Newsletter for Parents | June 2018
Sex, Body, and Relationship After Baby
Adjusting to the (Other) Big Stuff After the Baby Arrives

This special newsletter addresses the three big facets of your life that change after you bring home a new baby: sex, body, and relationship. These are also the parts of your life that you might not feel comfortable sharing with others or asking others about. And these three issues are frequently intertwined--body image impacts sex, sex impacts your relationship, your relationship impacts how you feel about your body, and so on.

This month, we are proud to feature articles on marriage and relationship struggles after the baby; detailed information about sex during pregnancy and after having a baby; and how sex, body, and relationships can all impact each other. With each article, you'll notice a focus on tips and tricks that might help.

As always, though, if a part of your postpartum life is concerning you, reach out to a professional for help. If you need help tracking down the right person, you can start with Perinatal Support Washington's Warmline at 1-888-404-7763.

We always appreciate getting your feedback about our newsletters.
In This Issue

No One Told Me This Marriage Would Be So Hard

Is There Sex After Baby?

The Chicken and the Egg: Sex, Body, and Relationships

Information and Resources About Relationships, Body Image, and Sex

Upcoming Events
No One Told Me This Marriage Would Be So Hard
“When you have a baby, you set off an explosion in your marriage. And when the dust settles, your marriage is different from what it was.” --Nora Ephron
 
Among the dirty little secrets that surround new parenthood, relationship conflict with a partner or spouse almost always makes the short list, often rising to the very top of the list. It is not possible to imagine, pre-baby, how much your intimate romantic and sexual relationship could alter so drastically just from the arrival of a 5 to 8 pound bundle of “joy." It is equally unfathomable to imagine the amount of work that will be added once baby makes three (or more). Making matters worse, the full story is rarely told, leaving the mother feeling isolated, like she is the only one struggling in her marriage. Meanwhile, the partner is often left feeling rejected by the mother, even resentful and jealous of their own progeny. It’s a recipe on both sides for anger, frustration, even rage.

Many mothers complain about being touched out by the end of the day, feeling like sex has become just another chore on the to-do list. Far and away the biggest complaint, however, is about the partner not doing their share of the household chores. It is also usually the mother who does the mental work of the family: keeping track of the doctor’s appointments, and determining the best baby products and baby practices (Are there enough diapers and baby food in the house and what is the best way to carry the baby or put her down for a nap?). This role often causes tension with the partner. Even when she is not physically exhausted from the endless loads of laundry and feedings, the mother often can’t just relax because even a night out require someone (usually the mother) to find and arrange for a babysitter. Women often lose power in the relationship because they are no longer earning money outside the house (at least temporarily). This wouldn’t necessarily be a problem but for the value that society puts on making money. The partner may come home from work and ask “What did you do all day?” Whether the question is benevolent or not, the mother may believe that keeping a a fussy nap-avoidant baby alive all day has less value than being the family wage earner. Even worse, the partner may become disproportionately powerful, taking control of the family decisions and finances.

The complaint list for the partner often looks very different. They may complain about not having sex, or enough sex. This is often intimately related to emotional closeness. In short, the non-birthing partners miss the sex but they also miss their partners. The number two complaint is being shut out of the mother-baby bond. The partner may desperately want to take care of and bond with the baby, but the mother doesn’t trust her partner and lets them know in no uncertain terms that they are not doing it “right,” discouraging the partner from trying at all.

Here are a few tips and suggestions to get through this challenging time when parents struggle to adjust their relationship as their family grows.

