What Midwives Know About Sex: Pregnancy, Birth and the First Year
Sam Geuens, Ana Polona Mivšek, Wout Gianotten (eds.), 2023
Why does closeness change for almost every couple after a child is born, and why does nobody ask about it? Some 35 specialists from 14 countries wrote a textbook for midwives about sex in the most vulnerable period of a couple's life. Here their knowledge is translated into the language of your life: what is normal in each trimester and after birth, why feeding affects desire and how to talk about it without hurting each other.
Who it is for
For couples who are expecting a child, have just become parents or are about to, and for anyone who wants to understand what happens to desire, the body and closeness from pregnancy to the baby's first birthday.
Try, as far as possible, to be future parents and lovers at the same time.
The question no one asks new parents
You are holding your first child, and everyone around you asks about sleep, feeding and weight. Nobody asks about what has happened to intimacy in your couple: not doctors, not friends, not the partners themselves. And it changes a lot. According to the data the book's editors cite, most couples see the quality of their relationship drop after the first child, and satisfaction with sex falls for the next four years. For some couples it does not return to its old level even after eight years.
Why is it kept quiet? The book answers honestly. Couples hope that a specialist will start the conversation, and specialists wait for the couple to ask. Midwives are hardly ever taught to talk about sex, and in their textbooks the subject is mentioned in passing or not at all. So Sam Geuens, Ana Polona Mivšek and Wout Gianotten gathered some 35 authors from 14 countries and made a textbook for midwives in which sex and intimacy stand at the centre.
The book is written for professionals, but almost all of it concerns the couple itself: how desire changes in each trimester, what happens to the body after birth, why breastfeeding affects arousal, and how to talk about it without hurting each other. Here that knowledge is gathered for you. You will learn what counts as sex when your usual way is temporarily not an option, why a healthy pregnancy is no reason to give up closeness, and what to do in the first months, when it hurts, when it is dry, and when all you want is sleep.
The main idea of the authors is simple: parents who stay lovers find the first years with a child easier to get through. Let's start with advice almost every couple hears on discharge from the maternity ward.
Six weeks that the couple understood too literally
The couple is discharged from the maternity ward, and at parting they are given a caring piece of advice: it is best to abstain from sex for six weeks. The advice is medical and sensible. The vagina and vulva need time to heal, and doctors fear infection. But the authors of the book note that couples often take away something quite different from this phrase. They stop touching each other at all, although only one thing was meant: no penetration into the vagina.
To put it precisely, the picture changes. Everything else is safe in these weeks: kissing, hugging, caresses of the breasts and the clitoris. And this is no small thing. Research the book cites shows that exactly such intimate moments help a couple stay together at the start of parenthood, when for many it is a very tense time.
The trouble is that everyone understands the word “sex” in their own way, and people have no single definition. A couple for whom closeness has always meant intercourse is left with nothing after such advice. The authors suggest that such couples widen their usual idea. For example, one or both partners caress themselves, but not apart: they do it in each other's arms. The book calls this linked masturbation. For many it is an unexpected but workable way out.
There is also a trap here, which Wout Gianotten considers one of the two main topics for future parents. Many couples get used to every closeness ending with penetration and the man's orgasm inside. There is nothing wrong with that as long as the body allows it. But in the last months of pregnancy and after birth a woman is often not ready for penetration. If “real sex” means only that, the meeting inevitably ends in pain for her, and then in disappointment for both.
The way out that many couples have found sounds simple. They hold each other while the woman still has enough tenderness, and then the partner brings themselves to orgasm alone, lying in her arms. Couples who agreed on such a change reported less tension, less pain, less guilt and more closeness. That is why the authors advise learning pleasure without penetration from the very beginning of pregnancy: by its end this reserve will be very useful.
About the author
Editors of the book: Belgian clinical sexologist Sam Geuens, Slovenian midwife and lecturer Ana Polona Mivšek, and Dutch doctor and psychotherapist Wout Gianotten. The original was published by Springer in 2023 as open access under the CC BY 4.0 licence.
All books by this author: Sam Geuens, Ana Polona Mivšek, Wout Gianotten (eds.)
Terms from the book
- Testosterone
- Oxytocin
- Rubin
- Meta-analysis
- Linked masturbation: A term from the book: one or both partners caress themselves to orgasm while staying in each other's arms and in close physical contact.
- Conception inefficiency: A concept of Wout Gianotten, not a diagnosis: in a healthy couple conception drags on because sex by schedule and stress rob intimacy of arousal.
- Outercourse: From the English outercourse: any long sexual caresses without penetration.
- Perineum: The area of the body between the entrance to the vagina and the anus. It stretches a lot in birth and can tear.
- Leila: The heroine of a case study in the book: a woman giving birth for the first time, for whom sex after birth is painful.
- Vacuum extractor: A medical device with a suction cup that helps a doctor deliver the baby.
- Raul: Leila's partner in the case study in the book, the father of their child.
- Dyspareunia: The medical name for pain during sex, especially with penetration.
- Estrogen: The female sex hormone. It keeps the lining of the vagina thick and moist.
- Prolactin: The hormone that starts milk production. A high level of prolactin lowers sexual desire.
- Pelvic floor: The layer of muscles and connective tissue at the bottom of the pelvis. It supports the bladder, the uterus and the bowel, and takes part in sexual sensation.
- Lubricant: An artificial lubricant for sex. The authors advise simple water-based lubricants without additives after birth.
- Couvade: Couvade syndrome: the expectant father shows signs of his partner's pregnancy, such as nausea, tiredness and mood swings.
All terms
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