Chapter Four: The Sexuality of Pregnancy and Birth (abridged)

When conception occurs, a complex series of hormonal, physical, and psychological changes begin to take place. These changes profoundly affect a woman's emotional stability and sense of self. Especially at first, pregnancy can make a woman feel like her life has been turned on end. But this is normal; it is part of the process. 

Pregnancy is comprised of three trimesters, each lasting approximately thirteen weeks. Each of these trimesters has its own challenges and joys, which begin to make sense when the process is viewed as a whole. 

THE FIRST TRIMESTER

Increased circulation in pelvic tissues as a means for uterine growth can lead to pelvic engorgement, similar to that in premenstrual or ovulatory phases of the cycle. This may cause a woman to wonder what's hit her, and whether her desire for deep and forceful penetration is really safe. There is no doubt that orgasm causes uterine contractions, but to a degree so minor as to have no serious impact on placental circulation. 

If there is a history of miscarriage or episodes of bleeding in the current pregnancy, sexual activity should probably be curtailed, at least for the first trimester. Barring these exceptions, sex brings physiological benefits of increased pelvic circulation, release of tension, and internal muscle toning particularly helpful in preparation for birth. Many couples describe their sexual encounters in pregnancy as re-bonding experiences, akin to those in the initial phase of their relationship. No wonder, for both partners are assuming new roles, and are discovering aspects of one another heretofore unknown. 

A woman's level of desire in the first trimester may also have something to do with the sex of the child she is carrying. At about six to eight weeks, when the baby's brain is developing, male fetuses are exposed to an enormous dose of testosterone, the level of which is four times that of infancy and childhood.¹ This undoubtedly has some impact on the mother, quite possibly increasing her libido. By the same token, it may be that a mother's ability to recognize the sex of her unborn has a hormonal basis, since surges of testosterone continue to occur in male fetuses at regular intervals during gestation.

Women's reactions to the specific stages of childbearing also vary according to personality type. A physically oriented woman, for example, may find the natural softening of her body and loss of emotional control due to hormone swings at the onset of pregnancy to be fairly excruciating. She is apt to complain that her body doesn't work anymore; no longer can she make her way by physical intent alone. Naturally, this will affect her sexual self-image. For her, the key to adjustment is to express her feelings, while learning more about the unique capabilities of her changing body.

More emotionally oriented women are quite the opposite, glorying in the heightened sensitivities of pregnancy. They may enjoy sex as much as ever, as long as there are no major upheavals in relationship. Increased needs for food and exercise may go unnoticed, though, resulting in decreased physical energy and emotional instability, which ultimately affects sexual enjoyment. Emotionally based women must learn to hear the messages from their bodies. They also need concrete, factual information on nutrition and the physiology of pregnancy.

Mentally oriented women, with a penchant for control and having everything in place, may make their adaptation by the book and yet feel disoriented by surges of emotion and extreme mental states beyond their experience. They need a way to explore their feelings, perhaps by connecting mind and body through dance, movement, massage, or whatever serves to facilitate spontaneity. This can add an entirely new dimension to sexual experience. 

For more on the sexuality of pregnancy: Women’s Sexual Passages: Finding Pleasure and Intimacy at Every Stage of Life, by Elizabeth Davis, Hunter House Publishers, 2000. Find it on Amazon.

THE SECOND TRIMESTER 

Throughout pregnancy, oxytocin levels continue to rise. Oxytocin initiates Braxton-Hicks contractions, which tone the uterus and prepare it for labor. In large amounts, oxytocin has also been shown to cause mood elevation and alleviate depression--perhaps this accounts for feelings of joy and well being many women experience at this stage of pregnancy. Take ample amounts of oxytocin, mix with high levels of estrogen, blend with vaginal engorgement, and no wonder many women in their second trimester find themselves sexually insatiable, surprising both themselves and their partners. 

Let's take a closer look at men's reactions to sex in pregnancy. If a man feels concern about jeopardizing the pregnancy during the first trimester, feeling the baby move in the second may further compound his fear. The average male believes the vagina to be somewhat delicate, and the idea of deep thrusting close to where a baby is developing makes some men squeamish. But there is more. A surprising number of men struggle with conflicting images of Madonna/Whore, the Mother versus the Lover, unable to blend the two and hence uncertain of how to relate to their pregnant partner sexually. That a woman nurturing new life might also be blatantly lustful and erotic is a powerful merger of two culturally disparate aspects of femininity. 

Note that some women feel this too and may manifest it either by avoiding sex or by wanting to focus exclusively on the baby. Resulting problems may be considerable; disrupted intimacy in a rapidly changing relationship will breed estrangement and mistrust unless lines of communication are kept open. In my practice, I remind women of the sexual nature of birth, and use it as a reference point to encourage them to stay open to their partners as much as possible. Labor is, after all, an intensely physical experience; the estimated caloric output of the first birth is equivalent to that of a 50-mile hike! And it involves the same kind of emotional surrender as spontaneous orgasm.