  1. Sit down and divvy up your household chores. Make sure it’s clear who is doing what. Consider a white board or wall calendar where more urgent chores get listed. Check in regularly, perhaps weekly, to discuss what is working and what is not. Make sure that one partner isn’t doing more than their fair share of the load. 
  2. Don’t be a gatekeeper for access to the baby even if you feel that you would provide better care than your partner. Sometimes we have to let our partners struggle or just caretake differently from us.
  3. Find ways to be intimate whether that includes sex or not. Schedule regular dates and times for hanging out with each other with and without clothes on. Don’t expect spontaneity and a burning sexual desire to get you through. Establishing an emotional connection by holding hands or leaning into each other. If need be, schedule sex. You may be pleasantly surprised that it’s not actually such a chore after all. (And don’t be afraid to ask the partner to arrange for the babysitter.)
  4. Ask for what you need before you’re burning with resentment and rage. No one can continually give from an empty well without drying up. Don’t expect people to read your mind. Take time every week to exercise, socialize with adults, or just be alone and do nothing. 
  5. Respect each other’s roles and jobs. You’re probably both working harder than you ever have in your life. Don’t equate bringing home a paycheck (or a larger paycheck) with who gets more power in the relationship. If you believe that your stay-at-home partner isn’t working as hard as you, try caring for the baby alone all day for a week to experience first-hand how challenging it can be.
  6. Communicate, communicate, communicate. Relationships, by definition, include occasional conflicts, and everyone needs to know how to deal with them.* Your partner may not realize you need the bottles cleaned regularly without your specifically asking. You may not realize that your partner's feelings are hurt when you take the baby every time they cry. One way to start a difficult conversation is “The story that I’m telling myself (about this situation) is. . . .” Use “I” statements and be concrete in what changes you need to see. In turn, be a good listener and try to hear the story from your partner’s perspective.

*For an honest, funny, and helpful read on the topic of marital (dis)harmony after children, please check out How Not to Hate Your Husband After Kids by Jancee Dunn.


Terri Buysse is a clinical psychologist with a private psychotherapy practice in Edmonds and Everett, Washington. She specializes in perinatal, parenting, and trauma work. She is one of the facilitators for Little Sprouts, a new mothers' support group in Mountlake Terrace, and is a member of Perinatal Support Washington.
Is There Sex After Baby?
There seems to be no shortage of information available to the newly pregnant couple. Myriad books, blogs, and online articles cover just about everything you may wish to know about pregnancy, birth, and the postpartum period.

However, if you want to know what your sex life might be like after transitioning to parenthood, you may find a bit less information. There are certainly sitcom jokes about the death of one’s sex life and sexless marriages after children, as well as the rise of so-called “mommy porn” a la Fifty Shades of Grey and the like, but not too much in between.

Pregnancy itself, the enormous physical, emotional and hormonal changes that come along with it, and each couple’s unique pathway to get there influence sex during pregnancy and afterward. Dealing with infertility, miscarriage, pregnancy complications, or birth trauma can all provide complicating factors to sexuality after baby. As a sex therapist, I often field questions from clients about sex after baby or help couples and individuals who are experiencing sexual issues during this period of transition. Here are a few concerns that seem to surface.

What about sex during pregnancy?

Many couples express concern about having sex during pregnancy, wondering if it can endanger the growing fetus. These concerns can be exacerbated if there have been previous miscarriages or infertility issues, so I encourage clients to speak with their healthcare providers about their concerns to discuss what is safe to engage in during pregnancy.

Generally, sexual activity is safe for healthy pregnancies and is often pleasurable for couples if they understand the physical changes occurring. Many women experience physical changes such as breast tenderness or sensitivity, nausea, fatigue, and swelling or engorgement of vaginal tissue (due to increase blood flow to the pelvic region). Some women experience increased sexual desire and arousal, particularly during the second trimester, while others are significantly less interested in sex due to the impact of nausea and fatigue, or pregnancy complications.

It is important to maintain good communication between partners during this time, as desire may change (for both partners), and it is helpful to talk frequently about what feels good and what doesn’t. As pregnancy progresses, it may be necessary to change positions and be a bit more creative; breaking out of the “sexual script” that is usually followed can be fun and expand beyond penetrative sex. For example, in late pregnancy, rear entry and side-by-side positioning can be more comfortable for the pregnant partner if penetration is desired. If you are in a lesbian relationship and typically use vibrators or dildos for arousal or penetration, continue to discuss the comfort level of these as pregnancy progresses and physical changes occur.

What changes occur after birth?

