For new moms, sex may be the last thing on their minds after a long labor. But eventually, interest in the bedroom will return — once the mother has healed physically and mentally.
Many providers recommend waiting a few weeks after delivery before getting intimate, regardless of whether you had a vaginal or cesarean birth. During this time, your uterus and cervix will be more vulnerable to infection, and your lubrication supply may have diminished.
Vaginal Bleeding
Bleeding or spotting that doesn’t happen during your menstrual period is not normal and may be a sign of a medical problem. Talk to your doctor if you’re experiencing this kind of bleeding, especially if it’s heavy or lasts longer than your usual period.
Some women may bleed lightly between periods when their hormone levels change. This is common for women who use hormonal contraception or have certain medical conditions. For example, if you’re taking blood-thinning medicine to prevent clots or a condition called von Willebrand disease causes your blood vessels to bleed easily. Bleeding between periods can also be a sign of some cancers in the lining of the uterus, cervix or vagina.
If you’re worried about your vaginal bleeding, make an appointment with a gynaecologist, who specialises in women’s health. They’ll be able to check that the bleeding is coming from your uterus or cervix and work out what might be causing it. This could include an ultrasound scan or a pelvic exam.
Bleeding in the vagina or vulva is often caused by infections like thrush or sexually transmitted infections (STIs). If you’re having problems with this, your doctor will prescribe you antibiotics to treat the infection. It’s also possible that your bleeding is a symptom of a serious blood condition, such as disseminated intravascular coagulation (DIC). This happens when you have a complication from pregnancy or childbirth, such as placenta accreta. This condition causes blood vessels that carry blood to the cervix to break, and can cause a dangerous amount of bleeding.
Postpartum Hemorrhage
Normal postpartum bleeding comes from the area in your uterus where the placenta was attached. It is usually heaviest at the time of birth and slowly reduces over a few weeks. If the bleeding is heavier than usual, it’s called postpartum hemorrhage (PPH). It can cause a sudden drop in blood pressure that can restrict oxygen flow to your brain and other organs. If not treated quickly, it can be life threatening.
PPH occurs when your uterus doesn’t contract properly after your baby is born. It’s more common in vaginal deliveries but can also happen with cesarean sections. Your doctor will offer an injection of medicine containing oxytocin after your childbirth to help the uterus contract, which can cut your risk of PPH by half. They’ll also be more attentive if you say that you’re feeling unwell in the delivery room or postpartum unit, so they can act sooner if needed.
Symptoms of PPH include heavy bleeding, pain in your abdomen and a severe drop in blood pressure that can affect the flow of blood to your brain, heart and other organs. Your doctor can treat PPH by using uterotonic medications such as oxytocin, methylergonovine or prostaglandins. They can also use manual uterine massage and compression. If these aren’t effective, they can perform a laparotomy or hysterectomy.
Perineal Tear
Up to 9 in 10 first-time mums will have some sort of tear, graze or episiotomy in the area between their vaginal opening and anus (butthole). It’s known as your perineum. These types of tears can be minor or severe, and they may require stitches to close them.
A small first-degree perineal tear will only affect the skin and is unlikely to cause any long-term problems, but it can be sore. A second-degree tear is deeper, affecting the skin and some of the muscle around the anus. This type of tear is more likely to need stitches. A third-degree tear extends deep into the muscle that controls your anus, and this will also need stitches.
It’s important to know that a fourth-degree tear, the most serious kind, can result in permanent damage to your vulva and bladder. This could lead to faecal incontinence, which means urine leaks during physical activity or when you sit down. This is why it’s very important to be seen for a perineal tear promptly, and for your doctor to assess the severity of it.
A doctor will examine your genitals including the perineum, and may use a gloved finger to check the depth of your tear. They will then decide if it needs suturing, and they will probably do this under local anaesthetic in the delivery room.
Postpartum Depression
Women who experience severe feelings of sadness after childbirth, or “baby blues” that last more than two weeks, may have postpartum depression. This is a serious mental health condition caused by hormonal changes after pregnancy and delivery, stress and worries about being a new mother, and a loss of self-esteem and identity. If untreated, it can lead to a range of serious problems for the mother, such as suicidal thoughts, insomnia and impaired thinking and concentration.
Hormones in the body increase tenfold during pregnancy and drop sharply after birth, which can cause a wide variety of mood swings. Symptoms include feeling sad, anxious or hopeless, feeling guilty or worthless, a lack of interest in the baby or other things that used to bring pleasure, weight loss or gain, and trouble sleeping or feeling tired all the time.
If you have symptoms of PPD, contact your obstetrician or primary care doctor right away. They can arrange for you to see a mental health professional or a support group. Medication, such as antidepressants and certain types of psychotherapy (talk therapy), can help. Often, a combination of treatments is most effective.
Some women with severe depression need hospitalization, especially if they have hallucinations or delusions like a false sense of reality, or if they think about hurting themselves or the baby. In those cases, doctors sometimes use a special medicine called brexanolone (Zulresso) or electroconvulsive therapy, which can be given in the hospital.
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