An important aside here about physical and sexual abuse: more and more women are becoming aware of forgotten or repressed experiences now that support is available. For many, the emotional vulnerability of pregnancy may trigger recollections for the first time that are doubly difficult to handle if their own parents or other relatives are implicated. The accompanying sorrows and fears are apt to interfere with the primary relationship. But wherever possible, it is better to bring these to the surface while pregnant than to have them arise and interfere with labor or mothering. Precisely because pregnancy is such a labile state, I recommend hypnotherapy, as it can be especially useful for reactivating and healing the past.

This, or early in the third trimester, is also an opportune time for a ritual celebration of the pregnancy and forthcoming birth. Increasingly, women are honored by their loved ones with a special ceremony, something more in depth than the conventional baby shower. In Native American tradition, a Blessingway is performed for every pregnant woman/couple. See boxed section, page 113, for ideas for a contemporary "Birthingway" celebration. 

THE THIRD TRIMESTER

By overview, the first trimester is initiation into pregnancy; the second, integration and equilibrium; and the third, completion and transition to labor and parenting. Sexuality is often disrupted at this stage by the physical discomforts of extra weight. Sleep may be sporadic, especially if heartburn is a problem, and urination becomes frequent again as the baby moves low. None of this is particularly conducive to amour, but a midday rendezvous can help. These inconveniences promote readiness to give up pregnancy and get on with labor, simultaneously preparing a woman for the challenges of caring for her newborn.

Emotionally these are trying times, with mixed feelings in relationship. Sometimes a woman wants to cling to her partner and hold back time, aware that the baby will soon be out in the world (or in the middle of the bed) and nothing will ever be the same again. Sometimes she wants the privacy just to be with the baby, trying to get to know it as well as she can before it is born, so that sex seems extraneous, or more for her partner than for herself. Especially when she is thinking of the challenges ahead and her ongoing need for support, a woman may be demanding, moody, or fearful. 

But in the last week or so, a drop in progesterone often leads to loss of water weight, and a feeling of lightness and well-being. Substances called prostaglandins, found in the brain as well as seminal and menstrual fluids, may also be responsible for labor's onset. Or it may be the fetus that is responsible; it too releases prostaglandins as its brain matures. Prostaglandins soften the cervix and cause uterine contractions. 

This is why many care providers now encourage intercourse at term, especially if the baby is overdue. Seminal fluid is extremely high in prostaglandins and thus may help trigger labor. (A substitute may be found in evening primrose oil, reputed to have a similar effect when rubbed gently on the cervix.)

BIRTH AS A SEXUAL EVENT

Is birth really a sexual event? How can this be, when it's reputed to be so painful?

Let's consider these questions one at a time. Birth as a sexual event—however can we doubt it? After all, it is an intensely physical experience centered in a woman's vagina. In fact, the entire pelvic area is highly stimulated in labor: not just the vagina, but the clitoris, rectum, anus, the supporting tissues and musculature. We can compare the sensations of labor contractions to those of strong menstrual cramps, but with one important difference. Contractions come in waves; they build up steadily instead of taking hold abruptly. Women who have learned to cope with menstrual cramps by relaxing, staying loose and letting go, have a distinct advantage in labor. And here is where the parallels to sexual intercourse begin. Particularly when sex is very passionate and forceful, there may be moments of pain or cramping discomfort with deep thrusting and intense pelvic movement, particularly if the cervix is being hit directly or the uterus is jolted against the intestines. Relaxation, rhythmic breathing, and a change of position help a woman ease through these sensations without losing momentum, as she would if she tightened up or shut down emotionally. Especially with orgasm, the ability to surrender and diffuse sensation throughout the body is critical.

Deep relaxation, surrender, letting go: when midwives are asked to disclose the secret of giving birth with relative ease, these are the words we choose. More than metaphors for coping, these responses are based on physiological imperatives, as we will see in the forthcoming section. We will also look closely at how environment affects the spontaneity of the birth process.

FIRST-STAGE LABOR

The first stage is the phase of labor when the cervix dilates fully to allow the baby to begin its passage through the vagina and into the world. Over the course of labor, oxytocin intensifies contractions and brings them closer together, which speeds dilation.

In early labor, up to about four centimeters of dilation, contractions may be scarcely noticeable. They may feel more like waves of pelvic warmth "with an edge" than painful cramping. So how about making love in early labor? Considering the link between sex and the release of oxytocin, this is really quite a good idea. A caution, though: most practitioners feel that vaginal penetration should be avoided once the waters have broken, lest infection occur. But generally, intercourse in early labor relaxes the pelvis, gets the hormones pumping, and eases both partners into an intimate and relaxed state conducive to ready progress. Especially if labor is prolonged in the early phase, sex may be just the thing to get it going. 