During and shortly after childbirth, the woman’s body is flooded with what are known as attachment and security hormones, oxytocin and vasopressin. Oxytocin is also released during sexual arousal and is associated with the beginning of labor. Significant mood changes, crying spells, and feelings of being overwhelmed are normal after birth.

Physical discomfort is also experienced at times due to low estrogen and progesterone levels, so there may be vaginal dryness and thinning of the vaginal tissues, especially for nursing mothers. Healing from episiotomy or cesarean section can take time and cause soreness and difficulty with movement. Sleep deprivation can lead to significant fatigue, for both partners.

During the postpartum period, many women express that their bodies do not feel like their own. There are many physical changes, nursing women may express milk or leak, vaginal secretions and bleeding can continue for a while, and there is breast soreness associated with nursing and milk engorgement. The pelvic floor muscles, vagina, and cervix often feel different and are more relaxed, resulting in women stating things “feel different down there.”

Frequent nursing and holding the baby can result in touch overload. Partners may withdraw from physical touch, and hugs and cuddling may decrease during this period. When coupled with the additional stress and sleep deprivation of the postpartum period, this can lead to increased tension and conflict between partners.

Will I ever want sex again? I’m worried that I feel no desire at all.

When I talk to couples about resuming sex after baby, I talk most about expectations, time, and patience. First, we talk about keeping expectations reasonable. Given what we know about the changes that have occurred for both partners, physically and emotionally, couples can expect to have to communicate more, and both partners should be prepared for things to go differently than in the past. Arousal may take more time, certain positions and activities may be painful at first or less desired than before, and pleasure may be found in unexpected ways.

Couples that have struggled to talk openly about sex in the past may have more difficulty with the postpartum adjustment. Allow time for each partner to adjust to the changes, and try not to make sex a race for the “finish” of orgasm, for either partner, at least at first. This is a time for exploration of each other’s bodies in a new and perhaps more tender way. If one or both partners do not feel emotionally connected because of tension or conflict that is unresolved, it can be helpful to talk about those issues before attempting physical intimacy.

Women often are alarmed that they do not have any sexual desire during the postpartum period, and wonder if it will ever return. It is helpful to chat with your medical provider about when you are ready physically to resume sex, understanding that even when this is the case, you may not be emotionally ready or feel spontaneous desire. Much of this is due to the shift in focus to the role of mother/caregiver, and occurs in lesbian, gay, and heterosexual couples. It often also relates to fatigue and sleep deprivation and the lack of time to devote to being a couple. Continuing to connect physically in intimate but not specifically sexual ways is helpful during this time. Seeking breaks from caregiving is also helpful, if you have a support system that can be called upon to keep the baby for a few hours. Even escaping as a couple to a coffee shop for an hour can be restorative to the sense of self.

Will my body ever feel the same again?

Because of the many changes during pregnancy and childbirth, body image issues are particularly prevalent during the postpartum period, often compounding a decrease in desire for sexual activity. A woman may feel that the birth experience itself, or the way her body looks after birth, makes sexual activity undesirable for the partner as well, especially if she is not feeling particularly close to her partner. What is key here is making sure that partners are spending time together and sharing affirmations with each other, with both partners feeling loved and appreciated. I encourage new mothers to take a look at themselves in the mirror several times a week, and affirm what their body has done, the work of pregnancy, labor and delivery, and now feeding the baby as well (if breastfeeding). It can be helpful for partners to take part in this activity, and to affirm the continued desirability and sexiness of their partners’ body.

As for how these physical changes affect sex, be prepared that things may not feel the same. There are some simple solutions for some of the changes you may experience when you resume sexual activity after birth.

If breastfeeding, the breasts can leak or even squirt fluid if stimulated during sex. Nursing or pumping before sex can help. If you or your partner are uncomfortable with this, you may wish to focus on other parts of the body, which can be a fun exploration of other erotic zones you may not have discovered before. Breasts can be sensitive during this period, which is arousing for some women and a turnoff for others. Some women find wearing a nursing bra or tank top during sex can help with this issue.

