Postpartum Concerns – Beyond Postpartum Depression

When can sex resume? What about tub baths? And other questions about Baby

In addition to questions about Baby, new mothers often have a list of concerns about their own recovery. Read on for some common postpartum questions.

Immediately following childbirth is a recuperative time for new mothers. While moms are dealing with a myriad of emotions and “firsts,” most first-time mothers have the same concerns.

When can sex resume?

Usually after six weeks of healing (even with a bad tear) your vagina will be ready to receive visitors. Only one, of course-I think that’s the understanding. If there were no lacerations or episiotomy, you can even begin sooner, as early as four weeks. Your doctor will “clear” you for sex, as if you’re a 747 being cleared for take off. But a GYN exam is not the same thing as sex, in spite of all the overused comments I hear at every high school reunion.

No exam can predict how well you tolerate the rhythmic, persistent mechanical nature of intercourse. It really comes down to your comfort. If sex hurts, back off for another week or two, in spite of what your doctor tells you.

Also, I recommend you not resume until you’re “in the mood” again. A baby crying can wreck the mood faster than seeing a mouse run across the bed. And you’re tired. And you’re worried about the next day. And you’re dry. And you haven’t used your vagina, except as an exit, for a while.

Stack the deck in your favor by waiting for everything-physical as well as psychological-to be favorable for an enjoyable experience. You may get a pout from your husband, but your body is for both of you, not just him.

Some women complain that they have lost the ability to have an orgasm after delivery. This is probably due to the psychological concerns stated above, but it’s also due to the distortion to the anatomy. Almost always it’s a temporary problem.

What about birth control?

If you’re not breastfeeding, you need not worry about possible exposure of your baby to pharmaceuticals, so you can start immediately. Besides the birth control pill (combination estrogen/progesterone oral contraceptive), the mini pill (progesterone only pill), Depo Provera shot, and condoms, there are also the newer Lunelle (estrogen and progesterone injection), and the hard to find Norplant (time released progesterone in under-the-skin capsules).

A diaphragm is a bad idea in the early postpartum period, because it won’t fit well after the distorting influences of your recent delivery. Even when you feel you’re completely back to normal, you will need to be refitted in case there’s been a change in shape of your vagina.

Your doctor won’t discuss these options until your final postpartum check-up, and that’s OK, because you’re not supposed to be having intercourse until cleared anyway.

What about circumcision?

If you choose to have your son circumcised, it’s best done after twenty-four hours, so that your pediatrician has had a chance to check your baby. Waiting any longer allows your son to further develop the sheathing over his nerves that will better carry pain sensation. But the window, from purely a private practice experience, is still several days. Today, using topical anesthetic creams is urged, but I haven’t seen convincing results. Some babies holler, some don’t. And they all fall back asleep immediately after. The only anesthetic that will completely numb the area involves sticking needles into skin all around the glans, but I think this is crazy and more of a production than what’s involved in circumcision.

If a circumcision is done, it will be done either by your obstetrician or the pediatrician. The obstetrician lays claim on the procedure because it has been a traditional part of the global delivery process. The pediatrician lays claim to it because, after all, your baby is now his patient. It’s a friendly turf battle of sorts, but it really doesn’t matter-they both do a good job. More than likely, the obstetrician will do it, because your doctor is already paying crazy malpractice insurance premiums that include surgery, and many pediatricians don’t want to pay so much for the privilege to do the procedure we all love to hate.

What about tub baths?

The great hypocrisy is that you’re told to avoid tub baths, but if you have an infection from an episiotomy, you’re urged to soak in warm water.

The bottom line is that baths are fine, otherwise they wouldn’t be recommended with infection. The vagina is what is called a “potential” space. For you men out there, this doesn’t mean that it has a great potential, but that it’s not a space unless something actually occupies it. Otherwise, its walls, floor, and ceiling collapse together. Water won’t get in unless you open the lips of your vagina and swoosh it in. That would be bad, cause infections, and warrant the admonitions. But that won’t happen accidentally, so tub baths are fine. Keep in mind that tub baths make you more prone to bladder infections, though.

What about driving?

You can drive as soon as you’re not dizzy. The fluid shifts, and anemia that can accompany delivery may make you a little unsteady for a few days. But if you don’t suffer from that, driving’s fine. For C-sections, the above applies, but add that you should also be able to wear a seat belt without discomfort. Why go through all of the trouble of having a baby if you’re not going to wear a seat belt?

What about stairs?

Any activity, including stair climbing, if it doesn’t hurt or easily fatigue you, is O.K. Even after a C-section. If you listen to your Grandma, she’ll have you “lying in” for six weeks. Get as active as your body lets you. Those who join the land of the living fastest, heal the fastest.

What about scissors?

Don’t run with them, but now that you’re a Mom, you already know that.