1. Keep lines of communication open between partners. As pregnancy progresses, the experience of intercourse changes for both people. Each partner may experience mixed feelings about the new shape mom’s body is adopting during the course of pregnancy, or the possibility of hurting mom or baby during intercourse (both are unlikely). Additionally, as the woman’s belly grows, sexual intimacy can become awkward—requiring patience, creativity and acceptance. Talking through these feelings and challenges can help both partners feel less frustrated and more on the same page with each other.
2. Assume sex is safe during pregnancy unless your provider specifically tells you otherwise: A small number of medical conditions associated with a woman’s pregnancy can place her and her baby at increased risk and require “pelvic rest” for the duration of the pregnancy, following the diagnosis of the problem. Examples of these conditions include, placenta previa, cervical incompetence (premature shortening of the cervix), previous pre-term birth (questionable) and leaking amniotic fluid.
3. Avoid intercourse if known bladder infection or vaginal infection (such as bacterial vaginosis or an STD) is present, and until treated. Existent infection in the genitourinary tract can move upward into or beyond the uterus or urinary tract during intercourse. Once thought to be protective against sexually transmitted disease spread, pregnancy does not prevent transfer of an STD between partners. A pregnant woman who has any concern over the potential of her partner being colonized with an STD should request the use of a condom. Better yet, she should consider making sure both partners are infection-free (following appropriate treatment and post-treatment testing from a qualified healthcare provider) prior to resuming sexual intimacy.
4. Avoid orovaginal sexual contact and rear-entry intercourse during pregnancy: Orovaginal intercourse is sometimes accompanied by blowing air into the vagina (a.k.a., vaginal insufflation). This, along with rear-entry vaginal intercourse when the woman’s uterus and pelvis are above the level of her heart, can place her at risk for venous air embolism. An air embolism can be fatal to the woman if not recognized and treated immediately.
5. Sex is NOT miserable for all pregnant women: In fact, many women find sex to be better experientially when they are pregnant. Particularly in the second trimester, when fatigue, nausea and vomiting are most likely to be at bay, some women find a renewed interest in sex. With increased blood flow to the vaginal vault and a different hormonal cocktail than normal surging through her system, some women even experience orgasm for the first time during pregnancy.
6. Be creative with positioning: As noted above, a pregnant woman’s growing belly can become an awkward obstacle to love making, late in pregnancy. Several sexual positions can improve her—and his—comfort during intercourse, such as woman-on-top, or side-lying rear-entry vaginal intercourse. For more information on sex during pregnancy, go here.
7. Consider alternate methods of intimacy: Whether placed on strict pelvic rest by your healthcare provider or due to extreme fatigue associated with pregnancy, many couples find themselves seeking other forms of intimacy during a pregnancy. Other forms of intimacy to consider during pregnancy include:
8. Sex as a natural method of labor induction: When a woman is nearing (or past) her due date, the big question looms: when is this baby ever going to be born? Before signing up for a medical labor induction, some women will opt for natural induction methods first. Nipple stimulation is known to increase oxytocin level production in the brain—resulting in uterine contractions that can sometimes create a cascade of other hormonal changes—and successfully induce labor. Sexual intercourse has also been known to bring on labor. Whether it is from the oxytocin release that naturally occurs during intercourse, the prostaglandins present in sperm (creating softening and other changes of the cervix and uterus) or due to the contractions brought about by female orgasm, sex can be a great way to get labor started! These methods of natural labor induction are, of course, more likely to be successful if the woman’s body is already close to going into labor.
*It should be noted that intercourse is not recommended if the woman’s water has already broken.
9. When to resume sex after birth. Many maternity care providers stick with a strict six week waiting period when it comes to advising couples about post-birth intercourse. Others invite a woman to resume having sex whenever she feels up to it. There is likely no perfect answer here, and the move to re-engage in sexual activity depends on several factors. If the woman suffered a perineal tear or an episiotomy during birth, she will likely need 6-8 weeks of pelvic rest before the injury site has healed enough to avoid pain during intercourse. The same goes for the unlikely event of a vaginal wall tear during birth (although vaginal mucosa, being extremely vascular, would likely heal quicker than 6 weeks). Other women, consumed by the new role of motherhood and exhausted by sleep-deprived nights, may simply feel disinterested in sex for weeks to months after a baby’s birth. In any case, taking it slowly, maintaining a great deal of patience, and easing into sexual intimacy after a baby’s birth are all important things to remember. Lubricant can be a helpful accoutrement—especially for the breastfeeding mom who will likely experience some vaginal dryness due to the unique hormonal balance maintained during lactation.
10. Trust that sexual intimacy will return. Seek help, if needed: Sex is an important part of a committed relationship. The sexual desire that existed between a couple prior to pregnancy and birth should reestablish itself within several months following a baby’s birth. Sometimes this takes longer than just a few months, and exploring other means of intimacy in the meantime can help maintain some of that emotional connection. However, if the lack of libido becomes concerning to a woman/couple, seeking assessment and treatment from a qualified care provider may be warranted. A doctor or midwife can run a panel of tests to analyze the woman’s hormonal balance as well as screen her for a postpartum mood disorder that might be affecting her general feelings toward intimacy. Additionally, a trained counselor can help couples trouble shoot this reintegration of their sex life as they learn how to balance parenthood with their needs as a couple.
Kimmelin Hull, PA, LCCE, has been a Lamaze Certified Childbirth Educator since 2005 and is the Community Manger for Lamaze International’s Science & Sensibility research blog site. She is a physician assistant and is the author of A Dozen Invisible Pieces and Other Confessions of Motherhood. Kimmelin has also written freelance articles for regional and international parenting magazines, and maintained her own blog site, Writing My Way Through Motherhood and Beyond since 2008. A member of Montana Childbirth Collective, Kimmelin has participated in numerous community education, normal birth and gentle parenting advocacy events. A mother of three, Kimmelin and her husband raise their family in the beautiful Rocky Mountain town of Bozeman, Montana.