The pelvic muscles have done amazing work during delivery, so it is expected that these muscles may feel stretched out or looser than before. With time these muscles will tighten, although some women report that “normal” remains different than before. Occasionally a bit of urine will leak during sexual activity after pregnancy. Kegels can help with both these issues, and are easy to do almost anywhere.

Any helpful specifics for sex after baby?

Once you have the go-ahead from your doctor to resume sexual activity, here are some specifics. Most couples want to feel secure about birth control, so this is an area you want to cover with your doctor during your postnatal checkups. Breastfeeding is not a reliable method of birth control, even if you haven’t resumed your menstrual cycle. Having birth control figured out can help both partners relax back into sexual activity.

Make sure to have plenty of lubricant on hand, even if you have not needed to use any in the past. Look for lubricants with minimal additives and natural ingredients, and try both water-based and silicone, remembering not to use silicone with silicone toys. Use liberally at first, more than you think you need.

Warm up together, maybe a nice bath or massage, and take your time. More foreplay and communication about what feels good is helpful here. Couples may need to experiment with the positions that feel best, often with new mother on top or side by side to put the least pressure on stitches. It helps for new mom to have more control over penetration, whether with penis or dildo. Start with a finger the first time out.

If there is pain, speak up! It is never a good idea to “push through the pain.” Let your partner know it’s happening, shift positions, take a break, add more lubrication. Some pain and irritation are expected, but if pain continues, seek assistance from your doctor; there may be scar tissue or delayed healing that needs to be addressed.

It’s been months, and sex just isn’t working. This is starting to be a real problem between us. What should we do?

Given all of the changes occurring, it is not unusual for couples to need more help with sexuality after having a baby. If you need help, it is best to find a couples counselor who is a trained sex therapist. A sex therapist is a licensed therapist who has had additional training in the areas of sexuality and sexual problems. Look for words such as sex-positive, LGBTQIA affirming, and evidence of additional training in sexuality when you are looking for a therapist. The gold standard for sex therapists is having been certified by AASECT, the American Association of Sexuality Educators, Counselors and Therapists. You can find an AASECT certified professional here.


If you cannot find an AASECT certified therapist in your area, ask questions about the additional training the therapist may have in the area of sexuality and about their approach to therapy to make sure you are both comfortable.

Some couples are concerned about what to expect from a sex therapist; after all, for many couples these are difficult issues to talk about openly. The therapist can help with this, and will likely take a full relationship and sexual history from both partners, as well as help you talk about the problems you have been having that bring you into therapy. The therapist may also suggest exercises for you to try at home, or refer you to other professionals, such as a urologist or pelvic floor specialist, depending on what sorts of issues you are having. Sex therapists do not touch you or expect you to touch each other in session; they are present to help you have conversations you need to have to improve your connection and sex life. Most sex therapists are also trained in couples counseling and can help with relationship issues that are getting in the way of better sex.

Nancy Owen, MA, LMHC, is a licensed mental health counselor with a private practice in Kirkland, Washington. She has over 25 years of experience and specializes in helping individuals and couples navigate conflict and life transitions, with a particular focus in sexual issues. For over ten years she has taught the Gottman course Bringing Baby Home and utilized those principles with couples and individuals navigating the transition to parenthood and the struggles the the postpartum period can bring.
The Chicken and the Egg: Sex, Body, and Relationships
It’s like a never-ending chicken and the egg situation. Which came first? How body image impacts sex impacts relationship satisfaction. Working with new moms and their partners often brings up this cycle. There may be disappointment with body after baby, disappointments with what sex after baby looks like or feels like (or that it is nonexistent), and these may impact the relationship with our partner. Here we are and it sometimes feels like a big ball of yarn that your grandmother let you play with and now you have two ends and a big ol' mess in the middle. Where do we even start?! Sometimes it feels so overwhelming that throwing your hands in the air and forgetting about it feels like the best option. Sometimes getting to the root of the issues can get clients feeling "unstuck," and breaking it into baby steps (no pun intended) can feel like movement, which creates momentum, and movement in a healthy direction feels good.

