by Andrea Robertson
Pregnancy and birth are very "sexy" topics. A pregnancy is a very obvious sign of a sexual activity but more than that, they demonstrate that a woman's sexual cycle is in full bloom and that she is fulfilling her biological destiny to reproduce. It's no wonder that sex and sexuality are integral themes of prenatal classes for expectant parents - all around them are signs of the sexual hormones at work. Incorporating these topics into your program will not only be relevant and interesting (everyone is interested in sex, after all) it is also easy and can be fun. Before we look at some possible ways to raise these subjects, it is again important to check your own attitudes and views as these will heavily influence your presentation.
Midwives should have few problems with the sexual aspects of birth. They are very familiar with the sights and sounds of labor and will be likely to have fielded questions about sexuality, libido and love making posed by women in their care. Postnatal issues such as contraception, breastfeeding, vaginal trauma following episiotomy or tears, lochia and resumption of sexual intercourse will all be familiar territory for the midwife and should therefore not be difficult to talk about. Bringing these issues into the prenatal program often seems much harder and many educators deliberately shy away from them perhaps through fear of causing embarrassment to group members or else because they themselves find it hard to talk about these topics.
It is certainly helpful to feel comfortable yourself and to give the outward appearance of being relaxed with these subjects. Remember that the people you are working with are all adults; they all have sex lives (that's how they got pregnant); they are all exposed to the media, and especially TV, where these topics are deliberately used to attract interest; these topics are out in the open and discussed daily in various ways; even our children get a good dose of them in their school curricula. So, having accepted that these are not topics anyone is likely to be embarrassed by (and in fact they are of considerable interest), how can we introduce them into our programs?
In a pregnancy class, the small group discussion about "positives and negatives of being pregnant" will often raise comments about changing body image, libido and sexual relationships. Since this activity may be scheduled when the people in the group don't know each other very well, it often helps to split them into single sex groups - men and women often talk more freely with members of their own sex. This activity is a good way to help people get to know each other quickly, and it is surprising how frank and open they can be once they settle down to the task.
Since the feedback to the large group will be anonymous, it is often much easier for intimate thoughts to be shared. If neither group mentions changes in their sexual life or libido, then you can raise them yourself with the comment "I'm surprised that these issues didn't come up, as they affect so many people. Perhaps we should take some time to talk about ..." Often the reaction will be "well, it was on our list, but we didn't like to say". Once you broach the subject, it demonstrates that you are very open to these topics and are happy to talk about them, and this can open up the whole area of sharing emotions and feelings in a very positive way. Once the groundwork has been laid, parents often ask questions about safety of sexual intercourse during pregnancy, the strength of Braxton-Hicks contractions, tonic contractions after orgasm, positions for love making and other personal issues.
Stages and phases of labor is an area that is ripe with possibilities. Ask parents if they know of any "alternative" of initiating labor. Many will have heard of using sex to start the birth process and you can mention the role that prostaglandin in the semen can play in ripening the cervix (do remind them that sex is safe as long as the membranes have not ruptured - after that they have to stop!). Kissing, cuddling, nipple and clitoral stimulation can all be mentioned as useful ways to stimulate labor, especially if it proceeding slowly.
This is also a neat way to remind parents that the best environment in which to give birth (from a hormonal perspective) is one in which they could feel comfortable making love. Ask each couple to privately list the attributes such a place would possess - prompt them by asking them to consider what it might feel like against their skin; important color; temperature; sounds; smells; light level; privacy etc. For an interesting variation, give each couple some paper and colored pencils and ask them to draw such a place. Once they have described the main elements of the setting, their next task is to imagine how they can adapt the place they have chosen (hospital labor ward?) to fit this picture of a sexually stimulating environment.
Parents find it helpful to have a basic understanding of the hormonal interplay during labor and birth, especially the role of the main players: oxytocin, endorphin, adrenaline. Use examples they can readily imagine to illustrate the ways these hormones interact to make your points: have them imagine they are making passionate love when the phone rings beside the bed, or there is a knock on the door. What would happen to the passion? What effect would the interruption have on their hormones? How easy would it be to get back into the love making once the disturbance goes away (is it possible at all?).
Using this strategy, you are not only alerting parents to the difficulties of giving birth in an intrusive, non-private place, but using an analogy they can readily imagine (and using sex creatively as well).
The role of the hormones postnatally also raises important issues of sexuality. For many years the innate sexuality of breastfeeding was not acknowledged and many women and their partners were dismayed to find that their sex lives were affected by her lowered libido and the fact that her breasts seemingly belonged to the baby. Scenario cards are a useful way of raising these issues, which need to be discussed. We know that one of the most significant barriers to successful breastfeeding is lack of partner support, so it is important that they have a chance to discuss these issues before the baby arrives.
Another discussion starter are appropriate cartoons or excerpts from novels, which can be used to get people thinking. Practical issues such as when to resume having sex and contraception can be fun if props are used. A kit containing samples of contraceptives can be assembled quite easily and is a helpful way of showing parents new methods they may need to use postnatally until they can return to their usual form of contraception. Try passing around a bag containing the samples and having each person take a "lucky dip" before explaining what they know about the contraceptive in hand. Back this up with printed information for them to take away.
These ideas are just a beginning. Almost any teaching strategy can be adapted for presenting a topic on sex and sexuality. Adopting the approach that these are not issues that are 'difficult' but ones that offer a chance to grab people's attention and personalize their experience is a good place to start. After that, it is a matter of asking yourself which of the many areas of sexuality you can include in the next session. If you can't get a bit of sex into every class then you are not trying!
This article first appeared in "The Practicing Midwife" Vol 3 No 8, September 2000.
Andrea Robertson is an independent consultant in Childbirth Education, the Principal of the post Graduate Diploma in Childbirth Education, the author of 6 best selling books on pregnancy and birth and numerous articles for midwives, parents, educators and doulas.
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