Sex and contraception after childbirth Supporting women’s choices in the postnatal period Sex and pregnancy they feel they cannot carry to term. We regularly see contraception women experiencing an unplanned pregnancy in the year after childbirth after giving birth. Our experience is mirrored elsewhere: recent Introduction research presented at the European Society of Contraception The World Health Organisation and Reproductive Health found recognises the importance of that around 10% of women pleasurable and safe sexual presenting with unplanned experiences, and the ability to pregnancy at one NHS clinic had control the number, timing and given birth in the last 12 months. spacing of one’s children.1 In the In this study, unplanned UK, there has been much focus on pregnancy within a year of birth developing sexual health policies was significantly more prevalent and services for younger age than after abortion within the groups which has led to a same space of time.2 welcome fall in rates of After an initial shock, for many unintended pregnancy. However women the news that they are the needs of other groups at other expecting again can be a source of life stages have sometimes not real joy, but for others the received the attention they should, discovery can cause considerable including women in the postnatal distress. Experiencing an period. In 2012, the last year for unplanned pregnancy can be which figures are available, emotionally and physically around 800,000 women in the UK challenging at any stage of a gave birth. There has been woman’s life, but it may be relatively little research on the particularly difficult while coping sexual health needs of this group with a baby and the upheavals of women. that in itself brings. While the The British Pregnancy Advisory risks of having 2 children close Service is a charity which counsels together should never be over- more than 60,000 women a year stated, shorter inter-pregnancy with unplanned pregnancy or a intervals are associated with an bpas |Sex and contraception after childbirth 2 increased risk of adverse again with their partner within a outcomes for both mother and short period. baby.3 However it should be With the welcome support of acknowledged that some women, Bounty, we are now able to ensure particularly as more couples delay most new mothers in the country childbearing into their late 30s, receive our guide to contraception may seek to become pregnant after a baby, which provides again relatively quickly before information on the return of fertility further declines, while fertility, when breastfeeding others may feel there are protects against pregnancy, and economic advantages associated which methods can safely be used with closer birth spacing. Their whether a mum is breastfeeding choices should absolutely be or not. We have also undertaken respected. research with Bounty’s Word of The reasons for unplanned Mum panel, surveying 1,323 pregnancy within a year of women who had given birth at maternity may be diverse. More least once within the last 4 years, women are initiating to better understand women’s breastfeeding than previously, and choices about resuming sex after may believe that breastfeeding childbirth, providing the first either provides full contraceptive modern UK data in this area. The cover or do not know what research also looked at their effective contraception can safely knowledge of contraception and be used while breastfeeding. Live ease of obtaining what they births increased by 22% between needed, when they needed it. This 2002 and 20124, and midwives builds on research undertaken in say they do not always have the conjunction with the parenting time and resources to provide the site Mumsnet in late 2012 and our information and support about guide has been produced in direct contraception they believe women response to their calls for better need.5 Women may not always written information on know how rapidly fertility can contraception choices after having return, but particularly if they a baby. Unless otherwise stated, have had a straightforward birth, all survey results in this report are may feel ready to start having sex from the Bounty panel and bpas |Sex and contraception after childbirth 3 exclude those who answered “prefer not to say” (the base is Those who are least likely to have stated in each graph). Quotations, started having sex again before 6 unless otherwise stated, are from weeks are those who underwent users of Mumsnet who had given an emergency caesarean (13% birth in the last 3 years. resumed before 6 weeks) followed Resuming sex by those who experienced tearing or an episiotomy, with little By 4 weeks postpartum, one in 5 difference in whether the birth women (20%) who have had a was assisted (forceps or ventouse) vaginal delivery without tearing or or non-assisted. (20% and 21% an episiotomy have started having respectively). Contrary to sex again. By 6 weeks, a third of previous studies, our survey women (35%) who had deliveries suggests it is perineal trauma without perineal trauma have rather than whether the birth is resumed sex, and a quarter of assisted or not which leads to a women who have undergone differences in the timing of the planned caesarean sections resumption of sex.6 In our survey (25%). around 85% of first time mothers delivering vaginally experienced Resumed sex before 6 weeks Base: 1,169 tearing or an episiotomy, 45% compared to 58% of women with 40% subsequent vaginal deliveries. 