Bumps and Babies: Intimacy after Pregnancy

Midwife Emma McNerlin explores the sensitive and complex issue of returning to sexual intimacy following the birth of a baby.

By Emma McNerlin

One could be forgiven for thinking that if these two pages in the BAMBI magazine were completely blank it might more accurately reflect many couple’s experience of sex after having a baby…non-existent. After all that focus on oxytocin for labour, birth, and breastfeeding, it feels like there is none left for sex.

However, in truth, the time to return to intimacy for parents is more complex and varies greatly. A study of 1,500 first-time mums found that three-quarters of those surveyed had resumed vaginal sex by 12 weeks postpartum, with many reporting returning to other sexual activity by six weeks.[1]

Medical recommendations

Traditional advice states that couples should refrain from sexual intercourse until after the six-week postpartum check to allow the cervix to close. Waiting this long will limit the risk of infection.[2]

Stitches from a vaginal delivery usually heal quickly, within two weeks. C-section stitches are more complicated: the skin layer will heal within two weeks, whereas internal stitches can take four to six weeks to heal completely, hence the longer physical recovery time.

Infection risk is greatly reduced if sex is postponed until after all postnatal bleeding has stopped. However, physical recovery is only one consideration when resuming sex after having a baby.

There’s a new boss in town

No amount of parenting classes in pregnancy can prepare new couples for the reality of life with the newborn. Reading books with magical routines guaranteeing a compliant textbook baby is futile. Babies have not read the books; they are just communicating their needs, and while it can be frustrating, it takes a while for new parents to learn what their baby needs.

The feeding, winding, changing and settling cycles seem to blend into each other in the first weeks and months. Being physically intimate will likely be the last thing on either parent’s minds during this time.

Whilst it’s clichéd, it is important to keep communicating and take opportunities where possible to connect. Try to have at least one conversation a day that is not about baby or parenting, check in on how each other are feeling. No one knows you better than your partner, so if you are struggling, talk about it.

From experience of supporting couples though their postpartum adjustment, I have found that being thoughtful and taking initiative to help each other is probably going to bring you much closer. Tempers can fray at times and resentment can build on both sides, with new mums feeling overwhelmed with caring for baby and maybe feeling less confident with their postnatal body. Fathers may have been affected by witnessing the birth, or may experience pressure between responsibilities at work and at home.

Being quick to forgive and offering to share the practical baby care will remind you that you are a team and in it together, making physical intimacy more likely when the time is right.

Don’t forget the hormones

The postpartum period is a hormonal maelstrom. There are physical and emotional effects of plummeting progesterone and oestrogen with their related mood swings, tearfulness, and night sweats.

Rising prolactin levels which helps to sustain milk production has the side effect of reducing testosterone and suppressing libido in new mums. Research has shown that new fathers, especially those who spent time regularly skin to skin and caring for their newborns also experienced rising prolactin and lower testosterone. Evolutionary biologists hypothesize that this is a primal response to protect and provide security for a newborn.[3]

Like all things in the parenting journey, this hormonal flux is just a phase, and every new mother’s experience is unique. If you have concerns about how you are feeling overall during the postpartum period, you should consult your doctor, or reach out to the BAMBI Bumps team for advice and support.

Getting down to business

When you both feel physically and emotionally ready to have sex again, a certain level of apprehension is normal. It is quite normal for it to take more than one attempt. Sex may feel different after a baby. Rehabilitation of the pelvic floor with pilates and other core and floor strengthening exercises will help to improve sensation during sex, and much like parenthood, your commitment to your pelvic floor will be lifelong.

Hormonal changes mean you may experience vaginal dryness, so consider using a lubricant and changing positions to help make it more comfortable while your body adjusts. Breasts may be tender, and some women experience a let-down of milk when they have sex due to the release of oxytocin.

An ounce of protection

It is a cruel biological joke that the body is primed to get pregnant again quickly after birth, so before resuming intimacy and unless you would like another baby right away, talk with your doctor about which method of contraception is right for you. The combined pill is contraindicated for breastfeeding.

Lactational Amenorrhea Method (LAM) is recognized as a form of contraception. Exclusive breastfeeding (at least every four hours during the day and every six hours at night) suppressed ovulation. This may only be used in the first six months postpartum, and any disruption to nursing from sickness or return to work, etc., will reduce its effectiveness.[4] 

It is important to also remember that you ovulate two weeks before you menstruate, so it is very possible to become pregnant again before your period returns.

Whilst physical intimacy is usually way down on the list of priorities after baby’s arrival, for very valid reasons, like everything as a parent you find that it is a phase that passes and eventually you find a new equilibrium and space to reconnect physically. The timing will be different for everyone, and the physical all clear is only one aspect to feeling ready to have sex again.

Will it be the same as before? Probably not, but that doesn’t make it better or worse, just different and that’s OK.

References

[1] McDonald, EA. and Brown, SJ. (2013) Does Method of Birth make a difference to when women resume sex after childbirth British Journal Of Obs and Gynae available online: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12166

[2]ACOG (2016) A Partner’s guide to Pregnancy. Available online: www.acog.org/Patients/FAQs/A-Partners-Guide-to-Pregnancy?IsMobileSet=false

[3]Fausto-Sterling, A. (2014) The Biology of Fatherhood. Science and Nature available online: bostonreview.net/world-us/anne-fausto-sterling-biology-fatherhood

[4]Australian Breastfeeding Association (2017) – Factsheet on LAM available online: www.breastfeeding.asn.au/bfinfo/lactational-amenorrhea-method-lam-postpartum-contraception

About the Author

Originally from Ireland, Emma is a UK-trained midwife who worked in the maternity unit at a busy NHS hospital just outside London. Emma moved to Bangkok with her husband in 2014; they have an eleven-year-old son, Toby. Volunteering with BAMBI Bumps and Babies since August 2015, Emma regularly conducts sessions on pregnancy, birth, breastfeeding and Infant First Aid. In her spare time, she enjoys baking and Muay Thai, and is an active member of her son’s parent group at school.


The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects.

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