First of all, remember it is all related to relationship. After having a baby, relationships have to be redefined. It doesn’t matter if it’s the first baby or fourth baby, roles will change or shift, and responsibilities will too. Feeling safe, encouraged, isolated, or rejected all play a role in our relationship with sex, our partner, or our own body. 

Relationship with Our Own Body. Yes, I said with your own body. We forget that we have to have a relationship with our body. How we feel before we have a baby can magnify how we feel after baby. Often times, we have identified ourselves a certain way, and after having a baby, there can be a disconnect with our bodies. It looks different, it feels different, it’s harder now to lose weight. It is ALL DIFFERENT! Sometimes we feel that our body may have betrayed us somehow. Remembering that carrying a baby, growing a baby, and delivering that baby, regardless of how that exactly happened, have a definite impact. Often times with my clients, I work with them on connecting with their bodies, finding ways to thank their bodies, check in with their bodies, allowing their bodies to heal and recover. In the world of social media and expectations, we forget that the body just grew a human being in it! The reality is that we have to develop and create a new relationship with our bodies.

Our Relationship with Sex. Yes, sex. It’s something that clients don’t typically bring up until I do. How sex can change after a baby both physically and emotionally for women continues to be one of the "hot topics" during session. Many times, moms feel "touched out," overly "needed," exhausted, and drained by the end of the day. Along with hormones and sleep deprivation, interest in sex can dwindle. Yes, this can be nature's way of spacing pregnancies, however it can be a confusing time for partners to navigate. Couples that never had an issue in the intimacy department now are faced with this. This is the number one reason that couples come in together to sessions. How we view sex can directly influence our relationship with our partner and is directly influenced by our relationship to our body.

Relationship with Our Partner. How do we continue to connect with our partner when we are just reconnecting with our own body? There seems to be this expectation that along with the baby’s needs, we will meet the needs of our partner and other children, job, house, etc. It is not uncommon to have sessions discussing how to juggle all of the demands, and with partners, being intimate is often a topic of concern. Reconnecting with partners may look different than it did also before baby. Redefining the role as a couple, as a parent, with new financial constraints and time demands all influence what your relationship as a couple will look like.

So now looking at all three of these areas as intertwined, where do we go from here? How do we grow, develop awareness, and embrace our roles as mother and partner and continue to love our bodies? I could go on and on and on about all three of these, but here are a few ideas on unraveling this intertwined ball of yarn we are left holding:

  • Recognize the power of self-talk. Listen to yourself. What are you telling yourself? If you wouldn’t let someone talk to a child that way, you shouldn’t talk to yourself that way. Replace the negative talk with positive. Find a phrase, quote, or scripture that you can place on sticky notes where you can be reminded during the day.
  • Journal to yourself. Write love notes to yourself. Journal about the things you are grateful of, the things you notice are different. The things you would like back. Journaling can sometimes help us to find a place to start, too. Write a letter to your body, both pre-baby and post.
  • Partners are not mind readers. As much as we would like them to "just get it," a lot of the time, we need to ask for help. We need to let people close to us know how we are feeling. Whether it is in relation to sex, intimacy, or needing help, people don’t know unless you let them in.
  • Surround yourself with others who "get it." Breastfeeding? Find a group! Attachment parent? Find a group! Working mom? Find support! Stay at home mom? Find a group! Get plugged in. Surrounding yourself with others who are going through the same thing can help you normalize and ultimately feel less isolated and alone. You aren’t alone; most new parents are dealing with some variant of the above. Even if you aren’t a "group" person, you can still be a part of something: look into groups at the library, church, mall, etc. Sometimes being in the presence of others can increase awareness, too.

Remember, be kind to yourself. If you are feeling like you need extra support, professionals are there. You don’t have to navigate this journey alone.


