Let me preface this by saying that whatever you do, childbearing wise, you'll be at an increased risk for something or another. Experience a vaginal birth — even just the once — and your odds of urinary incontinence, abdominal pain, and severe bleeding immediately postpartum go up. A cesarean, meanwhile, comes with, among other things, the risk of infection, adhesions, and deep vein thrombosis. Women who don't have any biological children may, on the other hand, may go through the menopause earlier than those that do.
These risks are studied, but socially accepted. It's considered normal to give birth vaginally, to have a c-section, and also not to have any children at all.
Women who have many children — say, four or more — in developed countries, may, however, begin hearing about the great risks involved in their choice to have a large family more and more with each pregnancy. Both doctors and people they encounter in their personal lives may make comments about the risks of going through pregnancy and birth many times.
What do women who would like large families, or already have them and are planning to continue adding to them, need to know about the risks of having more than a few children?
A "multipara" is, in medical terminology, any woman who has more than one child. Women who have given birth more than five times are called "grand multiparas", while those with more than 10 children are "great grand multiparas".
Your Risk Of Pregnancy Complications
Grand multiparas, research indicates, have an increased risk of the following complications during pregnancy:
- Gestational diabetes
- Placenta previa, a very dangerous pregnancy complication in which the placenta covers the cervix partially or completely, and which requires a c-section
- Anemia during pregnancy
- Preterm delivery, which can potentially affect the child's long-term health outcome
Maternal And Neonatal Health Risks
Various research studies conducted in different countries found that grand multiparas are more likely than women who have had fewer children to face fetal malpresentations, which means that the baby is in a position not most ideal for labor and birth. Besides breech (bottom or feet first), which most people will have heard of, such presentations include transverse, shoulder, and brow presentations. While some of these can be delivered vaginally by an experienced midwife, this risk of malpresentation goes a long way toward explaining why women who have had many children are much more likely to have a c-section in modern western nations.
Women who are grand multiparas likewise have a higher risk of obstructed labor (the birth does not progress despite normal contractions), postpartum hemorrhage, and meconium-stained liquor (amniotic fluid that contains meconium, the baby's first stool — this is a sign of fetal distress).
Babies born to grand multiparas have a higher risk of:
- Being born with a low birth weight
- Being preterm
- Having a low APGAR score at birth
They are more likely to need to spend time in the NICU, and are, sadly, also more likely to not make it.
What Does This Mean For Me?
If you've had more than five children and are pregnant again, these increased risks simply mean that you need access to excellent prenatal and obstetric care. Your healthcare provider will monitor your health and your baby's just like during earlier pregnancies, and step in to provide extra care as needed. You will make decisions concerning labor and birth together, and decide whether you would benefit from a c-section where relevant. If you can get your hands on a healthcare provider (depending on where you live, this may be a high-risk gynecologist-obstetrician or a highly experienced midwife) who has ample previous experience with mothers of many, make use of it! Interview several candidates if you can, and choose a healthcare provider who is both competent and able to give you the compassionate, human, care that you deserve.
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