Most Chinese couples who are now eligible to have a second child are over 35, risking a dangerous pregnancy for the mother. Photo: Li Hao/GT

Li Yijing just gave birth to her second child in August, at the age of 31. As a full-time housewife for years, Li is good at turning to past experiences to tackle new domestic problems. But this skill was of little use when it came to the birth of her second child. When she was pregnant with her eldest child nine years ago, she often experienced pains as the due date approached. Every time she went to the hospital, the pains were false alarms. The second time around, she did not bother going to the hospital until she felt more intense pains.

"I did numerous physical exams when I was pregnant with my first child and I thought there was no need to go through them again since I have been healthy," said Li. "But I was wrong."

When Li and her husband arrived at the hospital, she told the doctor that she "felt a little pain and wanted to have a checkup." However, the doctor discovered that her cervix had already fully dilated and the fetus was about to crown. Her procrastination led to a prolapsed umbilical cord, which could have suffocated the fetus before birth. "I was sent to the operating theater immediately and had a cesarean," said Li. "Fortunately my son was safe."

Last Thursday, the Chinese government announced that after three decades, it was scrapping the country's one-child policy. Every couple in China is allowed to have two children without having to apply for permission.

According to an October 31 report by the People's Daily, there are about 90 million couples in China who are eligible to have a second child. However, about half of them were born between 1965 and 1975, making their average age over 40.

Experts said that Chinese parents planning to have a second child will now need to become more knowledgeable about how to prepare, because unlike when they had their first child, they are now older and might have different health conditions. Although they have experienced a birth, thorough health checks are still important to avoid any possible childbearing risks and birth defects.

Experts say mothers planning to have a second child should take extra precautions and prepare earlier than they did for their first pregnancy. Photos: IC, Li Hao/GT

Every experience is different

Many second-time mothers may think that pregnancy is a case of "been there, done that." But in reality, no two pregnancies are ever alike. "Because of my first delivery experience, I got used to the second pregnancy quicker than the first time," said Li. "Everything went smoothly, so I let down my guard and did not do health checks on time."

Mo Lifang, director of the obstetrical department at Dongguan Third People's Hospital in Guangdong Province, has warned mothers expecting a second child against complacency in a recent report in the Dongguan Times. She said they should not neglect antenatal examinations. When they feel uncomfortable, they should immediately go to the hospital.

"Experience didn't count for anything after I learned about my condition from the doctor," said Li. "They said if I had arrived an hour later, my baby may have been born on the way to the hospital, which could have been very dangerous for both of us."

Generally speaking, the second delivery usually happens sooner than the first, and sometimes it may even seem faster in your mind, but every delivery experience is different, said Mo. Many unexpected health problems may also crop up. For example, the second birth may trigger the same problems one had during the first birth, and make them even worse. "If a pregnant woman had urinary incontinence and vaginal prolapse during her first delivery, the second delivery may trigger and worsen these conditions."

Mo said many women have their second child a relatively long time after their first, and they are likely to be over 30. A large proportion of them are over 35. So the situations are usually more complicated. According to Mo, the best preparation for the second child is to do a comprehensive evaluation on both the mother and the father's physical health, including the functions of the heart, liver, kidneys, blood sugar and blood pressure. Women should have their ovaries checked as well as their pelvic structure to see if there's any sequelae from the first birth, which could affect the second delivery.

"Parents wanting a second baby should prepare early, even earlier than they did for the first birth," said Shi Jie, a nutritionist in Beijing. "They should adopt a regular life pattern such as an earlier bedtime and quit smoking and drinking one year before falling pregnant with the second child."

Shi said women planning to fall pregnant the first time, commonly start taking folic acid at least three months before, which is important to avoid birth defects. However, older women who plan to have a second child may start taking folic acid up to six months before the intended pregnancy.

Health matters more than age

The age of older mothers is always a topic of heated debate. Jiang Tao, gynecologist and obstetrician at Nanjing Maternity and Child Health Care Hospital in Jiangsu Province, told the Yangtze Evening Post on November 2, that the oldest pregnant woman her hospital has treated, was 48.

Whether a woman is suitable to give birth depends on two aspects, said Jiang. First is her physical health. If a woman has serious chronic ailments such as liver disease, having a safe pregnancy can be problematic. The second aspect is age. "Women older than 35 have higher risks of birth defects and postpartum bleeding, and older women who have a second delivery can experience even higher risks than the first delivery."

However, Jiang said age is not an absolute limitation. Some women in their 40s can also give birth to a healthy newborn, if they themselves are very healthy. However, older women with relatively poor health need to take more precautions. "I suggest older woman take vitamins and minerals according to their doctor's advice, and do frequent pre-pregnancy checkups and an amniocentesis on the fetus to check for any birth defects that can be caused by chromosome abnormality," said Jiang. Besides, older women are at greater risk of gestational hypertension and diabetes, so their blood pressure and blood levels should be carefully monitored. They should also limit their intake of sugar and salt.

Natural vs Cesarean birth

Choosing the right delivery method for a second child may come down to the first pregnancy experience.

According to Jiang, it depends on the recovery of the uterus.

Women who choose a cesarean for their first-born, may suffer from uterine rupture complications if they try to give natural birth the second time.

However, women can still choose a vaginal delivery for their second pregnancy as long as the uterus has recovered well and the fetal weight is controlled properly.

"We suggest cesareans for the second-born, especially for those who had cesareans the first time," said Jiang. "But for those who had natural labor the first time, it may also be OK to do it naturally the second time."

As for the interval of pregnancy, Jiang suggested that it is safer to have a second child two or more years after the first pregnancy.

But she pointed out that pregnancy interval varies from woman to woman. If the first birth is a natural delivery, the mother can conceive again after she has stopped breastfeeding and menstruation has returned. Even when women are still breastfeeding, they can fall pregnant again.

However, Jiang said if the first baby was born by a cesarean section, it is safer to have a second child only after two or more years, to avoid potential risks.

Despite her trauma, Li's son has been growing healthily and she has recovered well from the second birth. "Since my negligence before and during my second delivery could have caused serious complications, I have tried to be more careful post delivery," said Li.

She feels that she has recovered faster and better the second time around. A definite case of "better late than never."

Global Times - Agencies