THE CHANGING SEXUALITY SURROUNDING CHILDBEARING WOMEN

A Guide for Doulas and Families in the Postpartum Period

Of all the myriad changes that come with the birth of a new baby, a woman's sexuality may be one of the issues least addressed in the American birth arena. Doulas may develop a relationship with a newly birthed moher that allows for intimate discussions about female sexuality after birth. Sharing information, and supporting a woman through this incredible change, heightens the experience of birth and parenting. As the mother adjusts to caring for her newborn, sexuality is rarely an approached topic, and a woman may put the idea out of her mind. Timing and discretion play a role in determining how receptive a woman may be in talking openly about her sexual needs and expectations. If a woman is in a monogamous relationship with a partner, most certainly the issue of sex will come up in the first few weeks postpartum. Encouraging partners to talk openly with each other about their desires and feelings is the first step in making the transition into sex after childbirth. Identifying the scope of a mother's understanding of her own sexuality can be approached by asking her specific questions about her birth experience. The act of childbirth is actually another heightened dimension of a woman's sexuality. The sensations of childbirth may be considered hard work, but can be very gratifying sexually. Many women remark on how pushing the baby down the birth canal feels similar to having a wonderfully successful bowel movement; the same sense of relief and a "job well done" is expressed. Some woman feel orgasmic when giving birth and enjoy the sensation immensely. Other women have sensations that they are being torn apart and do not have pleasant memories of birth. A woman who has a history of sexual abuse may need extra attention in expressing her feelings postpartum. And those women who have had a cesarean section have a different type of experience to process.

Loving relationships can evolve through birth Babies love intimacy and warmth

If the baby was born vaginally, find out how the mother felt as the baby stretched the perineum. Did she have an opportunity to reach down and touch the baby's head before its body was born? How does she feel about her body, now that the baby is out? Does she remember the sounds and smells of her birth? Did she like them? All of her responses can give subtle clues to identifying how comfortable she is with her sexuality, offering the doula a moderate framework within which she may discuss the changes in sexuality to be expected in the following months.

A woman recovering from a c-section will usually need much emotional support to assist in her psychic recovery. The doula can openly listen to a new mother relay her cesarean birth story while consciously avoiding judgement. Some women feel horribly violated and others believe deeply that their bodies betrayed them. Some women may simply accept the surgical intervention for their birth as necessary, and are grateful to be home now recovering with their baby. The doula's job is not to arouse a woman's emotionality about her birth experience at this time, but to build a woman's self esteem toward her body and and her baby. Maintaining a woman's sense of well being is the most advantageous course of care.

Body image will affect a woman's interest in intimacy and sex as she progresses through recovery from a c-section. If she feels her body is deficient or scarred, there may be emotional blocks for feeling good about herself and her essential femininity. Speak openly and lovingly to these women, as their whole recovery process may be much more difficult. The doula's kindness and acceptance will assist them to feel good about themselves. Stay open to helping them process their feelings and desires.

A woman's sexual desires after recovery vary immensely. Most women do not have a strong interest in sexual activity in the postpartum period. A few women experience interest in sexual relations very shortly after birth, but this is rare. A new mother may be absorbed in adjusting to new routines, experiencing exhaustion, finding sexual satisfaction in simple cuddling, or while breastfeeding her infant. Many women are dealing with the pain or discomfort of stitches in very sensitive perineal tissue, making the the idea of intercourse less than appealing. Couples may have feelings that the newborn is demanding so much attention that they no longer have time for one another.

When sexuality comes to the forefront, encourage partners to communicate their intimate needs to one another. Exploring new avenues of gratification with a partner in lovemaking can be fulfilling and comforting. This is a time for compromise and emotional support. Suggest that a couple take a few moments each day to tell each other what felt good or gratifying in the relationship recently. The postpartum period is always a time for personal growth and change.

At some point in your extended postpartum care it is advisable to stimulate the mother to begin thinking about the type of contraception she will want to use to avoid another pregnancy when her body begins ovulating. Her primary health care provider or Planned Parenthood will be the most knowledgeable sources of the contraceptives available, their effectiveness, cost, and risk factors.

