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Will VBAC Negatively Impact Your Sex Life?

QUESTION: I have one child and I am expecting my second baby shortly. I am very anxious about the upcoming birth. My first child was delivered by cesarean, but my doctor wants me to try to deliver this baby vaginally. The mere thought of this frightens me terribly. With my first pregnancy, I just knew I wouldn't be able to deliver vaginally and was right. I'm also worried that VBAC will negatively affect my sex life. Any suggestions?

ANSWER: If your obstetrician believes you may deliver vaginally, he or she probably does not see any significant physical limitations at this time. And certainly due to having already stretched from your first pregnancy and labor, your body will be more supple and responsive to the birthing process. Additionally, there are health risks to you and your baby in a cesarean delivery. And most physicians now believe that a vaginal birth after cesarean is safe, and a preferred alternative to elective surgery.

A baby's descent through the vagina can be thought of as a vigorous massage that prepares the baby for the world outside the womb. Mucous is squeezed out of it's lungs for breathing and it's skin is massaged for increased circulation. Birth by cesarean can be a more abrupt transition for a newborn, particularly if there was no or little labor preceding the operation.

It is natural to be afraid of labor. Horror stories abound and childbirth is a truly vulnerable transition. But coping with the natural pain of labor as well as using pain medication available if needed can help you stay present through the labor in a way that can also feel very positive and empowered. Many things can influence your ability to cope with the birth, including associations to childbirth that have been learned, or even your own experience of being born.

If you are concerned about damage to the perineum (the area between the vagina and anal opening), talk with your doctor about not having a routine episiotomy (automatic cutting of the perineum for faster delivery of the baby). Michael Klein, M.D. chief of family practice at McGill University in Canada conducted a study that documents that without episiotomies, half of women deliver babies over intact perineums. The other 50 percent generally suffer minor tears which are easily repaired without damage to the perineum. However, when women have routine episiotomies, Dr. Klein has found they continue to tear into deeper vaginal tissue and result in more trauma to the vaginal area.

Ask your doctor about his or her episiotomy rate and whether he or she knows about the research which shows that women fare better when not given routine episiotomies. Request that your physician honor your request to not traumatize your body unnecessarily. Or consider interviewing other doctors about their willingness to support you in not having a routine episiotomy. Taking charge of your medical care will help to ease your fear and empower you during this very significant life event.

Research also shows the effectiveness of having a "doula", a woman who is knowledgeable about labor and assists you and your husband through the birth process. Education decreases fear. Read books, go to classes, and talk to other women who have experienced positive birthing experiences, including vaginal births after cesarean. What do they say contributed to their ability to cope with the experience and feel empowered by it?

Perhaps your overriding anxiety about labor as well as your fear of becoming less attractive to your husband sexually got in the way of your labor and birth preparation in your first childbirth. It is true that significant fear can decrease oxytocin in labor, contributing to dysfunctional labor and increasing the possibility for cesarean.

You can indeed resume a normal sex life with your husband after a vaginal childbirth! Though it is true that your vagina will be more relaxed, this does not mean less sensual. In fact, the blood brought to the lower pelvic floor in pregnancy and childbirth generally increases sensuality in post childbearing women.

Talk with your husband about your fears about the changes in your body after vaginal delivery. It is his job to love you and accept your changing body over time. Childbirth is just one of the changes that he will witness if you live full lives together. To avoid these natural body changes is to deny the reality and intimacy of living.

It is also true that dealing with pain in childbirth is a main source of fear for women. However the pain of labor is a healthy pain, not the pain of something wrong, and it can be addressed and mastered. As a society, we have difficulty accepting that something intensely difficult or even painful can also encompass a feeling of power, beauty and ease. Childbirth is such an experience.

Childbirth is an event of significance which impacts a woman's developing sense of herself. Whether you deliver vaginally or by cesarean birth, it is the process by which you give birth that matters. Transforming fear by meeting the labor contractions can have far reaching consequences on self esteem and empowerment in other areas of life. Mastering fear can yield energy available for other situations in life which challenge us.


Gayle Peterson, MSSW, LCSW, PhD is a family therapist specializing in prenatal and family development. She trains professionals in her prenatal counseling model and is the author of An Easier Childbirth, Birthing Normally and her latest book, Making Healthy Families. Her articles on family relationships appear in professional journals and she is an oft-quoted expert in popular magazines such as Woman's Day, Mothering and Parenting. . She also serves on the advisory board for Fit Pregnancy Magazine.

Dr. Gayle Peterson has written family columns for ParentsPlace.com, igrandparents.com, the Bay Area's Parents Press newspaper and the Sierra Foothill's Family Post. She has also hosted a live radio show, "Ask Dr. Gayle" on www.ivillage.com, answering questions on family relationships and parenting. Dr. Peterson has appeared on numerous radio and television interviews including Canadian broadcast as a family and communications expert in the twelve part documentary "Baby's Best Chance". She is former clinical director of the Holistic Health Program at John F. Kennedy University in Northern California and adjunct faculty at the California Institute for Integral Studies in San Francisco. A national public speaker on women's issues and family development, Gayle Peterson practices psychotherapy in Oakland, California and Nevada City, California. She also offers an online certification training program in Prenatal Counseling and Birth Hypnosis. Gayle and is a wife, mother of two adult children and a proud grandmother of three lively boys and one sparkling granddaughter..

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