35% 30% Overall around a quarter of 25% women (23%) will have started 20% having sex again before 6 weeks, 15% which is before a postnatal check 10% 5% is scheduled where contraception 0% is generally discussed. There is absolutely no reason why women who wish to start having sex again should delay until this appointment, but they should be informed that in non- bpas |Sex and contraception after childbirth 4 breastfeeding women When did you resume sex contraception is needed from 3 after childbirth? weeks after the birth and offered Base: 1,169 their choice of contraception if 87% they want to avoid pregnancy. “I think being advised of how 60% quickly you can fall pregnant again after the birth of a baby (I fell pregnant again when my 10% 3% eldest was 2 months old).7 By 3 By 6 Between 6 Longer By 3 months, around 60% of months months months than a year women have resumed sex, but this and a year ranges from 50% of women who underwent an emergency Our survey shows little difference caesarean section to 73% of in resumption of sex between first women with a vaginal delivery time and second time mothers, with no tearing or episiotomy. By however it does show some 6 months 87% of women had difference by age. resumed sex, with very little variation by mode of delivery. Resumed sex by 3 months 10% waited between 6 months Base: 1,169 and a year, and a further 3% 70% longer than a year. 60% 50% 61% 40% 57% 30% 20% 10% 0% First time Subsequent mum mum Nearly 3/4 of mothers (73%) under 25 have resumed sex by 3 months, compared to just over half of women aged 35-44. bpas |Sex and contraception after childbirth 5 “pressured by my partner into it” Resumed sex by 3 months (8%) or that they had felt they Base: 1,169 should do it because “other couples were probably doing it”. 80% 70% How did you feel about resuming 73% sex again? 60% 60% Base: 1,164 50% 60% 52% 40% 50% 30% 40% 20% 30% 10% 20% 0% 16-24 25-34 35-44 10% 0% The survey shows therefore a wide timetable for resumption of sex, which means that sexual and reproductive health services need to be flexible to the individual needs of women in the postnatal period – needs which may well in the initial months at least be Pain and exhaustion were the influenced by their mode of principle barriers to women delivery. resuming sex, and worryingly nearly half of women (45%) When asked to describe how they women said feeling uncomfortable felt about resuming sex, women about their own body was a were more likely to respond that it barrier. Research has shown that was “important for me and my body image – and weight loss – are partner” (50%) than “I felt like some of the most prevalent it/it felt right” (48%). concerns for women in the Reassuringly relatively few postnatal period.8 A survey women replied that they felt conducted by the Royal College of bpas |Sex and contraception after childbirth 6 Midwives (RCM) and the While guidance from the Faculty parenting site Netmums in 2010 of Sexual and Reproductive found 6 in 10 new mothers felt Healthcare (FSRH) says health “celebrity culture” put more professionals should create pressure on them to lose their opportunities for women to raise pregnancy weight quickly. 9 issues relating to postnatal sexual health and body image,10nearly What put you off having sex after half of women (47%) in our childbirth? survey did not feel they could Base: 1,244 speak to a health professional 60% about any concerns they had with 50% regards to resuming sex, if they needed to, compared to 37% who 40% said they could, with the 30% remainder unsure. A study 20% published in 2000, found around 80% of women reported a 10% postnatal sexual problem (eg pain, 0% vaginal tightness, difficulty reaching orgasm), but only 15% of those said they discussed it with a healthcare professional.11 “What I would have liked was further discussion about sexual health in general, after I had a second degree tear – no-one asked about it save when I was getting my stitches checked, and it took such a long time to re- establish a sex life with my More than one in five also worried partner.