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Archive for the ‘childbirth education’ Category

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POST-PARTUM SEX By Cynthia Gabriel, Ph.D.

No one talks about the sex life of new parents. I could make a joke here about how that’s because there is none, but that is not true at all. We would just rather gossip about a celebrity’s sex life than talk about real and challenging issues in an open, accepting way. Here in this land of individual freedom, we just let people figure things out (I mean struggle) by themselves. But it doesn’t have to be this way!

I, myself, have struggled with my sexuality in the wake of becoming a mother and I could have used some advice and reality checks. I feel lucky and privileged to have talked about this intimate subject with hundreds of women in interviews and in mother-baby groups. So, from the get-go, let me acknowledge that this is a one-sided piece. I have only heard from a handful of new fathers and even fewer lesbian mothers about this issue. But from these new mothers, I want to share some observations.

Friends, family, and medical professionals may assume you haven’t had sex in a LONG time – as if pregnancy and sex were incompatible.

Although pregnancy does slow down a sex life for some couples, for many couples pregnancy is a time of great sexual exploration. Still, birth has a way of changing the sexual dynamic, even if you were enjoying yourselves fully just a few days or weeks ago.

It takes longer to have sex after the baby is born for many couples than you think. Many people assume that the six-week mark is some magic date because there is usually a check-up at six weeks with a doctor or midwife. Yes, one of the topics of conversation at this check up is supposed to be birth control and, yes, the medical professional will examine the perineal area and the abdomen for healing. But this does not mean that a magic date has arrived. Do not think for a moment that MOST people have sex sometime around the six-week mark. Some do. But many, many, many do not.

The first time you have sex after having a baby is more of a “check in” than an act of passion. This may continue for a while.

A woman often wonders what sex will feel like after having a baby, even if she gave birth by cesarean. “Things” feel different in her body and it’s not clear ahead of time how these new sensations will affect sex. Lactating women are probably experiencing leaking and spraying as part of their everyday lives and they usually worry about how this will affect the sexual experience. She may have relied on nipple stimulation in the past to help get to arousal. What if her nipples are too sore from a baby’s mouth to be played with like they were in the past?

If you go into the first time – and, realistically, the first five or six times – as experiments, you will be less disappointed. These are occasions to figure out what is going to work for you, not occasions to measure something about your sexual success.

Women are often deeply worried about how their partner will “see” them now. They NEED reassurance, but part of that need is not wanting to ask for it.

The partner probably needs and wants reassurance, too. The partner wants reassurance that s/he is still desirable and that the new birth mother is not so wrapped up in the infant that there is no room for their “couple-ness.” The bad news is that the new birth mother is in NO POSITION to offer this reassurance. She will be able to do this better when the baby is one year old and she is feeling more confident herself. But right now, these first MONTHS (that’s right. Months. Not weeks) she is the one who needs reassurance. It’s part of the trade-off about growing the baby and giving birth to the baby. So, no matter how much you wish she would tear your clothes off and tell you how sexy you are, now is the time for you to tenderly reassure her that you find her attractive AS SHE IS.

Getting annoyed at the baby is a TURN-OFF. Being understanding of her attunement to the baby is a TURN-ON.

If you manage to get all the things in order to have a sexual encounter (you are rested enough, had a shower, the baby is asleep, the bed is not full of baby poop or throw up, you are not mad at each other about who got up in the middle of the night for burping, etc.) and the baby wakes up and interrupts you…

If you can be understanding and caring toward your partner if she needs to take care of the baby (or if she asks you to do so) you are more likely to get another shot at this the next time the opportunity arises. It might be in five minutes, when the baby is calm or it may be another day.

If you groan and complain, you are less likely to get that second shot.

The choice is yours.

Figuring out WHEN and WHERE is more complicated than you think.

Some babies sleep enough that it’s possible to have a good sex life in your own bed. But many babies do not sleep enough and couples have to figure out where to go to have sex. The problem is that most babysitters come to YOUR house. If you can afford it, think of a hotel room for an afternoon as the same price as dinner and a movie. Once a month, this may be worth it.

Sex can hurt more after having a baby.

Although this is not true for all women, for a certain percentage of women sex after giving birth is more painful than it was before. Generally, the first thing to try is more lubrication. If that does not fix the issue, an estrogen cream can be helpful. This is a topical cream, not an estrogen pill that you take internally, so it does not have the same effects on your body that hormone pills do. In studies of “women’s sexual health after childbirth” about half of women report vaginal dryness as an issue. You are not alone!

Feeling “Touched Out” is a real problem for new mothers.

 Many new mothers who spend their days and nights caring for needy newborns want to spend their non-baby time not being touched. It’s a serious mismatch for new mothers and their partners who, likely, are feeling less touched than they were before the baby arrived.

There is not an easy answer to this problem; however, if you are the partner reading this essay, I would take away that providing down time without the baby is likely to be helpful to the new mother’s receptiveness to touch. Otherwise, this is an issue that just requires patience and understanding.

For you science geeks out there I am going to copy some information from a 2000 British Journal of Obstetrics and Gynecology about this issue. What I find fascinating is that the medical professionals write it this way “Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38%.”

I would reframe it this way:

Most of us hope that we will return to our pre-pregnancy sex life by about six weeks after our babies are born because this is what we are led to believe by birth books and doctors. The reality is that this expectation is not realistic, but no one talks about it openly. The truth: 38% of us have sexual difficulties even before we have babies and 83% of us are not having the same kind of sex life we used to have for THREE MONTHS and 64% for SIX MONTHS after our babies are born.

In other words, it is NORMAL to have a very different kind of sex life for a LONG TIME after our babies are born. It is UNUSUAL to return to an easy-peasy sex life within six months post-partum.

