It’s not rocket science that sleep deprivation and anxiety associated with a young baby, often trumps sex & intimacy after childbirth.

One study found that at 6 months post partum, 46.3% of women reported a lack of interest in having sex. That's almost every second mum!

First time mums report more pain during sex than mum’s who have given birth before.  Research has identified that may be because there are higher rates of perineal trauma & birth complications in first time mums.

It is well documented that first time mums are most likely to have a forceps & vacuum birth, which means that they are more likely to have more perineal trauma.  It is also important to note, mode of birth has not been found to impact on sexual function.  In other words, if you have a straight forward vaginal birth without intervention Vs a forceps or caesarian birth, sexual activity in after birth is likely to be the same.

On a high note, has been found that breastfeeding mums report higher levels of comfort with their sexual function compared to mums who bottle feed their babies.

I honestly, found this to be surprising, because breastfeeding mums have lower oestrogen levels and higher prolactin levels. These hormones cause a decrease in vaginal lubrication and libido. The effect of this is causing vaginal discomfort, tightness and/or tenderness. 

Did you know that due when a breastfeeding mum has an orgasm, breastmilk to be squirted due to the high oxytocin levels involved in milk release (aka ‘letdown’) with breastfeeding?

It appears that further studies are needed to explore why breastfeeding mothers express increased comfort with their sexual satisfaction compared bottle feeding mums.  It is also important to note that some bottle feeding mums exclusively feed their baby breastmilk, whereas others exclusively formula feed, some mums even do a combination of breastfeeding, breastmilk and formula feeding.  So it would be good to see some research that takes these variables into account.  

Regardless, whether you breast or bottle feed, sex & intimacy with your partner is going to be change and will be influenced by many factors such as your:

• Relationship satisfaction
• Emotional health
• Physical comfort
• Medical wellbeing

Sexual relationship and intimacy requires motivated partners, undivided attention to mutual gratification, and freedom from outside interferences.
Having a baby/ies is replete with factors and events that interfere with all or some of these dimensions.

Many studies and policy documents have highlighted that insufficient number of parents' attend prenatal and early parenting education.
Studies have indicated the need for an improvement in parents' preparation for parenthood, the importance of including fathers in antenatal education, and that inadequate preparation remains a concern to both women, their partners as well as health professionals. 

Prenatal Support, education & counselling regarding post partum intimacy and sexuality, needs to be addressed with your close peers and trusted health providers.   This can help couples to engage in best supporting one another and be most likely to have positive attitudes towards parenting.

My take home messages here:

• Be aware that early parenting will impact on your emotional wellbeing, relationship & sexual intimacy
• It is really important to engage in discussing these changes with your close supports including Midwife and Obstetrician
• In being informed about relationship, sex & intimacy changes before baby arrives, you can expect what is normal & what isn’t so that you can address it early on

SOURCES
1. Gutzeit, O., Levy, G., & Lowenstein, L. (2020). Postpartum Female Sexual Function: Risk Factors for Postpartum Sexual Dysfunction. Sexual medicine, 8(1), 8–13. doi.org/10.1016/j.esxm.2019.10.005
2. Mohrbacher, M., Breastfeeding Answers Made Simple,  Hale Publishing, Amarillo, TX, 2010, p. 489.
3. O’Malley, D., Higgins, A., Begley, C. et al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 18, 196 (2018). https://doi.org/10.1186/s12884-018-1838-6

As IBCLC's, we always aim to wave our magic wands.  
Truth be known, I have always believed that I have some link with magic & white witchcraft.  
You see, my ancestors used to support women in childbirth & parenting.
Often with some involvement of magical locally grown herbs mixed into potions for pain relief &. boosting mama's milk supplies & easing baby colic.
I don't really see myself as casting spells, but I do know that I have some tricks in my bag to make positive changes in the families I help care for.
Today, I met with a gorgeous first time mum & her 3 week old babe.  He was born via vacuum birth, fatiguing during breastfeeds & struggling to regain his birthweight. The week prior he had gained 20g in 8 days, when it really should have been a minimum weight gain of 160g in that period of time.
Mum mentioned that latching was really painful at times as well.  Mum was also under the impression that her breastmilk supply was low.
As it turns out, this bubba has some residual muscle tension through his head, neck, jaw, shoulders & lower back.  This was resulting in his clenching his jaw at the breast, rather than opening & closing his jaw to help scoop mama's magic milk.
Such muscle tension is often residual from being compacted in the womb & also from birth.  It usually has no long term harm or impact on the baby's health & wellbeing.
In waving my magic, I was able to locate the cause of the issue & initiate some intra oral massage to help relax the tension in his mouth.  In further guiding relaxation to his whole body tension,  was also able to apply some gentle deep pressure massage to his tiny body whilst mum was breastfeeding.  Please don't expect your IBCLC to be able to do this, as I have had advanced training in order to do this.  It isn't within the repertoire of most IBCLC"s.
For the first time, mum noted that he was actively drinking & not fatiguing.  
He was able to elicit a wide gape & latch deeply & comfortably to her breast.
There was no evidence of mum having a low milk supply, but there was a definite issue with her baby being able to effectively remove her breastmilk whilst breastfeeding.
I am so happy that she came to see me so soon, because this situation could have easily deteriorated to one that would be incredibly stressful for mum to manage.
One of the biggest reasons that I work in a multidisciplinary clinic was evidenced by today.
This gorgeous little boy desperately needed the hands of a suitably qualified Osteopath - so I was able to access someone for some emergency treatment.  Guess what - he latched again & fed even better still, whilst he was having his Osteopathic treatment.
I have to say that this mum & baby's MCHN was totally onto managing this.  She had been checking in on them closely. She had mum pumping & giving this bub extra breastmilk.  This ensured his caloric & nutritional needs were met. It also helps with maintaining mum's lactation for the short term, until he is able to fully breastfeed effectively.
So mum & babe will be seen by their MCHN in 2 days time, I will call them in 2 days time & review them again in my clinic in 2 weeks time.
I anticipate that breastfeeding will already begin to improve markedly as will his weight gain this week.
Fingers crossed, all going well over the next fortnight, I should be able to discharge this mum & baby to be happily & comfortably breastfeeding!  I love such wonderful outcomes....I love it when mum's are so dedicated & proactive in seeking help rather than putting it off until things get far worse!