The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
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.
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.
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.
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:
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!
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.
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.
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.
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