, which happens when you can’t seem to get pregnant again after attempting to conceive, although you had no trouble with the previous pregnancy and birth. This could be due to factors such as fallopian tube damage, irregular ovulation, scarring from endometriosis, uterine fibroids or adenomyosis, lack of movement or amount of sperm, and changes in life including age, weight and medications.

If you are planning on having more kids after your first but feeling concerned about any potential complications, there are actions you can take to prepare yourself. First, discuss your reproductive life plan with your gynecologist. If you want to have a child when you’re 25 and another when you’re 30, explore the possibilities with a true expert and create a tentative plan around how many children you’d like to have, along with when and how to make it possible. With this plan,  you may also consider procedures such as oocyte cryopreservation and in vitro fertilization (IVF), which both contribute to the process of freezing your eggs for fertilization down the road. Though expensive, they can be great options for women who wish to preserve younger eggs, and also for those who may be undergoing medical procedures such as chemotherapy, radiation therapy or other fertility-impacting surgeries.

How soon can I get pregnant after giving birth?

As your body recovers, you may be thinking about having sex again, motivated by the desire to regain intimacy with your partner, or the readiness to try for another child. However, it is important that you wait six weeks before engaging in physical intimacy to ensure that any scars or tears are properly healed, regardless of whether delivered vaginally or by cesarean.

Another factor that may limit your ability to conceive soon after giving birth is whether you decide to breastfeed. According to Dr. Alan B. Copperman, the Director of Reproductive Endocrinology and Infertility at Icahn School of Medicine at Mount Sinai in New York City,

“Breastfeeding can cause a temporary suppression of ovulation due to the release of a hormone called prolactin which inhibits secretion of other hormones necessary for ovulation and fertility. The degree to which breastfeeding inhibits ovulation is dependent on the amount and duration of breastfeeding and the nutrition status of the mother.”

TLDR: If you’re counting on breastfeeding, it may delay your period and act as a temporary birth control. However, it is not one hundred percent effective; in fact, while breastfeeding can suppress your period for six to 12 weeks, there is still a small chance that you can  become pregnant before your monthlies return.

In consideration of all this information, the CDC and March of Dimes recommend that moms who just gave birth wait 12 to 18 months before trying for another child. However, research also presents that waiting for longer than 5 years to have another baby can result in similar complications: the implications of conceiving too soon or too late include premature or low-weight babies, with increased risk of asthma, developmental delays, and hearing troubles.

All in all, preparing your reproductive life plan and discussing it with your OB/GYN yearly will aid in making decisions around having more children and when. Furthermore, communicating with your partner openly and fully about your expectations, dreams, and goals about the family that you’d like to create together to ensure that you’re both comfortable and ready for this next step will be of utmost importance.

When should I expect my first period? When it comes, does it mean I am able to conceive?

Let’s take a step back. After you’ve given birth and prior to your period returning, you may encounter lochia. Though similar in appearance to our menstrual cycle, it is a sign your body is recovering as it sheds the lining of your uterus that built up for forty weeks as you carried your baby. To determine if the discharge you’re experiencing is your typical monthly or lochia, assess the color from the first day to the last. Lochia will begin to lighten as time goes on, unlike our periods.

Then comes your period. Whether you decide to breastfeed or not will be the most important factor determining when mother nature will come calling again. Also known as lactational amenorrhea, this temporary pause of the menstrual cycle is due to consistent breastfeeding preventing the release of hormones that aid in ovulation. Based on a variety of factors, including this one, you may have your first period at four weeks or even 24 months after giving birth. The return of your period postpartum signifies that yes, you can conceive, and as a matter of fact, you have been able to for about two weeks now; because ovulation precedes the shedding of the uterine lining, you can become pregnant before the cycle returns for the first time after birth. However, as with almost everything regarding our monthlies, they are particular to you and your body. Some women may be able to conceive immediately after birth, and some may have to try a few times, or wait a couple cycles before they get pregnant again.

If I don’t wish to conceive right away, what are the best birth control options?

The continuous fight for reproductive rights has opened the doors to a variety of birth control options. Whether you appreciate routine, or prefer to ‘get it and forget it’, there’s an option for you.

If you plan on preventing pregnancy immediately after birth, condoms, implants, injections, IUD’s, and progestin-only pills can be used. The variety of options allows you to choose between easily accessible options, like condoms, as well as options that sync to your routine: those that need to be taken daily, every three months, or every five years.

For women who don’t wish to have another child or plan on waiting at least a few years before trying again may consider long-acting reversible contraceptives which are available immediately after giving birth. These include IUDs and implants, and oftentimes inserting IUDs post-birth can be less painful as your cervix is still dilated. Alongside this, you may also want to assess the pros and cons of getting the tubes tied, a permanent form of birth control.

Barrier methods such as cervical caps, sponges, and diaphragms should only be used 4-6 weeks after giving birth due to the cervix still returning to its original size. Similarly, combined hormonal pills should be put on standby for the fact that estrogen in these pills may affect milk supply. Breastfeeding, or the lactational amenorrhea method, can be utilized as a form of birth control as well, but again, is not reliable as its effectiveness depends on consistency and frequency of breastfeeding.

While there were 3.61 million babies born in 2020, what is often left out of this astonishing number is that roughly 3.61 million women gave birth to these babies. Every story behind the creation and delivery of a child is different–but what we do know is that the female body that breeds and bears each of these births is breathtaking in everything they can do. In the blink of an eye, our bodies bounce back ready to do it all over again; whether you choose to follow through or not, know that there are limitless resources and communities that will help you get there, but that the decision that you make has to be the right one for you.