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Is There Sex after Childbirth?

Practice Variation in Cesarean Rates: Not Due to Maternal Complications
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients.  This analysis shows that:

    Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
    Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
    Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.

Tips for Choosing a Care Provider - great overview! from Henci Goer

Chapter 7 from Becoming a Father - How to Nurture & Enjoy Your Family by William Sears, M.D., 1986, p. 119-129.

“I feel left out.” “All my wife does is nurse the baby.” “We need to get away—alone.” “We haven't made love for weeks.“ “I've got needs, too.”

Nearly every father has had these feelings at some time in the first few months after the birth of a baby. Let me assure you that your feelings and your wife's strong attachment to your baby are both very normal.

Why Your Sex Life Isn't the Same

Being aware of the hormonal changes that take place in your wife after birth, and recognizing the importance of mother-infant attachment, may help you understand your wife's apparent lack of interest in sex. Before a woman gives birth, the hormones that influence her sexual behavior are at a fairly high level. After the birth, the pattern changes and the maternal hormones predominate. This situation lasts for at least three to six months and sometimes longer: it may last until the baby is weaned. During this time, your wife's desire to take care of and nurse her baby may take priority over her desire for sexual intimacy with you.

As a survivor of my wife's hormonal changes through six pregnancies and six children, I have developed a theory as to why these changes occur.  During my many years as a pediatrician and as a father I have learned not only that babies do what they do because they are designed that way, but  also that mothers do what they do because they're designed that way. The shift from attachment to the husband to attachment to the baby seems to be a part of the normal design for the survival of the species. It ensures that the young of the species are well mothered. I explained this all one day to a left-out new father. He commented, “This seems to be part of the for-better-or-for-worse clause in the marriage vows: better for baby, worse for daddy:’

Another reason for your wife's apparent sexual disinterest is sheer fatigue. Mothers often feel so drained by the incessant demands of the baby and the household that at bedtime all they want to do is sleep. Mothers have described this end-of-the-day feeling as being “all touched out” or “all used up:”  A mother is programmed to be attached to her baby (your baby) physically, chemically, and emotionally. This does not mean that you are being  displaced by your baby, but that some of the energies previously directed toward you are now being directed toward your baby. For the first few months after birth (sometimes longer) most wives do not have the energy to engage in a high level of intimacy both as a mother and as a sexual partner. These energies will eventually be redirected toward you. Meanwhile, you can do some \ thing to build up your equity in your wife's sexual interest in you: if you become a supportive and sensitive husband ) during this early attachment period, your wife's love and respect for you will grow and  her interest in you will return at a higher level. This early attachment period is a season of the marriage, a time to parent. If the tasks of the season are carefully tended to, the season to be sexual which will follow will be all the richer.

Rekindling the Sexual Fire

Don't Pressure

Pregnancy, birth, and the early postpartum adjustment period leave a woman physically and emotionally challenged. Let your wife's whole system settle down a while before hinting at sexual demands. As most husbands know, the mental component of sex is much more important in women than it is in men. In women physical and emotional readiness for sex occur together. This is especially true during the postpartum period. A woman's mind is usually not ready for sex until her body is. Many women are truly not ready for sexual intercourse for several months after birth. Pressuring your wife to give too much too soon is doomed to failure. Sex given out of a sense of obligation is not as good as sex motivated by desire.


Go Slowly

Dan, a highly sexual new father, was complaining to his friends that he hadn't had any sex since the baby was born. “The doctor says it's not safe to have sex until six weeks have passed. I can hardly wait:’ When the sixth week finally arrived Dan made love to his wife, but she at best only passively accommodated him. Their sexual reunion was physically unsatisfying for Dan and emotionally unsatisfying for his wife.

The doctor's idea of when a new mother is ready for sex may be vastly different from when she herself feels ready. After all, the doctor is not the one who is recovering from pregnancy and childbirth while learning to cope with a new baby. Your wife's postpartum checkup is not a green light indicating your sexual relationship can pick up right where it left off.

There is a better way. There is a natural warm-up period that must precede sexual fulfillment after childbirth. A new mother needs to be courted, to be wooed all over again. Most postpartum women respond to a progression very similar to the premarital courtship. Postpartum women want to be held, caressed, looked at, cared for, and loved. For a man, sex equals intercourse. Women, especially postpartum mothers, can experience sexual fulfillment without intercourse. New mothers do feel the necessity to be reconnected sexually to their mates, but sexual intimacy does not return automatically for most new mothers. Many women need a warm-up period of eye-to-eye contact, touching, caressing. and many “I care” messages  before sexual intercourse can become fulfilling.