Teresa M. Eltrich-Auvil MS, LMHC, is a therapist in the Puyallup, Washington, area and has been in private practice at Picket Fence Therapy & Consulting since 2006. Specializing in Perinatal Mental Health, she finds great enjoyment in working with new parents navigating this transition and creating a safe place to gain insights, skills, and support as it pertains to identity, relationships, and empowerment. Teresa also specializes in Postpartum Anxiety & Depression as well as Infertility, Miscarriage, and Loss.  
Information and Resources for Postpartum Relationships, Body Changes, and Sex
Relationships


Fantastic, research-based blog with resources on relationships. Within the blog is a specific column entitled “Bringing Baby Home” that features posts about improving the marital relationship while welcoming a new baby. The Gottman mission is to reach out to families in order to help create and maintain greater love and health in relationships. They are committed to an ongoing program of research that increases the understanding of relationships and adds to the development of interventions that have been carefully evaluated.


A must-read for couples experiencing a postpartum disorder. In this article by licensed clinician Kate Kripke, she highlights five major changes that couples go through when they become parents. She further outlines the most common relationship and marital challenges she sees in her clinical practices working with women struggling with perinatal mood and anxiety disorders.


The follow-up article to How Postpartum Depression Affects Your Marriage or Partnership, written by licensed clinician Kate Kripke. This article lists some of the ways couples can work together to get their relationship back on track during the postpartum period. 


Body Changes


Written by the creator of Postpartum Progress, Katherine Stone. She shares her own struggles with body image and postpartum depression and anxiety. 
 
Timeline of Postpartum Recovery   (The Alpha Parent)

This is a very detailed list of what to expect physically after a baby is born. The list begins at day one post delivery and includes information all the way through the first year.
 

This interview with Sylvia Brown, author of Postpartum Handbook, provides information about what to expect in terms of how pregnancy affects the body physically. 


A blog with beautiful pictures of real moms and babies. The 4th Trimester Bodies Project is a movement dedicated to educating, embracing and empowering humans through photographs and story telling. 


Sex


A video with Penny Simkin & Dr. Amy Gilliland. Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. Dr. Gilliland is an AASECT Certified Sexuality Educator, a psychology instructor at Madison College, and is one of the first DONA International birth doula trainers. Over her twenty-five year career, her work has spanned the perinatal spectrum. Dr. Gilliland has published research on birth doula support for over ten years, but has also published on female sexuality.

The video is a look at how birth can affect sex for couples, and information on resuming sex after childbirth. Amy and Penny discuss the current research on sexuality in the postpartum period.


A flashy title, but the advice is simple and to the point. The article is a short explanation of what can be expected postpartum. 


A helpful, comprehensive read for couples, especially for partners, highlighting the reasons why a woman may not want to have sex immediately following having a baby and ways in which partners can help. 
Mom Myths
  • I should want to have sex with my partner by 6 weeks postpartum.
  • My partner and I need to have sex ASAP in order to maintain our relationship.
  • I should be back to my pre-pregnancy size by now.
  • Breastfeeding protects me from getting pregnant.
  • After giving birth I shouldn't look pregnant anymore.
  • Peeing a little without meaning to is normal.
  • Painful sex is normal, and I should just grin and bear it.
  • Breastfeeding will make all my pregnancy weight dissolve away.
Upcoming Events
Climb Out of the Darkness is Saturday, June 23, 10am-1pm, Maple Leaf Park, Seattle. Join us as we walk the loop around the park's paved trail to celebrate recovery and raise awareness about perinatal mood and anxiety disorders. Click HERE for more info, and click HERE to sign up and sign a waiver (no fundraising necessary!). Family friendly!
Call Our Warm Line for Support!
1-888-404-7763
Perinatal Support Washington has a toll[-free support line for new parents. Leave a message, and a trained volunteer will return your call within 24 hours. The line is staffed by a parent who has experienced a perinatal mood and/or anxiety disorder and has recovered fully, or a licensed therapist with specialized training in perinatal mental health.

We provide warm, understanding, effective, and private support, as well as professional referrals to providers who can help. We also provide details about community support groups and resources and information in the community and online.

FOR DADS- Would it feel more comfortable to talk with a dad who has been through his own perinatal mood or anxiety disorder, or has supported a partner who has? Call our warm line and ask to talk with a dad.
Giving To Perinatal Support Washington
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WARMLINE: 1-888-404-7763 (PPMD)

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(formerly Postpartum Support International of Washington)