New parents often joke about sex, or more often the lack of it. It is important to understand that it takes time to re-establish a couples sexual relationship.
Resuming sex after birth is very much up to individual couples. Pain is usually a good guide in finding the right time.
For some couples waiting until the woman is ready may not be an issue however for other couples this may cause unhappiness and put strain on the relationship. Between 25 and 50 percent of women report that sex is a problem postnatally.
Sex may be more uncomfortable
- after a forceps birth
- after a tear or episiotomy
- where the perineum continues to be painful
- the woman feels tired and depressed
When the woman is breastfeeding or using the mini pill for contraception she may have a reduced interest in sex. The explanation for this is that her feelings may be affected by hormones. You may be feeling less attractive sexually after birth. Your muscles may feel less toned and you may have stretch marks, scars, leaking breasts and extra weight. Some of these changes will be temporary and some permanent. All of these changes become less important with time. If these changes prove to be an ongoing concern to yourself or your partner then it may be advisable to consult either your family doctor or a councillor.
After a day of caring for your baby alone, at the end of the day you may feel that you do not have the energy for being intimate. Your partner may be wanting to be close to you by having sex with you. Your partner may not understand and be hurt when you don’t respond as expected.
Your tiredness may bring to the surface other aspects of your relationship that you are unhappy with. For example you may feel that your partner is not contributing to the housework. This can lead to you feeling even less interested in sex. It is important to talk about these issues with your partner. It is important to remember that your partner is going through a period of adjustment too. Your partner may be coping with financial pressures, demands on time as well as relationship adjustments. You want your partner to be supportive and in turn your partner will need to feel appreciated and included in this new journey of parenting.
What can you do?
- If there is a problem talk to your partner about how you are feeling
- Be honest when talking with your partner and suggest other ways that you can experience closeness as a couple
- Plan time to be together when the baby is either asleep or being cared for
- If you are concerned about perineal pain try different positions to take the pressure of the painful area and use a lubricant
- If the mini pill is affecting your libido consider an alternative method of contraception
- If you have concerns about your relationship you could ask your Maternal and Child Health Nurse for a referral to a family councillor
If you do not wish to have another baby in the immediate future, you will need to use contraception. Another name for contraception is birth control or family planning. There are many choices of contraceptives to choose from. It is important to select the one that will be suitable for you. You could discuss your options with your doctor, a midwife at the hospital, your family doctor or your Maternal and Child Health Nurse.
Some of your choices are;
- A contraceptive implant: Implanon is a contraceptive rod, about the size of a match, containing the hormone etonogestrel, which is similar to the naturally occurring hormone progesterone. It is the most effective reversible method of contraception available. It is more than 99.9% effective.
- An intra-uterine device. An intra-uterine device that is put into the uterus (womb). There are two types available in Australia. The copper IUD and the hormonal IUD (Mirena). Both are amongst the most effective forms of contraception and can stay in place for at least five years.
- Oral contraceptive pills; There are two types available;
- The Combined Oral Contraceptive pill which has two hormones (oestrogen and progesterone). The hormones prevent the ovaries releasing an egg each month and thickens the mucous in your cervix. The combined pill is very good at preventing pregnancy if used correctly.
- The Progesterone only mini-pill. This pill has only one hormone that changes the mucous at the entrance to the uterus to prevent sperm entering the uterus. The mini-pill is a good form of contraception if breast feeding however it must be used correctly.
- Emergency contraceptive pill sometimes called the morning after pill. If you have had sex without protection or you believe that your usual method of contraception (missed pill, vomiting or diarrhoea, broken condom) may not be effective then the emergency contraceptive pill can be used. It is best taken within the first 24 hours however it will still work up to 96 hours.
- Contraceptive injection (Depoprovera): The Depoprovera injection contains a hormone similar to progesterone that stops the body releasing an ovum (egg) and thickens the mucous in the cervix (entrance to the womb), preventing the sperm from getting through. Depoprovera needs to be repeated every 12 weeks.
- A diaphragm acts as a barrier method of contraception. It fits inside a woman’s vagina and covers the cervix (entrance to the womb) to stop sperm from meeting and fertilising an egg.
- The male condom is a fine rubber or synthetic sheath that is worn on an erect penis. It collects the sperm and stops them entering your vagina and uterus. You can buy condoms from a chemist or supermarket. Condoms reduce the risk of both pregnancy and STIs. Condoms are effective if they are used correctly. If they are not used correctly, which is common, you have a significant risk of getting pregnant or catching an STI.
- The female condom is a barrier method of contraception that fits all women and suits all ages. It offers women and men an alternative to the male condom. Studies have shown that, if used the right way, the female condom is effective in preventing an unintended pregnancy and giving protection from sexually transmissible infections (STIs). The female condom is available from Family Planning Victoria’s clinics, some pharmacies and other sexual health clinics.
- Breastfeeding: The Lactational Amenorrhea Method, known as LAM, is part of the World Health Organisation’s list of accepted and effective methods of family planning. Studies show LAM to be 98% effective if you have not had a menstrual bleed? Your baby is receiving only breast milk (no supplementary feeds) and your infant is less than six months old.
Information for women with pre-existing Diabtetes (Type 1 & 2) and Gestational Diabetes
For those women with pre-existing diabetes (both type one and type two diabetes) planned pregnancies are of the utmost importance so that maternal, foetal and neonatal complications are at least minimised and ideally prevented. Current recommendations advise women with either type one or type two diabetes to seek preconception care from their diabetes healthcare team at least six months prior to conceiving so that the optimal HbA1C has been achieved before conception. An HbA1C of less than 7% is ideal preconception. Common maternal, foetal and neonatal complications that may develop should women with pre-existing diabetes not seek preconception care include miscarriage, congenital abnormalities, preeclampsia, prematurity, small for gestational age baby, large for gestational age baby, labour and birth complications and significant neonatal hypoglycaemia.
For those women who had gestational diabetes in a previous pregnancy it is highly recommended to plan and prepare appropriately for future pregnancies so that optimal maternal, foetal and neonatal outcomes are achieved. Current recommendations are to perform an oral glucose tolerance test yearly for those women who plan to have more children. For those women who have decided to not have anymore children then an oral glucose tolerance test is only required every three years.