On the physical level, a new mother has a discharge of lochia which gradually diminishes if she allows herself time to recover. When the lochia is red, it is advisable to hold off on penile penetration, the most obvious reason being that the activity could cause an increase in uterine bleeding from the physical exertion of intercourse. It is wise to allow the pelvic organs to involute without undue strain, for the best recovery.

Some doctors/midwives will tell women not to bathe or have intercourse for a specific amount of time after birth. The doula needs to support a woman in her passage through her recovery phase and can encourage her to abide by the doctor's/midwife's orders. The doctor/midwife has a fair amount of responsibility for the mother's well being after she returns home. The newly birthed mother should feel free to call her health care provider at any time.

As the lochia diminishes, sexual intimacy can proceed within the mother's comfort level. She should not be made to feel that she must have sex to please her partner. Extra tenderness, sharing, and caring should be a part of the sexual interactions in those first few experiences with intercourse after birth. Some health practitioners will advise couples to use a condom until the lochia disappears. A tube of K-Y jelly or other water soluble lubricant is essential for mutual pleasure in intercourse, as vaginal lubrication is at a minimum in those first few weeks postpartum. Breastfeeding suppresses this natural secretion as well.

Remind couples that if scar tissue is present it can be sensitive for months. The more scar tissue, the longer the sensitivity lasts. Remind couples to go very slowly with intercourse, and talk about discomfort associated with healing tissue. A man may become very frustrated if he loses his sexual interaction with his wife because of the demands of the newborn and the sensitivity of healing tissue. Mutual regard for a partner's sexual needs is most advantageous for promoting feelings of satisfaction in the new roles of parenting. If penetration is uncomfortable for the mother, she may please her partner by other forms of stimulation that bring him to ejaculation in a loving, supportive manner.

Studies have indicated that women who breastfeed resume sexual relations several weeks earlier than women who bottlefeed. This could indicate that women who breastfeed have a greater comfort level with their body functions and sexuality, but there can be other factors involved as well. Remember to emphasize that the extent of vaginal trauma and repair will play a significant role in the decision to resume intercourse.

A lactating woman will have engorged breasts at times, and care needs to be taken in handling them in lovemaking. Some women enjoy having their partner taste their milk, while other women may not like this interaction, possibly due to a history of sexual abuse or a particular belief system.

Not much has been written on the changes in women's sexuality in the course of childbearing and prolongation of breastfeeding. From dialoguing with many mothers passing through this period of life it appears that significant reduction in erotic sexual desire is experienced by a large proportion of women. This does not necessarily mean that pregnant and lactating women do not participate in considerable amounts of sexual interaction with their partners, but that their desire is less pronounced. Several factors may influence this change in sexual fire. Most mothers find themselves getting up more frequently at night to monitor and care for young children. Babies invariably wake up right when mom and dad are relaxing and getting close sexually (it's almost as if the baby is its own little determined source of birth control). Fatigue and the role of parenting small children can also be a considerable ongoing distraction to total involvement mentally in sexual interactions.

A woman who chooses to breastfeed a baby and/or toddler for a prolonged period of time experiences a type of sexual gratification in the intimate exchange between herself and her baby. Physical contact, gazing, and the sense of fulfillment in nurturing provide a rich and substantial interaction that can represent a type of sexual love. In the last decade, a woman's feelings of sexual response to her nursing toddler were misconstrued as sexual perversion (New York). This is an abhorrent misconception that must be eradicated through education and dialogue. Even so, a woman may not feel open or comfortable speaking about her physical feelings of gratification in nursing because of religious or societal mores that remain rigid and judgmental.

As women move past their childbearing years, concluding cycles of pregnancy and nursing, their hormones readjust to the non-pregnant, non-lactating norms. A woman may find that she then enters a time of heightened sexuality, that her sex life is very fulfilling compared to the era when she was nurturing babies and toddlers. Since sexuality is not often addressed in the postpartum period, it is wise for the doula to share these common experiences with a new mother and her partner so they may know what to expect in the months that follow the birth of their baby.