Joan and Larry are an example of new parents going through the process of sexual reunion. Four weeks after the birth of their baby Joan was just beginning to feel sexual urges again. Meanwhile Larry hovered like a sexually thwarted male ready to pounce. When the doctor-prescribed waiting period was over, Larry moved too quickly, Joan stopped him and said “Please hold me for a while instead of making love right away:’ She needed more time before she felt ready for intercourse.

Go Easy

Respect the physical changes that are going on as your wife's body is returning to its pre-pregnancy state. Some fathers have described their sexual reunions with their wives as “getting to know her body all over again:’ Sensitivity and gentleness are the keys to fulfilling postpartum sex.

Your wife's breasts may be sensitive because of the changes that occur during lactation. They may leak milk while you are making love so be prepared for this with a towel nearby to catch the drips. Postpartum women may also experience vaginal discomfort or pain during intercourse. The hormones that usually prepare the vagina for intercourse by releasing a protective lubricant are at a lower level during lactation, making vaginal dryness very common in the months after birth. Vaginal pain may also occur if your wife had an episiotomy that is not yet completely healed.

Here are some suggestions to help you and your wife get sexually reacquainted:

  1. Make the first night you plan to have intercourse after the birth similar to your first experience of intercourse together—a special time of romance and courtship, complete with flowers and a special dinner. With all the recent changes in your wife's body, you will be getting to know each other all over again. One plus is that “the bulge” is gone, and you'll be able to snuggle close together again.
  2. Experiment with positions that do not put pressure on your wife's breasts or episiotomy for example, the side-lying position. Move slowly and ask her to guide your penetration to avoid pain.
  3. If dryness is a problem use a water-soluble lubricant.
  4. Leaking breast milk is a natural part of sex after childbirth. Don't give your wife the message that this normal bodily function is distasteful. If leaking milk bothers you, having sex after the baby has emptied the breasts may lessen the problem. Don't cry over spilled milk—understand it for what it is: a sign that your wife's body is responding to your lovemaking.

Be Considerate of the Mother-Infant Bond

The feelings of oneness between a mother and her new baby may affect your lovemaking. You may often feel that you are making love to a split personality: mother's body may be in your arms but her mind may be with her baby. Here's the scenario: while you and your wife are making love, your baby cries from another room. (The scent of mother's milk traverses closed doors and thick walls to awaken babies at the most untimely moments.) When this happens, your wife's body and mind respond and she will be more oriented toward comforting baby than satisfying daddy.  Fathers, it is impossible to compete with this normal biological programming. Above all, avoid giving your wife the feeling that your baby is spoiling your sexual pleasure. Instead of letting loose with an angry “foiled again” reaction, be sensitive to your wife's biology and to your baby's needs. Say to  her, “Go comfort baby first, and we'll make love later:’ Nothing will earn you more points (and better sex!) than to convey to your wife your understanding that the baby's needs come before yours. A woman is often turned off by selfishness in a man, particularly when it comes to sex. But she will return to your side feeling even loving and responsive if you have encouraged her to meet baby's needs first. Although you may feel deprived, your wife, in words or actions, that the baby has had enough of her attention and that “now it's my turn” is a guaranteed turn-off.


Help Your Wife Find the Time and Energy

Although you may not be able to counteract the natural postpartum changes in your wife's sexual drive, you can do some- rig about the fatigue that may make her feel simply too ‘to make love. Take an active part in baby-tending and either share the domestic chores or hire help. One of the ,t ways to  re-direct some of your wife's energy toward you to pitch in and help with all those household tasks that in her energy away from your sexual relationship.

Timing is an important consideration in new parents’ remaking. Time your lovemaking to occur when your wife the least tired. By bedtime, most new mothers just want go to sleep. If the baby has been awake and nursing several times during the night, come morning, all mother wants to do is stay asleep. So when do you make love? You'll have to be creative!

For Mothers Only

While it is true that husbands have trouble understanding the sexual changes in their wives after childbirth, it is equally ‘true that wives tend to forget that husbands’ sexual urges do not change after birth. Although your hormones change, your husband's do not. Husbands often complain that sex is no longer spontaneous. It has to be planned and scheduled to fit in with the competing demands of another individual in the family. Mothers, remember that for most men sex equals intercourse. While you may need only to be held and loved, your husband may feel he needs more. To a man holding and touching may be just a step to go through on the way to the real thing, orgasm. Let me share with some ideas for achieving sexual harmony after birth.

Communicate Your Needs and Feelings

‘Talk to your husband about your apparent sexual disinterest. Explain the hormonal changes described earlier in this chapter so that he can understand that you are feeling the way you do because you are designed that way, not because has done anything to turn you off. Be sure he understands how tired you are. Your husband needs to know that it not his fault that sex is not the same after Childbirth as was before.

