How Long To Wait Between Children

Learn from OBGYN, James T. Roth M.D., about how to tell if your body is ready for another baby. Dr. Roth is an OBGYN at Jordan Family Health who practices Specialty Care Network.

My name is James Roth. I’m an OBGYN, have been since 1993. After a woman has a baby, she sees her OBGYN at six weeks to make sure everything is healed, and we know that to completely recover from a pregnancy, the body needs over a year to recover hormonally, physically, emotionally.  And so women will ask, when should I have my next baby? And is there an optimal time to have another child?

And most of us would agree that a minimum of two years between children is healthy. Some women will have a biological clock that’s ticking who can’t afford to wait two years, but for women who are in their 20s or early 30s, I think for their emotional, physical, and mental health, it is clear that spacing children 18 months to two years apart is desirable.

How to Choose an OBGYN

The question that frequently is asked ,how do I choose my OBGYN, particularly in patients who have moved into the area or who perhaps lost their OBGYN due to retirement or the doctor she or he has moved out of the community. That is a very difficult thing to find, the right doctor for you, and most of my patients find me through either coworkers, neighbors or more recently, on the internet, saying that I have a good internet profile. I think it’s important to feel really comfortable with your doctor. And I would not be opposed to letting a patient interview me to see if I’m the right fit for her.

OBGYN is a very interesting field. Most of my patients stay with me for many, many years, both for obstetrics and gynecology. And we sometimes have an issue with insurance coverage, where we’re not always on all the panels that the patients are on, and I see it in their face when they find out they’re going to have to find a new doctor and how much anxiety that produces. But I think any doctor who’s been on staff at a hospital for several years, that’s always a good sign.

A board certification is important. In our office, all five of us are board certified by the American Board of OBGYN. Now in fairness, some younger OBGYNS will not be eligible for board certification for at least two years after their residency, and those doctors are very well trained and good doctors,but not as experienced. Somebody who is in the community for a while but is not board certified, I would ask why that is.

What is a Hysterectomy?

A lot of people ask me about hysterectomies. How come some hysterectomies are done open or abdominally, some are done vaginally, some are done laparoscopically, some are done robotically. Why are they done in different ways? Part of that is based on the dynamics of the case itself. For example vaginal hysterectomies are done extremely well in patients who have some degree of prolapse, meaning that the uterus itself has prolapsed into the vagina.

Women who have very large uteruses are usually not good candidates for vaginal surgery because of difficulty with visualization and difficulty manipulating the tissues. The number of hysterectomies that are done in the United States are decreasing every year and probably an equally valid question is, “Do I need a hysterectomy?” And there are so many non-hysterectomy options for women with gynecologic complaints that I think most of us feel that those should be exhausted first rather than going directly to hysterectomy.

But if you need a hysterectomy, I think the most important thing is to have a surgeon who is capable of doing the surgery, does it frequently, and can explain to you the pros and cons of each approach. Certainly the pros with the da Vinci are minimal incisions, we call it minimally invasive surgery, very quick recovery. That would also be true of a vaginal surgery. When we actually do a vaginal hysterectomy we make no incisions in the abdomen at all and all the incisions are performed vaginally, sometimes to the amazement of patients. But the recovery times from vaginal surgery and laparoscopic surgery are far better than open cases, although there is still a role for open surgery, particularly with very very large uterus. Or in certain cases cancer surgery is sometimes best done open so that all of the cancer can be resected.

Do I Ovulate On Birth Control?

One misconception that patients have is that they actually ovulate while on birth control pills, which is not the case at all. So if women are taking a birth control pill, or Neuvaring, that will actually block ovulation, and that’s exactly how the medication works to prevent pregnancy.

Now, the other cave at is that they will have artificially regular cycles. So if a woman has started on birth control pills or Neuvaring early on in her life, she might think that she’ll have no problem ovulating because her cycles have always been regular, and we tell people, well, if you have regular cycles, you’re probably ovulating, but if you’re having regular cycles on birth control, that’s actually the way that is a side effect of the medication and doesn’t mean that you’re ovulating. In fact, you shouldn’t be ovulating on birth control pills.

So frequently, patients will say to me, “Well before I started taking birth control pills, my cycles were all over the place,” and that’s kind of a hint that they probably were not ovulatory to begin with.