Caitlin Whyte: Being intimate after having a baby can involve more than just physical healing. Fear of getting pregnant again, less sleep, body changes, low libido and hormones play a role in resuming normal sexual activity. Dr. Tia Welsh will discuss questions related to birth control options, along with questions we might be hesitant to discuss with our doctor. She is the Chair of Obstetrics and Gynecology at Valley Medical Group and Valley Hospital.

Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad, everyday health topics to discuss very real and very specific subjects impacting adults and children. We think you'll enjoy our fresh take. Thanks for listening. I'm Caitlin Whyte. Now doctor, to start us off, what are some of the most common concerns that women and other pregnant people have when it comes to first having sex post-labor?

Tia Welsh, M.D.: I think having sex post-labor for most women is a little daunting. One, are they going to feel okay? Is it going to be painful? You know, are they going to have time, number two, and how is the intimacy going to be after the baby with their significant other.

Caitlin Whyte: Great. So we're going to dive into some of those today. Let's first discuss lubrication and pain. How can we make sex after labor the most pleasurable for those mothers?

Tia Welsh, M.D.: When it comes to lubrication, some woman, especially if breastfeeding, it causes some thinning of the vagina and can cause some dryness during intercourse. And for those reasons, there's lots of lubrications out there, extra lubrications. I tell my patients all the time lubrication can be fun whether it's heated lubrication, scented lubrication, sweet smelling or tasting lubrications, it's all for pleasure. I think some women, when they think about lubrication, they think about menopause and, "That is for older women, that's not from me." Even birth control can affect the thinning of the vagina. So young women also use lubrication, so they shouldn't be hesitant to use it.

Caitlin Whyte: Great. And how about postpartum depression? Does that affect libido and sex and how so?

Tia Welsh, M.D.: Absolutely. The childbirth experiences can be quite overwhelming for any woman and depression is real. If we're sad, if we're down, if we're overwhelmed, libido goes out the door. And sometimes there's nothing that's going to help that, but just playing support, sometimes, you know, therapy is needed and sometimes even medication just to get over that hump. But when women have a feeling that they may be down or they may be going through it, that's the best time to seek help, and just having a support system.

Probably the second thing that I ask when I have patients come through the door after having a child, "Who and where is your support system?" You know, many husbands work away from home. Some people have their parents, their aunts, you know, sisters, cousins. It is traumatic, but it should be a family experience if we can have it and support is definitely needed just to mitigate those circumstances. So there's nothing wrong. It is not uncommon. And the moment that you or a loved one notices that there's a change, that's when, you know, help should be asked for and frequent follow-ups to your doctor.

Caitlin Whyte: On that same note, what if I'm nervous about communicating to my partner? How can I do that best whether I don't have a desire for sex, I'm too tired, I don't feel quite sexy again yet? How can we open those lines of communication?

Tia Welsh, M.D.: One of the best things I would say is include your partner in some of your prenatal visits so that you can have those discussions beforehand so that they anticipate and know how to support you in that and how to respond. Two is be open and honest. I don't have a lack of females that come to the door that say, "I'm too tired. I don't want it. My libido is done. I don't want to be touched." But I think sometimes we focus totally on the mom and we don't focus on the partner in the relationship, the other person, and how they may respond. And I think just being open and honest, even from before the baby's born and during child birth.

If we know that there's a large episiotomy, which means that you actually have a cut at the bottom of the vagina or if it's opened and needs sutures there afterwards, that could have a traumatic effect on a woman and the healing process. So again, at that point in time, it's necessary to have that discussion. She's going to need time to heal. It may be painful afterward. You got to give her time so that those anticipations are already set and met.

Caitlin Whyte: Well, talking about healing time, I mean, are there any differences whether I get cesarean or I have a vaginal birth or any other kind of birth plans that can happen? Is one better for after sex or is there really any difference in what happens after labor?

Tia Welsh, M.D.: I don't think there's any difference. I think the vagina needs healing time, no matter what. There is going to be a period of up to six to seven weeks that a woman may continue to have bleeding. There is up to six to eight weeks where the uterus still has to contract down. If you can imagine how big a baby is when it's born and how big your uterus is, you know, it takes several weeks for the uterus to go back down to the size less than your fist. So when you have that big space in there in the pelvic area, yes, that's going to affect your sexual practices. So whether it's C-section or vaginal, you're still going to need the healing time. And if there is a vagina after a vaginal delivery that is free of any sort of sutures or lacerations, that's good, but you still need the healing time no matter what.

Caitlin Whyte: So we've had our first baby or our third, either way, how soon should I worry about getting pregnant again?

Tia Welsh, M.D.: You can become pregnant very quickly after delivery. And one should not rely on breastfeeding alone. We do know that breastfeeding does delay the return of menses, but that delay is not specific in time or nature for any one person. That delay could be a month. That delay could be 10 months if you're breastfeeding for that long. So the point of the matter is safe sex practices need to happen when sex resumes, because you can become pregnant at any one point in time. So that is a very big discussion that's had again, even before you deliver about how you want to preserve that interpregnancy interval and what the practices are going to look like thereafter and what's done about that, whether it's birth control, whether it's abstinence for some people, yeah, that discussion should occur between partners and their physicians way before you deliver.

Caitlin Whyte: Like we mentioned in the intro, it's about both being emotionally and physically ready. So what about our bodies? Is there any kind of wait time, just based on physical healing alone?

Tia Welsh, M.D.: I think a large part depends, when you resume sex, on the patient themselves for a normal vaginal delivery and even C-section, we like to say six to eight weeks,. However, if there was an extensive, any extensive suturing that occurred in the vagina, it may be a little longer before you resume because the pain may be there and the healing process may still be taking place. After a cesarean section, you know, the skin heals in three days, but the layers, the intricate layers that are sutured together inside the abdomen sometimes take six to eight weeks to heal. So that may cause pain as well. Whenever sex is initiated, it should be at the discretion of the patient and their pain tolerance and their comfort level. If you're comfortable, then I say, do it. If you're not, don't do it. And for some people, that looks different. There are people that have resumed within weeks. There have been people that have resumed in months, and it really depends on what kind of time you have as well when you have a new baby at home with lots of demands.

Caitlin Whyte: Well, doctor, we've covered a lot of great information here today. Is there anything else you want people to know out there when it comes to first having that intimate moment after labor?

Tia Welsh, M.D.: I would say know your body and don't be afraid. And it's like speaking to a woman who's never been touched, the same holds true. You have to know your body and you have to know your limits. If it makes you feel uncomfortable, don't do it. And if you want to do it and you're in the mood, take your time so that you know that you're not at risk for hurting yourself. If you have sutures, I would absolutely recommend waiting until you see a physician and know that you're healed perfectly. You don't want to have disfiguration later on because you have to have, you know, a procedure done again, just to redo what was done the first time. Include the partner in your feelings. It's very difficult to be open and honest, but I feel like there's more intimacy when you are. If you shut your partner out of what you're feeling and what you're going through, it's very difficult to have mutual understanding, so include your partner.

Caitlin Whyte: Well, thank you so much, doctor, for all you do in helping women and families out. And thank you for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic, or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Cailtin Whyte. Stay well.