Still, no matter how well a woman has prepared and how eagerly she has anticipated her labor, there may come a time when the going gets rough, as the sensations begin to exceed her expectations. This is the point when ideas of what labor is going to be like, and concepts of how to cope and behave must be swept aside for the real thing. In these moments of reckoning, a woman often finds she must go further in letting go, both physically and emotionally, than she ever has before. It dawns on her that labor is bigger than she is, beyond her experience or control. This can be rather frightening, as it tends to occur fairly early, at just four or five centimeters' dilation. She may feel that she has already tried everything, and still cannot handle it. Truth is, she's not going to handle or do it as her ordinary self; she must let herself be transformed to find the way. As you may surmise, this is also a time when women ask for drugs, particularly if they feel unsupported or exposed.

Imagine yourself in the hospital (not exactly an intimate environment), struggling with labor sensations much stronger than you expected, and painful the second you tense up or break your concentration. However, the constant stream of medical personnel in and out of your room makes it nearly impossible to let go and relax. You find yourself afraid, wanting to cry out and find relief or move around and change positions, but you just can't, your circumstances are far too inhibiting. Your attendants are sympathetic, but no one is really getting down to your level, looking you in the eye. Though your partner is standing by, she/he too feels afraid and helpless.

Niles Newton, to whom we must be forever grateful for her groundbreaking research on birth, breastfeeding, and sexuality, investigated the importance of environmental factors on the birth of mice. She found that births were longer and more difficult when mice were placed in unfamiliar surroundings, could not smell or see what they were used to, were moved repeatedly during labor, or were placed in clear (as opposed to opaque) cages. Opposite factors of familiar surroundings, privacy, and stability contributed to spontaneous, easy deliveries.²

When a woman is frightened or tense, elevated adrenaline levels shunt blood away from the uterus and cause the circular fibers of the cervix to become rigid. Similarly, if you are tense or frightened during intercourse, you are not likely to experience orgasm.

How to avoid all this? Picture yourself in a darkened room with just your partner, the two of you in bed relaxing in one another's arms, your midwife or doctor sitting quietly in the corner, coming over now and then to check the baby and offer encouragement, then perhaps retiring to an adjacent area so your privacy is complete. You still have to deal with the pain, both the physical intensity and the psychological shock of "it's not what I expected," but you can speak freely to your partner, you can cry, laugh, shout, whatever suits you as you work together; it is your experience.

A major problem with hospital birth is increasingly routine interventions in otherwise normal labor. Once the decision is made for one such intervention, others are likely to follow. For example, when pitocin is used to speed up labor (whether by hospital guidelines for progress or for the convenience of the obstetrician), contractions often become so unnaturally strong and painful that the mother requires pain relief. These contractions may also stress the baby, because when the uterus is forced beyond its capacity and does not relax fully between contractions, circulation is impaired and the baby receives less oxygen through the umbilical cord. If fetal distress intensifies, the probable conclusion is Cesarean birth. 

Consider that one in three births in the U.S. today is by Cesarean section--in some hospitals, as many as one in two. This is shocking but not really surprising, so deeply do we fear the mystery of women's bodies and so strongly do we venerate control. Some women have even request Cesarean birth for much the same reasons; it seems less threatening and easier to handle than vaginal birth. Little do they know that Cesarean section is major abdominal surgery, nor are they told how difficult recovery can be when one must deal with post-operative pain and tend a baby, establish breastfeeding, suffer sleep deprivation, and cope with the sweeping physiological and emotional changes of the postpartum period.

Whatever your environment, once you make the shift to active labor--with contractions long and strong, coming about every five minutes--neurohormones called endorphins begin to enter your bloodstream. These are commonly released with intense physical activity, and are responsible for the surge of strength, power and well being known as second wind (or "runner's high"). Once her endorphins have kicked in, a woman may actually enjoy labor or may even find it an ecstatic experience. I have many times told the story of one of my clients who was crying and desperate in early labor, only to be smiling and dancing around the room at nine centimeters' dilation. Not every woman maintains an external focus so far into labor; it depends on how quickly her labor is progressing and how strong contractions are. Many women do turn inward as they approach full dilation, eyes closed between contractions and peacefully out of body. Still, there is always the exception, like the woman who laughed, chatted and ate fried chicken until she was ready to push!