Tell your husband what you need. He may be feeling that you no longer want him because your baby has taken his place. Let your husband know that you still need him and that you need and want to be held and touched.

Susan, a woman who worked diligently at becoming both a giving mother and a giving wife, related the following story to me. She and her husband were blessed with a baby who woke frequently at night. Dad, who needed his sleep, moved out of the bedroom when baby was about one month old and spent most nights on the living room couch. Recognizing that everyone had nighttime needs, Susan would occasionally tiptoe into the living room and surprise her husband after the baby had fallen into a deep sleep. These midnight surprises did wonders to help dad accept Susan's commitment to nighttime mothering. Susan made up for the lost sleep by napping when the baby slept during the day.

Be Responsive

The number one complaint I receive from frustrated fathers “She doesn't respond to me:’ When asked about this, mothers often reply, “I'm too tired” or “1 need my sleep more than he needs sex” or “My baby needs me so much that want to save up my energy for her:’

Sometimes mothers seem to be physically with their husbands but mentally with their babies, and fathers can sense this detachment. Just as your husband does not expect you to be thinking primarily of him during breastfeeding, neither should you be thinking about your baby during lovemaking.  Mothers often have difficulty releasing themselves from the obligations of one role and giving themselves permission to experience the joys of another role. Release, respond, and enjoy your husband. For mother-baby attachment to work in the way it was designed to work, it must be practiced within the structure of a stable and fulfilled marriage. In the attachment style of parenting the whole family works together— mother-baby, father-baby, and husband-wife. Avoid the “but my baby needs me” syndrome. You should not make an either-or choice among these relationships. You need to work at all of them because they complement each other.

The following story is an example of a problem I see in my office all too frequently. Tom and Mary married in their late twenties and had their baby a few years later. Before becoming a mother, Mary had been very successful in her professional career and she wanted to be equally successful as a mother. She decided to stay home, be a full-time mother, and “do it all right:’ Tom was a bit uncomfortable about handling babies and was more at  home on the fast track of his career. Mary sensed Tom's uneasy feelings about his ability to care for the baby and was afraid to leave him alone with the baby. She didn't even trust him to comfort the baby when he cried. As an added stress they were blessed with a baby who had a high level of needs that required a great deal of attachment parenting. Tom felt more and more left out, and gradually they drifted down separate paths, Mary into her mothering and Tom into his work.

Mary became more attached to her baby, and Tom became more attached to his job and also formed a few outside “attachments” of his own. One day Mary was sitting in my office wondering why her marriage was disintegrating. “But I tried to be such a good mother:’ she said. “My baby needed me. I thought ‘Tom was a big boy and could take care of himself:’

Mothers, watch out for “red flags” in your family. Are there problems in your marriage? Is dad enjoying his work more and his home less? I told Mary  that “what your baby needs most is two parents:’ Tom needed more of her attention and her trust, and the two of them needed to decide together how  they could take care of each other's needs as well as the baby's. With better communication and some give-and- take, they managed to work things out. Both of them matured as parents and as spouses.

Maturing as a Father—Maturing as a Man

What's in it for dads? Nothing matures a man more than fathering a new baby. An important part of becoming a mature person is being able to give part of yourself to someone else. Another part of growing up is learning to delay your own desires in order to answer a need that someone else has.

New fathers go through a kind of second adolescence. Adolescents are naturally impulsive but must learn that it is often wise to delay the gratification of impulses. You may feel that you want to get away alone with your wife and that the baby always wants her when you want her. You realize that you must now share your mate with another person. Handling these feelings can have a maturing effect on a man. Remember that during the first year most of what a baby demands from parents is simply what he or she needs. Resenting your baby for taking your wife away from you or resenting your wife for putting the baby's needs first can stand in the way of becoming a giving father. It can also greatly diminish the joys of being a parent. Fatherhood is one big give-athon. The earlier we learn to give, the greater the joy in becoming a father.

Fathers who have felt that they suffered from an acute lack of sex in the first few months after birth but who have developed the maturity to accept delayed gratification of their needs often find that their overall relationship with their mate improves. Understanding and respecting the natural design in the first few months after birth forces the husband to seek ways of achieving sexual intimacy with his wife outside of intercourse. In ancient times writers about sex described the sexual relationship as “to know” another person. While this can be interpreted specifically to mean sexual intercourse, I believe the phrase “to know” conveys many other levels of meaning as well. It describes the mutual adjustments that a couple make when they become parents. By understanding that a sexual relationship involves more than intercourse the husband truly gets to know his wife. Yes, there is sex after birth! It is a fuller and richer kind of sex that matures a man as a male person a husband, and a father.



This Web page is referenced from another page containing related information about Postpartum Issues

 




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