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My wife and I agreed to stop after 3 kids, and she got a tubal ligation during the birth of our third.
With hindsight, I think this was the right decision - her births went from "C-section" to "with minor complications" to "with emergency post-op surgery", and one of my worst memories is of scouring medical journals on my laptop to try to figure out her survival odds while she was in that last surgery (around 99%, which sounds high now but sure felt terrifyingly low then).
With more hindsight, she now disagrees with me. She utterly hated being pregnant, and she doesn't have a death wish, but even in the hypothetical case of "what if the odds kept getting worse and you'd have been down to 90% next time" she thinks that would have been worth it for a fourth.
Her sister once had a kid who lost your game of Russian Roulette, with a severe mutation expressing both physically (he had stubs instead of lower arms or hands, legs he couldn't walk on, and cardiopulmonary problems that the doctors thought would kill him by age 3 or 4, and he eventually died of the flu at age 11) and mentally (at age 11 years he was mentally closer to 11 months). She still thought having him was worth the ordeal of caring for him.
I'm not sure what a good upper limit is, though. That sister has been raising (or completed raising; there's a wide age range) 4 other kids happily - but that might be partly due to good fortune in most of their lives? My father was the oldest of 6 young kids when his father died, and though his mother was a saint there's a limit to what a single parent on a limited survivor's pension can do to raise such a large family well.
I think that's the only reason I'm still glad we stopped at 3. As a terminal value I'd consider a 4th kid like our first 3 to be worth much more than a 10% chance of me dying, so I can't tell my wife not to feel likewise, but there's also the instrumental value of our lives to consider. If she had died then even our first 3 wouldn't be "like our first 3", they'd be in a sorrier state if they'd had only me (with a couple of her nearby relatives to help) raising them.
Nucleus Genomics just launched their "Nucleus Embryo" product yesterday, if you want to do IVF to get improved odds on the kid's genes. I'm not sure what their process is or how reliable it is, though.
Mean desired total fertility rate among young women in the USA is still over replacement; it's only the actual fertility rate that's now under 1.7 and still falling. But the biggest issues that have women delaying kids until it's too late to reach their desires aren't anything about the risks of pregnancy or difficulties of child rearing, it's the rapidly increasing difficulty of finding a spouse (especially difficulty finding a spouse while still young), combined with worry for their economic future.
That sounds pretty close to Gattaca unless I am missing something.
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Vaguely relevant (if mostly not actionable): LW on superbabies.
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I did start hemorrhaging after my second birth but I don't think it actually got to the point of being truly dangerous (it's a little hard to know, the medical professionals try not to make you panic, but they gave me the necessary medication and got it under control pretty quickly so I think it was just a routine complication) and at the time my PPD was severe enough the slim prospect of being dead felt like a relief, I mostly felt bad for my husband. (Spoiler: I did not die)
But I don't think I'd be ok with a 10% risk of dying to have a fourth kid. That seems pretty damn cruel to the first three.
(Of course large portions of human history people seemed to feel otherwise, unless the only reason husbands were still ejaculating inside their wives after the first kids during periods of history when maternal mortality was higher than 10% was because they had religious reasons so strong it was worth risking their wife's life over. Idk, I find it very very hard to relate to the choices made during time periods with high maternal mortality, it seems pretty crazy to me, but maybe it explains why women who feel the risk is worth it exist because we'd have gone extinct otherwise?)
I have a relative who got post partum psychosis, which I consider approximately 1000x more terrifying than PPD, and she's on her way to a fifth child. Discussing having kids with her is a very strange experience because she's so much less ambivalent than me. Like I was listening to her describe her experience and feeling my ovaries shriveling up inside my body from terror and meanwhile she was talking about how much she wanted another kid. I guess the evolutionary drive to reproduce is just that damn strong in some people? Idk.
It's a good point re age and finding a spouse. Definitely having more kids is a lot easier if you start younger. I know women freezing eggs and women single-parenting-by-choice so obviously options do exist but I guess I probably agree that most women would really prefer to have kids
And that of course is entirely dependent on factors not entirely in their control
Maternal mortality with no medical care isn't anywhere near 10% per birth- it's 1-2% per birth in the least developed parts of subsaharan Africa and that seems to line up with historic data from Europe(granted, needs to be taken with a grain of salt).
Yes? I feel like you're reading my comment out of context.
We were discussing
Edit: no actually I see your point. Yes, it makes no sense to invoke evolution for it for temporary periods (and in fairness when it spiked people surely didn't realize what was happening)
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