PART 2. Sex after childbirth
In the second article in our two-part series on
this taboo subject, Dr Rachel Jones talks about what happens to
your sex life after baby arrives.
Sex in the months following childbirth can be a stressful issue for
many new parents. You've successfully navigated your way through
nine months of immense change during pregnancy and survived the
rigours of labour only to find a whole new set of challenges
awaiting you and your partner in the postnatal period. New
Zealand's maternity system is generally proficient at looking after
women in their first few weeks following birth, but this care
usually finishes at the final postnatal check with your lead
maternity carer (LMC) at four to six weeks. Unfortunately, from
that point onward, many mums feel that they are left to fend for
themselves, and have to work out their new maternal role, and any
associated problems, in isolation. The lucky ones among us can turn
to close female relatives and friends for sex life advice, but even
then it can be a difficult and embarrassing topic to discuss. So
what are the real facts and issues surrounding sex after
birth?
When to start doing it
Standard medical advice is to wait until your LMC has given you the
all-clear at the final postnatal appointment before resuming
intercourse. This four- to-six-week time frame is based on a number
of factors.
After having a baby, most women feel
battered and bruised down below, and it normally takes around six
weeks for these sensations to subside as your body repairs. Your
womb needs to shrink again, the cervix has to recover, and
post-delivery vaginal discharge (lochia) will take a month or so to
stop.
Theoretically, intercourse during this
time can cause bacteria from the birth canal to travel into the
vulnerable lining of the womb, potentially causing infection.
The final postnatal consultation is also a good time to discuss
birth control before becoming sexually active again.
However, many women feel physically and
psychologically ready to resume sex sooner than the traditional
six-week wait, but it's still advisable to discuss the situation
with your LMC for specific advice tailored to the individual you
are, and the type of birth you've just had.
Ouch! It hurts!
The road to recovery can take longer if you had a difficult labour,
an instrumental delivery, or an episiotomy/tear. A small tear can
heal naturally in around two weeks, but larger ones or episiotomy
cuts will usually need suturing. These stitches can make
intercourse uncomfortable, and the time they take to dissolve can
vary between 10 days to several weeks, depending on the type of
material used.
The discomfort can be eased with
painkillers (check suitability if breastfeeding), a sanitary pad
soaked in witch hazel, and, if resuming intercourse, a lubricant
gel.
Occasionally, repairs made to the birth
canal can leave you feeling "too tight", and this is worth
discussing with your LMC or a gynaecologist, as corrective
treatment is available.
Sex can also be difficult after a
Caesarean section. Your body has undergone a major operation, and
although the pelvic floor remains intact, you will still experience
lochia and uterine after-pains. Scar tenderness and fear of the
incision site "bursting open" during lovemaking are very common
concerns, so it's sensible to have your scar reviewed at the final
postnatal check before restarting sexual athletics. If this
seems like an eternity, try making love in a position that doesn't
put pressure on your belly.
Whatever type of birth you've just
experienced, take things slowly and try to build up to full
intercourse in a stepwise fashion. Indulge in foreplay and when
you're ready, start with positions that allow you to control the
depth of penetration. Make your partner aware of potential sore
breasts and cracked nipples. Avoid oral sex from your partner in
the first week or so after delivery, as there have been rare but
documented cases of air bubbles getting into the maternal blood
vessels, and the out-come can be fatal. On a more positive note,
having an orgasm in the postnatal period is absolutely fine, and it
might feel even better than ever!
Your sex drive
Due to a mix of physical, psychological, and lifestyle changes,
many mothers experience a low sex drive in the first few months
after childbirth.
Sheer exhaustion is a major
passion-killer, as you struggle to cope with the new baby,
interrupted nights, housework, and maybe other children. Make
sure you rest as much as possible, and try to make love at
practical times. You may lose the spontaneity, but at least you'll
have some energy.
Your body image can be distorted after birth, and it's easy to lose
self-confidence when faced with leaky boobs, a saggy tummy, and
stretch marks. Try boosting your self-esteem with some gentle
exercise or a post-baby makeover.
Hormonal changes after pregnancy can also
affect libido. Your levels of oestrogen are reduced, especially in
women who are fully breastfeeding, and this can cause vaginal
dryness, making intercourse painful. Applying a personal lubricant
gel (available at the supermarket or pharmacy) can help make things
more comfortable for both partners.
Continued lack of interest in sex can be
associated with post-natal depression, so check you don't have
other warning signs.
What's he thinking?
The postnatal period is also tough on the man in your life, and
this can have a direct impact on his libido. Some men find the
whole birth experience a major turn-off, or are just plain scared
of causing you discomfort. A common concern is that you may have
changed "down below" and intercourse might feel different.
Your pelvic floor is never quite the same after a vaginal birth,
but muscle tone can improve significantly with specific exercises
that target the pelvic region.
Subconsciously, your partner may feel that your body now belongs to
the baby, and some dads can feel a little jealous and
excluded, especially if you are breastfeeding.
Identity issues are also common at this
time, and couples can find it difficult adjusting to their dual
roles as parents and lovers.
Communication is vital to prevent
misunderstandings and hurt feelings. Encourage your partner to
express his worries and allow him time to readjust. Ask a trusted
relative or friend to look after baby sometimes so you can make a
little time for the two of you.
Relax and enjoy
Don't get too disheartened, as you can recover quickly
from the rigours of childbirth and experience better sex than
before pregnancy. A newfound sense of womanhood and sensuality
sometimes arises after giving birth. For the first time, many women
are really aware of their body along with its capabilities and
limitations. Some men love the postnatal shape and
develop a new understanding and respect for their partner. In fact,
many couples find that their new baby immediately
makes them feel complete and adds a deeper level of intimacy to
their relationship and sex life.
Remember that time is the 
greatest of healers so try hard
not to be pressured by yourself or your partner. Take time to
adjust to your new body and your new role in life. In today's
society we are expected to be everything to everyone - the perfect
worker, mother, and lover. We live in an age in which we
excessively stress and strive for increasingly unrealistic goals.
Perhaps it's time to rethink and start being kinder to
ourselves.
Dr Rachel Jones is a family doctor, and currently
a full-time at-home mum to her three dynamic daughters, Cate (7),
Lauren (5) and Jess (2). She is passionate about health issues
involving women and their children. Rachel is now exploring the
more creative side of medicine with freelance medical
writing.
As seen in OHbaby!
magazine Issue 8: 2010
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