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Intimacy: You, me & us

Intimacy is not something parents usually visit the paediatrician about. Having said this, we deal with the “product” of intimacy and have a very keen interest in ensuring that the family unit stays strong if we are to have happy, well-adjusted children under our care.

My first encounter with a couple following discharge from the maternity ward is usually at the six-week check-up. My focus is on the baby’s feeding, sleep and milestones. I also enquire about the mother’s physical recovery following the birth and her adjustment to motherhood, breastfeeding struggles, lack of sleep, routine and returning to work.

Many partners attend the six-week check-up but this tails off with subsequent check-ups. So, what of the partner and all that changes for them once baby arrives? This is certainly an area which needs attention. I have had many tearful mothers sit across from me claiming that their partner’s lives haven’t changed at all, that they personally carry the full responsibility of caregiving and that they feel expended in every way. These statements do little to conjure up an image of a sweet, happy family unit. Unfortunately, it is often a true reflection of what is going on at home.

“Intimacy can take on many forms. It all begins with managing expectations, communicating needs and being open an honest with one another.”

Our role as healthcare professionals may be to explore why the image doesn’t match the expectation. Speaking as a doctor, husband and father it may be worth unpacking the factors I believe influence the “happy family unit”. Reality kicks in when we acknowledge that most separations or divorces happen within the first 18 months after the birth of the first child. Looking at the statistics, the most common cause for the breakdown of marriages is the lack of intimacy.

From my perspective, we need to consider this love triangle and some of the complexities. I believe being open and acknowledging some of the human factors as well as the medical facts may be helpful.

1. From the baby’s perspective:

  • I need to be fed. If my main source of nutrition is from breast milk then I need my mother. I need her every two to three hours for approximately 20 minutes or more. I need feeding 24 hours a day, no exceptions. Once I reach six months of age, I may not require a night feed, but until then I rely solely on her.
  • I need to be cuddled and nurtured. I spent nine months inside the womb where her heartbeat was my company. I was warm and snug. The outside world is bright and cold. The only way I feel secure is if my needs are being met and I am warm and protected.
  • My sleep rhythm is different from yours. Babies sleep cycles last for between 30 to 50 minutes, while adults usually have sleep cycles of around 90 minutes. This means that a baby will often wake when the adult is in the deepest sleep and in the middle of a sleep cycle. This plays havoc with hormones and recovery for parents.


2. From the mother’s perspective:

  • I am utterly exhausted. The final trimester of pregnancy is often marred by sleep difficulties. The birth was difficult and the lack of sleep with a newborn is far worse than any literature could have prepared me for. I want to sleep if I get any opportunity. Sex would rob me of precious minutes. Please understand!
  • A study published in the Journal of Sexual Medicine in 2015 showed that for every hour a woman sleeps her likelihood of having sex is increased by 14%.
  • I am breastfeeding. The hormone responsible for the production of milk is known as prolactin. It is vital for successful breastfeeding and also acts as a natural contraception. This hormone lowers the libido and may result in vaginal dryness. None of these factors are sexually enticing.
  • I am suffering from dyspareunia (painful intercourse). Doctors generally recommend that a couple avoid sex for six weeks after the baby is born. This is a guideline since it is generally accepted that after six weeks, the Caesar scar or episiotomy is healing well and that post-delivery bleeding has stopped, but for some women this may not be the case. Painful intercourse can continue for between six months and a year. The pain may be related to tiny tears following the delivery, hormonal dryness and stretched muscles. Interestingly, it has been found that woman who had had Caesars may experience the same if not more pain during intercourse than those who had vaginal deliveries.
  • My body looks and feels different and that makes me feel unattractive. It takes quite some time before a woman’s uterus returns to its normal size. This means that she may look pregnant for some time after giving birth. If she is breastfeeding, the possibility of leaking is high and many women are uncomfortable about this. Since the pelvic floor has been stretched by the baby’s head, a woman may pass urine during sex. It can be a very awkward experience if not handled correctly.
  • I find it very difficult to orgasm and sex is just not satisfying like it used to be. Hormones plummet after the delivery of a baby and this greatly affects a woman’s ability to have an orgasm. Added to this is the fact that the pelvic floor muscles stretch during pregnancy and delivery, making strong contraction difficult. This too inhibits a woman’s ability to have an orgasm. None of these factors are permanent and a woman’s body will correct itself given the correct time and exercise.
  • I am suffering from depression. Postpartum depression is estimated to affect 20% of woman and plays a huge role in the loss of libido, especially if a woman requires treatment with an anti-depressive.


3. From the partner’s perspective:

  • My sex drive has dipped. Many studies show that fathers may also experience a dip in their desire for sex. The reasons include being traumatised by watching the birth, being afraid to hurt his wife and depression. Men may also suffer postpartum depression as well. In fact, it is estimated that postpartum depression affects between 1.2% and 25% of men. Factors such as testosterone levels, an overwhelming sense of responsibility, increased stress around providing and exhaustion play a significant role in the first six months following the birth of a baby. As with mothers, depression negatively affects the libido.
  • This wasn’t what I expected. Couples often experience extreme closeness leading up to the birth of a baby. There is much anticipation about the baby’s gender, possible names and creating the perfect baby space. Once baby arrives, the mother takes on her role as primary caregiver while the partner is expected to provide financial and emotional support. For a time, both individuals are lost in separate worlds with stresses of their own and little time for the closeness they hoped would continue. Carving out “me-time” and time as a couple will help to bring the worlds together again.
  • I don’t think she is attracted to me anymore. Partners often feel that a mother is getting all that she needs from her baby and she just isn’t attracted to them anymore. From the points above relating to mothers, one can see that this just isn’t the case. She is struggling with issues that have nothing to do with you and everything to do with her body. More than 90% of couples experience a change in their sex lives following the birth of a baby. It is vital that women communicate with their partners, as a lack of interest in sex may be seen as rejection and taken personally.
  • I feel displaced from the centre of your life. Many partners express feelings of being on the periphery of the family when a mother is preoccupied with caring for a newborn. This exacerbates feelings of being expendable and the drop in sexual encounters then takes on more significance than it would have under other circumstances.


So, what now?

It goes without saying that we all want our children to grow up in happy families. It would be naïve to think that the lack of sex following the birth of a baby is the only reason for the breakdown of families, but it certainly plays a part. Intimacy can take on many forms. It all begins with managing expectations, communicating needs and being open an honest with one another. Beyond this, there may be a need for medical intervention if the cause is ongoing physical problems or depression.

Literature supports the notion that the first year of a baby’s life is difficult for the parents on many levels. What is important to me as a paediatrician is that the family is whole when that precious bundle begins to take its first steps. That day does come and is soon followed by running and then school and so on. Knowing that your relationship will also flow through different phases is vital if the partnership is to flourish. Believe me, it will never be the same as before children, but it has the potential to be so much more.

This article was Published on BabyYumYum by Paediatrician, Dr Maraschin.

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