Resuming sex after six weeks of childbirth and Methods of Contraception

Resuming sex after six weeks of childbirth and methods of contraception

​​Love Life After Giving Birth 

Making sacrifices is part of parenthood. But that does not mean that you have to give up your love life. 

Indeed, trying to meet the new demands of caring for your newborn as well as spending time to become an intimate couple can be difficult. It is important that you focus on your own and your partner’s needs as well. 

Good and strong relationships are based on trust and understanding. Being open and honest with each other is crucial. If you are too caught up with your new duties as a mother and feel the intense pressure, do confide with your partner. If you are worried that sexual intercourse will hurt, talk to your partner about what feels good and what hurts. Keep an open communication and he will definitely understand. 

Resume Your Love Life ​

Most women are able to resume sex after six weeks as it usually takes four to six weeks for your body to recover from delivery. However, there is no fixed time frame when you will actually start feeling the mood again. It varies from one woman to another. If you find that you are not in the mood for sexual intercourse yet, try to explore other ways of intimacy, for example, snuggling, kissing or caressing. 

Tips to Get into the Right Mood 

  • ​​​Take time to do things that make you feel good about your body. It could be a long soak in the tub, getting your hair done or going for a leisure walk outdoors. Feeling relaxed and good about yourself make a huge difference. 
  • Find time to be alone with your partner and enjoy the opportunity. (Getting a trusted friend or family member to baby-sit so that you do not have to spend the entire time worrying can really help things progress!) 
  • If you are nervous about making love, try easing into it slowly. Date each other for romantic outings. Start with just kissing, then gradually progress to touching and so on until you are ready for sex. 

Sex Can Be Good for You 

It is easy for new parents to adopt the attitude that sex is a luxury for those with lots of free time and energy on their hands — like all your childless friends. But the fact is, having sex can be really good for you! 

  • Sex helps to de-stress - Sex is one of the most effective forms of stress relief — plus it is natural. 
  • Sex is a great exercise - Making love three times a week burns around 7,500 calories in a year — that is equivalent to jogging for 75 miles. 
  • Production of natural hormones - Regular lovemaking can increase a woman’s estrogen level, which is important to keep her bones strong and improve the suppleness of her vaginal tissues. 
  • Increased oxygenation - All that heavy breathing increases the amount of oxygen in the cells, helping to keep organs and tissues functioning properly. 
  • Pain relief - Sex reduces arthritic pain, whiplash pain and headaches. What is more, the hormones that are released during sexual arousal and orgasm can actually elevate your pain threshold. 
  • Bonding - Affectionate touching increases your level of oxytocin — also known as the “bonding” hormone. 

10 Tips to Get You Back into Action 

  • ​​Environment - A romantic atmosphere can set the right mood for intimacy. 
  • Relax - Find ways to relax before trying to make love (for example, taking a shower together or exchanging massages). 
  • Lubricate - Lowered hormone levels after pregnancy can make the vagina tissue dry and uncomfortable. To avoid painful intercourse, use lubricating gel until your natural secretions return. 
  • Warm up - Do not rush into sex. The more foreplay you can fit in, the better. 
  • Minimise distractions - Turn off both your cell phones. This is your private time, so enjoy it. 
  • Experiment - Some positions give the woman more control over penetration and put less pressure on an episiotomy site or cesarean scar (eg. side-to-side or woman-on-top positions). 
  • Be realistic - Some women may not experience orgasms at all for several weeks after childbirth or orgasms may be a little delayed in coming. 
  • Communicate - Let your partner know what feels good and what does not. 
  • Make time to make love - While life has become more hectic with a newborn in the house, do not let lovemaking disappear from your lives. Take time to be intimate with your partner. 
  • Do not worry - You may feel like you will never be passionate about sex again. This is not true as it is only a temporary state of mind. ​

Planning for the Next Pregnancy 

While some couples believe in letting nature take its course, others may prefer to plan the timing of their subsequent pregnancies. Whatever your inclination may be, remember that what works for someone else may not necessarily be the best choice for you. Your circumstances are unique and should be taken into consideration. 

Some practical aspects that you should consider carefully before getting pregnant again include your financial status, your emotional and physical wellbeing and your partner’s preference. There is no absolute right or wrong in your decision. There are both pros and cons in spacing your children closer together or further apart.