INFO FROM THAT STUDY:

BJOG. 2000 Feb;107(2):186-95.

Women’s sexual health after childbirth.

Barrett G1, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I.

Author information

 Abstract

OBJECTIVE:

To investigate the impact of childbirth on the sexual health of primiparous women and identify factors associated with dyspareunia.

DESIGN:

Cross-sectional study using obstetric records, and postal survey six months after delivery.

SETTING:

Department of Obstetrics and Gynaecology, St George’s Hospital, London.

POPULATION:

All primiparous women (n = 796) delivered of a live birth in a six month period.

METHODS:

Quantitative analysis of obstetric and survey data.

MAIN OUTCOME MEASURES:

Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.

RESULTS:

Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38% . Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P = 0 x 01) and previous experience of dyspareunia (P = 0 x 03). At six months the association with type of delivery was not significant (P = 0 x 4); only experience of dyspareunia before pregnancy (P < 0 x 0001) and current breastfeeding were significant (P = 0 x 0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.

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Control Photo

This is a quick reflection on how birth is about “the unexpected” and about how important it is that women be in control of decision-making in birth precisely BECAUSE so much in birth is unexpected.

I think there is nothing worse than expecting one thing, having something entirely different happen, and feeling like the decisions were not in my control. Yet, this is what happens in birth across America every day.

We all have some vision in our mind of how our “perfect birth” will go. And I have yet to meet the woman who achieved her vision 100%, although I’ve definitely met a lot of women who are happy with their experiences. I’m always amazed at how even women with seemingly perfect births can obsess about the things that did not go right! (That’s a post for another day, because, come on! Let’s start talking about what went RIGHT at our births!) But this post is not about those seemingly “perfect” births.

It’s about the births in which we’ve planned really well, we’ve hired just the right support team, we’ve done everything we can to ensure that our vision has the best chance to succeed…

and then the baby decides to turn her head sideways or come out foot-first

or there is a flood/tornado/hurricane/outbreak of SARS (that last one happened to friends of mine who gave birth in Toronto!)

or our midwife is sick

or our blood pressure gets dangerously high during labor

or whatever….

And we have to improvise. We have to make decisions that we wish we didn’t have to make. We accept interventions because we know they are the right thing to do in the moment, but we also know that we researched and planned for HOURS and WEEKS and MONTHS to try to avoid them.

It’s just so important that women have as much decision-making control (and support) in birth because when these scenarios arise we will feel so differently about them when WE said, “Yes, it’s time for that intervention” than when we felt like it “happened to us.” Our healing for the days, weeks, and months after the birth will hinge in many ways on whether we feel like we had no choice or whether we chose.

We may be sad and angry that we did not have the perfect birth we envisioned, but we will not feel tricked, disempowered, or trampled upon. We can be sad and angry and also, simultaneously, grateful and empowered. These do not have to be mutually exclusive.

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Childbirth Classes: Necessity or Luxury? Redundant in the Internet Age?

(reposted from last year with a new graph below!)

Hello pregnant women!

Fewer of us than ever before are signing up for traditional childbirth education classes. You know, those old-fashioned classes that meet in person. With a teacher. And maybe a textbook. Perhaps “class” reminds you of high school. Or college. And you do not want to be in SCHOOL any longer.

Besides, everything you need to know about birth is on youtube. Right? OK, well, then. Maybe it’s on Parenting.com? Or Childbirth.org? Or the American Pregnancy Association? Or WhatToExpect.com?

Oh, dear. There’s a lot of websites that offer “childbirth information.” And the information they offer conflicts. A lot. More importantly, the information is not well-tailored to your unique situation.

No, problem, says the modern mama-to-be. I know how to get information tailored for me! I will jump into some chat rooms or join a website and ask my specific, individualized questions. Then the magic of the Internet will quickly provide me with the answers I need.

Check out this graph from the “Listening to Mothers-III” survey about how we judge the trustworthiness of information on-line about pregnancy and birth:

Screen Shot 2015-05-12 at 9.40.15 PM

This is, indeed, how the majority of American women are preparing for childbirth. But childbirth is a very different process than researching what car to buy or whether or not to cut bangs this week (Michelle says, “Yes!”). Preparing for childbirth on-line is sort of like preparing for a triathalon on-line. There are good tips out there, but we all know that the REAL preparation is occuring off-line in what I would call “real life.”

Childbirth is a unique life event and probably nothing you have ever done in your life (except give birth previously!) can serve as a good model for how to prepare. I don’t know of any other event that requires the combination of social (how to interact with hospital staff and birthing professionals well), emotional, relational (negotiating the needs/wants of partners and parents and siblings), intellectual, and physical that birth requires. Many people compare birth to endurance sports events like marathons, but the fact is that few marathoners have to negotiate important medical decisions with doctors while they are running.

So, what you get in childbirth education classes that you CANNOT get on-line is the opportunity to practice in the presence of an experienced guide. When you READ information, it does not stick with you nearly the way it does when you have practiced what that information tells you to do. As Yogi Berra said, “In theory there is no difference between theory and practice. In practice there is.“

You learn SO much by getting to ask a question and having a personal INTERACTION about your question. You get to practice — try out — different ideas in this safe place that is not yet your labor or your baby’s birth. In this place, you get to practice thinking and feeling and relating different ways. You have a teacher, who has probably been at a number of births and seen some of those ways play out in real life, who can guide you in your thinking and feeling and relating.

Childbirth education classes are not really about information. The “facts” are readily available on-line. It is the practice of trying this idea and then this one or, hey, maybe this one that makes this information useful for you. When you are in labor you do not need theoretical knowledge. You need very, very practical knowledge.

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