Surviving a Second Pregnancy That's Right After Your First

One pregnancy is challenging enough—what if another follows hot on its heels? Experts share tips for having healthy and happy back-to-back pregnancies.

Pregnant mom with baby second pregnancy
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Having a baby changes everything, as the saying goes. But what happens when you see those two pink lines again almost immediately after giving birth?

Finding out you'll be having back-to-back pregnancies can be a shock to anyone, but there are things you can do to have a healthy second pregnancy. Read on for the risks of back-to-back pregnancies, and figure out how to manage a second pregnancy when you're already caring for a baby.

The Risks of Back-to-Back Pregnancies

The American College of Obstetricians and Gynecologists (ACOG) recommends avoiding pregnancy intervals shorter than six months and ideally waiting at least 18 months before getting pregnant again. That's because close pregnancy intervals could increase the risk of complications, including premature birth and low birth weight.

Research has found the following risks of close pregnancy intervals:

  • Greater risk of infant and child mortality
  • Greater risk of maternal mortality
  • Preterm birth
  • Low birth weight
  • Maternal anemia
  • Obstetric fistula (a hole between the vagina and rectum or vagina and bladder)

Your body needs the time to recover between pregnancies, adds Erin Stevens, MD, an OB-GYN with Clinic Sofia in Edina and Maple Grove, Pennsylvania. "The pregnant person's body needs a chance to recover from the pregnancy itself, normalize weight, optimize nutrition, and potentially resolve pregnancy-related medical conditions, and there is evidence of increased maternal mortality and morbidity with these very closely spaced pregnancies as well," she says.

And if you delivered your baby via C-section, the risks of getting pregnant again right away are even greater. "The overall healing is particularly important for those who have had a C-section," says Dr. Stevens. "Births that occur 18 months or less apart have a higher risk of uterine rupture, an emergency situation in which the scar on the uterus opens prior to delivery."

Tips for Managing Back-to-Back Pregnancies

Of course, it's not all bad news if you happen to get pregnant again soon after delivering a baby. Sure, raising two small children at once can be challenging, but there are many wonderful things about having siblings close in age (think of all that baby gear you can reuse!). And when it comes to entertaining your little ones, they're much more likely to have similar interests and play together if they're close in age.

If you're expecting again within a year of delivering a baby, here's what you'll need to do to ensure a safe and healthy pregnancy.

Get prenatal care as soon as possible

The signs of a back-to-back pregnancy can be hard to read. Common postpartum experiences may mask early pregnancy symptoms. For example:

  • You're likely still carrying extra weight.
  • Your periods may not have returned.
  • You're fatigued from sleep deprivation.

These things can make detecting a pregnancy in the early stages hard. So, if you could be pregnant, try to pay attention to things like nausea (it could be morning sickness) as well as more subtle signs, like breast tenderness (which you might otherwise chalk up to breast engorgement or postpartum hormones).

For example, Jody Moss, a Los Angeles mother of three who conceived again six weeks after her first delivery, noted that her hair was thinning, as it had during her first pregnancy. If you think you could be pregnant, immediately see your provider.

Decide what to do about breastfeeding

You may decide to wean your first baby while pregnant. Or you may not, and that's fine, too! It's totally possible to breastfeed throughout a subsequent pregnancy. In an uncomplicated pregnancy, research suggests that nursing throughout is safe and does not increase risks.

In fact, a 2023 review of the literature found that breastfeeding during pregnancy appeared unrelated to pregnancy outcome and miscarriage risk. Researchers note that those at risk for preterm birth or with high-risk pregnancies should use caution, though.

Dr. Stevens says you may notice a drop in your milk supply due to hormonal changes expected in pregnancy. "It can also become more uncomfortable and difficult to continue breastfeeding due to pregnancy symptoms like breast tenderness, fatigue, and nausea," she says.

If you do continue nursing, consider the following:

  • During pregnancy, you need 300 to 400 extra calories; while nursing, you need an extra 500 calories—that's up to 900 extra calories, so be sure to get enough nutritious food.
  • Pregnancy hormones may make your nipples sore or sensitive.
  • You may need to experiment with different nursing positions as your pregnant belly grows.

Discuss the decision to continue breastfeeding during your pregnancy with a health care provider and seek support from a lactation consultant.

Don't be afraid to gain weight

You'll still want to gain weight during a second pregnancy, although perhaps less than with your first pregnancy if your weight now is higher than your pre-pregnancy weight was before your first pregnancy.

According to the Centers for Disease Control and Prevention (CDC), your pre-pregnancy weight should guide your weight gain during pregnancy. The CDC recommends the following pregnancy weight gain guidelines:

  • If you are underweight (BMI less than 18.5): 28–40 pounds
  • If you are normal weight (BMI 18.5–24.9): 25–35 pounds
  • If you have excess weight (BMI 25.0–29.9): 15–25 pounds
  • If you have obesity (BMI greater than or equal to 30.0): 11–20 pounds

Discuss expected weight gain with a health care provider.

The Problem With BMI

Body mass index (BMI) has long been seen as the ultimate measure of physical health, but it can be inaccurate and problematic. While some doctors still use BMI, it’s important to remember that it’s a dated, biased measure that doesn’t account for several factors, such as ethnic descent, race, gender, and age.

Get enough nutrients

A short interval between pregnancies means your body may be at a nutritional disadvantage, so you must be vigilant about eating a nutrient-dense diet. "Certain nutrients such as calcium and iron must be replenished after delivery, and that takes about six months," says John Botti, MD, professor of obstetrics and gynecology and director of maternal-fetal medicine at Pennsylvania State University's Hershey Medical Center.