Having children with ages further apart 

Advantages 

  • By the time your next child is due, the earlier one is old enough to do certain things on his or her own, relieving you of much stress. 
  • You can focus your time on one child before having another. 
  • You can have a recovery time before going through another pregnancy. Your body needs to replenish its store of nutrients (for example, calcium and iron stores). 

Disadvantages 

  • It may be difficult to attend to the different needs of a younger and an older child at the same time. 
  • Your children may not share similar interests because of their age difference and may have difficulty playing together. 
  • The older child may feel that he or she has lost your attention and love to the younger one. 

Having children with ages close together 

Advantages 

  • You can focus on similar needs of your children at the same time. 
  • You spend less number of years in bringing up your children. 
  • Children who are closer in age share similar interests and are often great playmates. 

Disadvantages 

  • You need to put in more energy in providing special care to more than one child during their early and crucial years. 

Contraception: What are Your Options? 

Your fertility can return within weeks after giving birth. Although your body may have barely recovered from childbirth, you may get pregnant when you have sex unless you are fully breastfeeding. 

If you are fully breastfeeding and your menstruation has not resumed, you are protected from pregnancy (1–2% risk failure rate though). This is known as lactational amenorhoea method (LAM). 

It is therefore important that you use contraception​ as soon as you start having sex again if you do not want an unplanned pregnancy.

There are many reliable methods of contraception. Some are suitable for breastfeeding (Table 51.1) while others are not (Table 51.2). 

Some women may not be suitable for certain types of contraception. For example, those with a history of breast cancer should not take the pill, while women with a history of pelvic infection are not suitable for intra-uterine copper device. 

Most methods of contraception are reversible and most women will get pregnant within six months of stopping contraception. 

The irreversible or permanent method like sterilisation or ligation must be considered carefully (Table 51.3). 

We do not recommend any woman under the age of 35 to undergo the permanent methods as they may regret in future and may not be able to bear another child again unless they go for reversal surgery or assisted reproductive techniques (test-tube baby). 

Please discuss with your doctor regarding the contraceptive method that is most suitable for you. 

Table 51.1 Contraception suitable for breastfeeding:

​Methods​Reliability (Success rate)​Contraceptive duration​Reversibility​How to use​
​Levonorgestrel releasing intrauterine system (IUS)​​​Very high (99.8%)​5 years​​Yes​One time insertion six weeks after delivery. Short and light periods.​
​Copper intrauterine device (IUD)​High (99.5%)​3 or 5 years (depends on type)​ ​Yes​One time insertion six weeks after delivery.
​Mini pill​High/Moderate (96–99%)​Daily​​​YesTake daily​
​Male condom
Female diaphragm
​High/Moderate (85–96%)​Per usage​​​Yes​​Must use before penetration. Effectiveness depends on correct technique of usage.
​Hormonal injectable​High/Moderate (98–99%)​​Monthly or 3-monthly injectable​s​Yes​May cause irregular periods​


Table 51.2 Contraception if you are NOT breastfeeding:

​Methods​Reliability (Success rate)​Contraceptive duration​Reversibility​How to use​
​Oral combined pills​High/very high (97–99.8%)​As used​​Yes​Daily oral pills for three weeks and one week of “pill holiday”. (Modern pills do not have the water-retention related weight gain and acne).

​Table 51.3 Irreversible or permanent methods of contraception:

​Methods​Reliability (Success rate)​Contraceptive duration​Reversibility​How to use​
​Female sterilisation (See Figure 51.1)​High (99.5%)​Permanent​No. [If fertility is still desired, the woman has to undergo surgical reversal of the ligation or test-tube baby (in vitro fertilisation)]​Involves permanent blockage of fallopian tubes with clips or cutting segments of tubes under general anaesthesia.
Can be done immediately after delivery via a mini incision (post-partum sterilisation or PPS).
Or at least six weeks after delivery via key-hole surgery (laparoscopy). This method has a lower failure rate than PPS as the tubes are swollen immediately after delivery and the clips have an increased risk of slippage.
​Male sterilisation (vasectomy)​​Most effective (99.95%)​​Permanent​No​​Involves cutting or tying of vas deferens of male partner.​


Frequently Asked Questions

1. What are the contraceptive options for women during the postpartum phase? 

Mothers, who are fully breastfeeding and have no menses yet, are protected from pregnancy in the first six months. This is known as lactational amenorrhoea method (LAM).​

Others use barrier methods like condoms.

