Pre/Post-Pregnancy Pelvic Care
Pre and Post Pregnancy Care
Both women and men have concerns about whether it is safe to continue having sex during pregnancy. For many years, it was believed that sex during early pregnancy could cause a miscarriage and that sex during the last couple of months of pregnancy could cause infection or premature labor. There is no medical evidence or proof to support either of these beliefs during a normal, healthy pregnancy. Intercourse can safely continue until approximately the last month before delivery.
There are also couples who will abstain from sex during pregnancy for fear it might harm the baby in some way. Typically, a baby is well cushioned in a sac of amniotic fluid within the uterus and is, therefore, quite unlikely to be hurt by lovemaking.
It is important for pregnant women, and their partners, to discuss their needs, concerns, and desires openly and honestly. For instance, a woman may not feel like having intercourse, or her sexual needs may decline through her pregnancy. Simultaneously, she may find she has an increased need for other kinds of physical intimacy like cuddling, holding, or hugging. A pregnant woman might also experience a heightened sense of her body and become more sexually expressive - it just depends on the woman and that particular pregnancy.
A pregnant woman’s changing body size may make familiar lovemaking positions uncomfortable or even impossible. A couple can look upon this as an opportunity to be creative with sex by trying different positions, mutual hand stimulation or even oral sex (oral sex can be performed with caution: blowing air into the vagina during pregnancy should be avoided as it may lead to complications).
When to Avoid Sex During Pregnancy
Though it is rare, there are some instances when a doctor may advise against a woman having sex during pregnancy, such as when:
- There is a history of premature birth or labor
- Her water has broken
- She is bleeding
- She has placenta previa, a condition in which part of the placenta covers the cervix
- Either partner has a sexually transmitted infection
Sex After Delivery
A woman may be physically able to resume having sex as soon as 6 weeks after delivery, even if she has had a small tear to the perineum (the muscular tissue of the pelvic floor located between the vagina and the anus). Most women will wait at least 4 to 6 weeks, or until they get the OK from their doctor. Of course, this will depend on the type of delivery, how difficult it was, how many stitches were needed, if there were any complications, or if an episiotomy was performed.
An episiotomy is a surgical cut to a woman’s perineum to make the baby’s birth easier and to prevent tears that can be difficult to repair. A woman will experience some pain after delivery if she has a suffered a tear, or if an episiotomy was performed during delivery.To help ease the pain from the stitches, it is advisable to do the following;
- Place a cooled gel pad, or ice pack wrapped in a towel, onto the stitches for no more than 15 minutes every one to two hours. The ice will numb the area and prevent, or reduce, swelling.
- Expose stitches to the air for approximately 10 minutes, once or twice per day.
- Exercise the pelvic floor area by walking as much as possible. Doing Kegel exercises will also stimulate blood circulation to the area and facilitate the healing process.
- Take pain medicine only as prescribed by the doctor.
If the pain worsens, or nothing seems to relieve it, there may be an infection present, and the stitches will need to be checked by a healthcare provider to ensure they are healing properly.
There is a difference between when a woman is physically able to have sex and when she feels emotionally ready to have sex. During the postpartum period, a woman’s body, hormones, lifestyle, sense of self and relationships are in a state of change and flux. Lack of sleep, the constant demands of a newborn, her changing body image, and any anxieties about motherhood can have a negative impact on her sexual desire. Her partner may also be experiencing many of the same feelings.
The decision to resume physical intimacy is a very personal one. Some couples get back to their previous level of sexual activity with few problems, but for many couples, this requires some time, adjustment and communication. Even if sex is the last thing on a couple’s minds, it is important for the partners to find non-sexual ways to nurture and strengthen their bond. This will go a long way in reinforcing their relationship as a couple and not just as parents.
A couple should take some time each day to reconnect by talking, cuddling or sharing an activity they both enjoy. Accepting offers from trusted friends and family to baby-sit provides an opportunity for the couple to go out on a few, much-needed “dates.”