In addition to taking a daily prenatal vitamin, ACOG recommends the following guidelines for getting enough key nutrients in pregnancy:

  • 1,000 milligrams (mg) of calcium
  • 27 mg of iron
  • 770 micrograms (mcg) of vitamin A
  • 85 mg of vitamin C
  • 600 international units (IU) of vitamin D
  • 600 mcg of folic acid

Consult with a health care provider about other nutritional supplements you might need.

Expect to feel extra exhausted

Since the second pregnancy progresses in a different environment—there's now a demanding newcomer to consider—you have to carve out adequate rest time. At the least, consider sleeping whenever your baby does.

If possible, arrange child care or household help throughout your pregnancy. Also, don't hesitate to ask your partner, family, and friends for assistance.

"A close second pregnancy wreaks havoc on your body—but taking breaks will help you to cope," says Moss. Above all, don't try to be perfect. Remember that first pregnancy lesson: Every challenging phase passes.

Continue exercising

According to ACOG, exercise is almost always recommended during pregnancy, as long as you are healthy and your pregnancy isn't high-risk. That said, they recommend discussing exercise with a health care provider first. A back-to-back pregnancy is a special consideration that warrants input.

"Good exercises are the ones that the pregnant person will do! Exercise is great for the pregnant person's health and reduces the risk of some medical conditions in pregnancy. There's also good evidence it reduces the duration of labor," says Dr. Stevens.

Whether you choose prenatal yoga, walking, or something in between, stay hydrated and don't set overly demanding goals. Do what feels right, and consult a health care provider before embarking on any new or different forms of exercise.

Also, focus on the health benefits and not weight management. "If you didn't lose weight between pregnancies," says Dr. Botti, "don't try to work it off now."

Be careful how you carry your baby

Carrying a non-walking baby while pregnant can cause painful muscle spasms in your neck, lower back pain, and other discomforts. Exercises that reestablish abdominal wall tone should help relieve back stress, but seek guidance from a health care provider before doing any abdominal exercises while pregnant.

Other strategies: Enlist child care help, eliminate unnecessary lifting, and always lift with proper form (making sure to bend at the knees).

Keep illnesses away

Since you're already physically worn down, try to avoid any person or situation that could make you more likely to get sick. Many pregnant people find that back-to-back pregnancies deplete their immune system, making them more susceptible to colds, flu, and other illnesses.

Eating nutritious food and getting a lot of rest is your best preventive strategy. Also, make sure you're up-to-date on vaccines. The CDC recommends the following vaccines during pregnancy:

  • Whooping cough (Pertussis)
  • Flu
  • COVID-19
  • Respiratory syncytial virus (RSV)

Avoiding Back-to-Back Pregnancies

If you don't want to get pregnant again right after giving birth, be sure to use birth control when you start having sex again. "We generally recommend waiting six weeks before resuming sexual activity after birth. Whether the birth was vaginal or C-section, healing is required!" says Dr. Stevens.

ACOG recommends thinking about birth control before you give birth so you can plan accordingly. Options include:

  • Intrauterine device (IUD): An IUD can be inserted immediately after vaginal birth or c-section or at your first postpartum visit.
  • Hormonal birth control pills: During the postpartum stage, there is a higher risk of developing blood clots on combined hormonal pills, plus those that include estrogen may interfere with milk production. Progestin-only pills do not carry the same risks are a commonly recommended alternative.
  • Birth control injection (Depo Provera): You can get your first shot immediately after birth, and it lasts for three months.
  • Condoms and spermicide: You can use condoms (and spermicide, if desired) as soon as you've been cleared for sexual activity.
  • Diaphragm or cervical cap: Diaphragms and cervical caps may be used as early as six weeks after birth, but you should be refitted since your size may have changed.

In addition, breastfeeding may delay the return of your menstrual cycle due to the production of the hormone prolactin, which naturally suppresses ovulation. But getting pregnant while breastfeeding before your first postpartum period is still possible because you ovulate before you bleed.

Moss, the mother who conceived again six weeks after her first delivery, says, "My postpartum checkup after my son was born was the prenatal check for my daughter! I never had a period between them."

Key Takeaways

Experts recommend avoiding back-to-back pregnancies because your body needs a chance to recover before going through another pregnancy. If you want to avoid back-to-back pregnancies, your best bet is to start birth control immediately after giving birth. If you do find yourself pregnant soon after giving birth, being proactive about early prenatal care, getting adequate nutrition, and using caution around living and exertion can help you have a healthy second pregnancy.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Pregnancy counseling. American College of Obstetricians and Gynecologists. 2019.

  2. Healthy timing and spacing of pregnancy: Reducing mortality among women and their childrenGlob Health Sci Pract. 2019.

  3. Breastfeeding during pregnancy: A systematic review of the literatureMaedica (Bucur). 2023.

  4. Can I breastfeed during pregnancy?. UT Southwestern Medical Center. 2017.

  5. Weight gain during pregnancy. Centers for Disease Control and Prevention. 2022.

  6. Nutrition during pregnancy. American College of Obstetricians and Gynecologists. 2023.

  7. Exercise during pregnancy. American College of Obstetricians and Gynecologists. 2022.

  8. Vaccines during and after pregnancy. Centers for Disease Control and Prevention. 2023.

  9. Postpartum birth control. American College of Obstetricians and Gynecologists. 2023.

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