As dilation gives way to bearing down, adrenaline is both physiologic and positive in effect. There are two different types of uterine receptors for adrenaline: beta-inhibitory and alpha-initiatory, and at this point, initiatory fibers become active. Women left to their own devices often scream or roar as they enter second stage, sometimes leaping to their feet or into a crouch with superhuman strength. These same women later revel in the power of this moment. "Those sounds," one recalled, "where were they coming from? Some deep part of me that had never been touched before.” They rang in my ears, raw, clear, and unbelievably strong." For many, this is one of the most sexual moments in giving birth, one that can transform a previously shy or inhibited woman into a powerfully assertive lover.

For more on the sexuality of pregnancy: Women’s Sexual Passages: Finding Pleasure and Intimacy at Every Stage of Life, by Elizabeth Davis, Hunter House Publishers, 2000. Find it on Amazon.

SECOND-STAGE LABOR

We must clarify that although second stage commences with full dilation, some women do not experience the adrenaline surge and urge to push for some time after, especially if the baby is still fairly high in the pelvis. Some even nap as the uterus rests, then wake with clear urges to push. 

When a woman in second stage is unfettered by outside direction to hold her breath or push hard, she will breathe very much as she would during sexual excitation and orgasm: up to three times more rapidly than usual, with periods of breath-holding punctuated by gasps, groans, or cries. Women who push their babies out spontaneously describe birth in terms of tremendous release, ecstatic rushes of emotion, and overwhelming happiness. 

For me, the ecstasy of second stage occurred when my uterus and I were working as one, beyond signal and response. In this mode, a woman can literally deliver her own baby, sensing exactly when she can take more stretch and when to ease up, gently breathing her baby out. I had been given a huge episiotomy (cut to enlarge the birth canal) with my first birth, and so was determined not to tear with the second. I really tuned in during pushing, just closed my eyes and did it all from the inside. I could feel everything, the precise contours of my daughter's head as I eased it out, even her little shoulders and body as she whooshed and squiggled through. It was absolutely the most exquisite thing I have ever felt in my life. Later, my midwives said they wished they had video taped the birth, it was so perfectly controlled. But for me, control had nothing to do with it, as I wasn't holding back. Beyond attunement, there was union, perfect union.

This raises yet another issue, the possibility of tearing with delivery. Isn't it better to have an episiotomy, rather than being stretched out or torn? 

Here we have one of the biggest lies perpetuated by modern obstetrics: that the human vagina is somehow inadequate to the task of delivery and must be surgically enhanced to accomplish it. Most women don't realize that the vagina's surface is covered with ruggae, accordion-like folds of tissue that expand naturally due to the hormonal effects in pregnancy. When a woman is relaxed and centered at delivery, not rushed but well 
supported, she will generally give birth without a scratch, or with abrasions so minor they require no treatment. 

But what about vaginal snugness after birth? Pleasurable friction is found not at the opening anyway, but from muscles immediately inside the vagina, which extend upwards several inches or so. Although it is possible to create a tight vaginal opening with surgical repair, scarred areas inside will be rigid, surrounding muscles flaccid, and the entire area dysfunctional for many months. In general, the woman who has given birth naturally and has retoned her vaginal muscles postpartum will be a more responsive and pleasurable partner than one with deep-tissue trauma and repair (at least until healing occurs, which can take a long time).

DELIVERY

At the final moment of crowning, when the widest part of the head stretches the vaginal opening to its maximum, some women love either to look in a mirror or to reach down and touch, for the first time, their little one. Sometimes this brings a tremendous flood of emotion, and the baby is born in an orgasm of delivery. Most women describe the moment of delivery as the high point of their lives, a physical and emotional pinnacle. All the waiting and wondering, all hopes and fears are finally unleashed and allowed to rush forward as the baby swooshes out and utters its first cry.

If she feels like it, the mother can reach down and lift the baby up when it is still partly inside her--something she will never forget. The baby is wet, warm, incredibly fragile yet surprisingly strong. It smells sweetly of birth. She touches its little hands and feet and then finds herself falling into its eyes, seeing the faces of relatives and ancestors, feeling past and future unite. Birth is a stunning victory for a woman, especially when she has retained her power and knows she has given it her all.

BIRTH IS A BLOOD MYSTERY

The real truth is that birth is a mystery, one by which we grow and learn exponentially as compared to ordinary life lessons. Here is a tale of our heritage as birthing women…

For this story (and the rest of the chapter) read Women’s Sexual Passages: Finding Pleasure and Intimacy at Every Stage of Life, by Elizabeth Davis, Hunter House Publishers, 2000. Find it on Amazon.


1. Niles Newton and Charlotte Modahl, "New Frontiers of Oxytocin Research," Free Woman: Women's Health in the 1990s (Canforth: Pantheon Publishing Group, 1989).

2. Niles Newton, Michael Newton and Donald Foshee, "Experimental Inhibition of Labor Through Environmental Disturbance," Obstetrics and Gynecology, vol. 27 (1966).