In addition to the new joys and responsibilities of parenthood, resuming intimacy is an important part of a relationship. Women, and their partners, often have questions about resuming sexual activity after having a baby as well as how to prevent another pregnancy.
When a couple decides to become sexual once again, it is important for them to communicate their feelings and expectations. The first time may be a little uncomfortable for a woman. Her vagina has recently been through some stretching and trauma, so it is important to take it slowly.
Setting the mood with candles and music, taking a relaxing bath, or giving each other massages can be effective ways to reduce anxiety and build desire. Remember, lovemaking does not have to start off with vaginal intercourse. A couple can gradually work up to that with plenty of foreplay that will ensure arousal. Even if lubrication was never a problem before, a couple may want to have some extra lubricant on hand. This is especially true if the woman is breastfeeding, since that can make the vaginal skin thinner and drier due to decreased estrogen levels.
Most importantly, a couple needs to be patient. At first, sex may not feel the same since the woman’s body is still adapting to the physical changes that have taken place. With time and practice, a couple can regain their sexual chemistry.
A woman’s breasts are designed for pleasure as well as nourishing an infant. A woman, and/or her partner, may have mixed feelings about whether her breasts should belong exclusively to the baby while she is still breastfeeding. While there is no right or wrong answer, if a woman’s nipples are cracked and sore, it is best to leave them alone.
It is important to note that lactating women can leak milk from their breasts due to direct nipple stimulation, or from orgasm even if the breasts are not touched. The amount varies from woman to woman from a few drops to a “squirt.” If this bothers either partner, breast stimulation should be avoided, and a bra, with an absorbent pad inside, should be worn. Nursing the baby prior to intercourse can help empty the breasts and make the woman more comfortable. In any case, a couple might want to keep a cloth, and a sense of humor, nearby.
If a woman is not going to be breastfeeding, it is important that nipple stimulation be avoided. That is because, after pregnancy, any nipple stimulation can initially cause hormonal changes that will continue milk production. During this time, the breasts may become sore and engorged. It is helpful for a woman to wear a well-fitting, supportive bra at all times until lactation stops. If the discomfort seems intolerable, taking Ibuprofen or Tylenol®, and applying cool compresses, can be helpful.
Although reduced sexual desire is very common after pregnancy and delivery, it can also be a sign of postpartum depression. Many women experience some moodiness, sadness or anxiety in the days following delivery (the so-called “baby blues”), but this normally improves within a couple of weeks.
If a woman is experiencing prolonged or very intense sadness, or if she has any thoughts of harming herself or the baby, she needs to get immediate help from her healthcare provider, a counselor, or a crisis center.
Returning to a Non-Pregnant State
After delivery, a woman’s body will gradually, over time, revert back to its non-pregnant state as follows:
- During the first six weeks post partum, the uterus will gradually decrease in size.
- The loose skin and muscles of the abdomen will gradually tighten to some degree.
- There will be a small amount of bloody vaginal discharge, called lochia, for 4 to 6 weeks.
- A vaginal tear or episiotomy will usually be healed within four to six weeks, but the tissue continues to change and remodel for up to a year.
- A cesarean (“C-section”) scar will take about six weeks to heal completely. Until then, heavy lifting must be avoided.
- How quickly the menstrual cycle resumes depends on if a woman is nursing or not. If she is breastfeeding exclusively day and night, it can take a year or longer before it returns. If a woman starts supplementing with formula, or the baby begins to sleep through the night, a woman’s menstrual cycle will tend to return sooner, typically within three to eight months. Non-nursing women tend to start menstruating as early as one month post partum.
- A woman’s body will release its first postpartum egg before she begins menstruating again. If she doesn’t start using birth control as soon as she begins having sex again, she could get pregnant. Also, it is a myth that women who are breastfeeding are not fertile.There are many nursing mothers who have been surprised by an unplanned pregnancy.
Related Women's Health and Wellness Resources:
- Kegel Products: Which One is Right for You?
- Had a baby? Having a baby? Time for pelvic floor exercises!
- How to Do Kegel Exercises Properly