The women who are breastfeeding can also decide on hormonal methods like mini pills and injectables. 

Another option is the intra-uterine device, which is inserted into the womb six weeks after delivery. 

Oral contraceptive pills can be used if the woman chooses not to breastfeed. 

​Some couples choose permanent sterilisation such as female fallopian tubal ligation/cutting or male sterilisation/vasectomy (tying of vas deferens). 

2. What is the efficacy and side effect profile of each option? 

Lactational Amenorrhoea Method has a failure rate of 1–2%. There is no side effect as this is a natural ​contraception. 

Hormonal methods are highly effective with a failure rate of less than 1%. The disadvantage of the mini pill is that it has to be taken daily and at around the same time of the day. This requires strong motivation and compliance. 

Injectables are convenient and given every three months. However, it causes irregular menstrual spotting which can be irritating. Some women develop depression and weight gain as well. 

Oral contraceptive pills (OCP) can be used for non-breastfeeding mothers​ and may interfere with breast milk production. It can worsen migraine in some women and rarely causes deep vein thrombosis (blood clots) in the legs. 

Intrauterine device is also effective with failure of less than 1%. However, it may cause pelvic pain and infection in some women and the insertion can result in womb perforation occasionally. 

Condoms are dependent on the correct technique of usage and has failure rate of 4–15%. It disrupts the sexual experience as condoms have to be worn before penetration and removed immediately after ejaculation. However, it is the only protection against sexually transmitted diseases. 

Natural methods like rhythm and withdrawal methods are least effective with failure rates of 30%. There is no side effect though. 

Permanent sterilisation is irreversible. Failure of tubal ligation is 1 in 200 women while failure of vasectomy is 1 in 2000. Besides, tubal ligation carries surgical risks and risk of ectopic pregnancy (outside the womb) if the contraception fails. 

3. Are there any special precautions that women should take into account while choosing a contraceptive method during the postpartum stage? 

When choosing a birth control method, it is always necessary to weigh the advantages and disadvantages. Consideration must be given to the effectiveness and the potential side effects as well as your individual circumstances, health, age and personal/partner’s preferences. 

The method you choose also depends on when you plan for the next baby or if you have completed your family (i.e. may choose permanent methods). Besides, your decision for breastfeeding also affects your contraceptive choice. 

Your doctor is an important partner in helping you choose the suitable form of contraception, but he/she cannot make the decision for you. Discuss with him/her! 

4. Which is the most popular contraceptive method in Singapore? 

In a population survey conducted by the Obstetrical and Gynecological Society of Singapore in 2006, only 47% of women in the reproductive age group used any form of contraception. Of those who used contraception, 47% used condoms and 21% used withdrawal or rhythm method. Only 13% tried the pills or injectables. 12% chose permanent sterilisation while the remaining 7% used intra-uterine contraceptive device (IUCD). 

5. Are there any new contraceptives available, or any new products or devices which will be available in the near future? 

The ideal contraceptive, which is 100% effective with no side effects and suitable for all age groups, has yet to be discovered. The medical profession will continue to work on it! 

6. I had unprotected sex last night and am worried about getting pregnant. What should I do? 

There 2 types of emergency contraception such as “morning-after pill” and use of copper intrauterine contraceptive device (IUCD). 

The morning-after pill consists of two large doses of hormonal pills. The first dose must be taken within 72 hours of unprotected or inadequately protected intercourse, followed by a second dose 12 hours later. It is meant only as a back-up method of birth control to be used on an emergency basis only. 

On the other hand, copper IUCD can also be inserted for suitable patients up to 5 days of unprotected intercourse. 

7. Are there risks if I use emergency contraception on a regular basis? 

The side-effects of high-dose hormonal pills are nausea and vomiting, irregular menses in the next period and breast tenderness. If the morning- after pill fails, there is an increased risk of tubal ectopic pregnancy. Also, the “morning-after pill” has a failure rate of 10–20% and thus will not be advised as a regular contraceptive method.


Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.    ​​