Ellie McDonald

Does method of birth make a difference to when women resume sex after childbirth

To investigate the timing of resumption of vaginal sex and assess associations with method of birth, perineal trauma and other obstetric and social factors.

Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy

BackgroundIn the first year after childbirth, 94% of women experience one or more major health problems (urinary incontinence, faecal incontinence, perineal pain, back pain). Difficulties in intimate partner relationships and changes affecting sexual health are also common. The aim of this study is to investigate changes in womens health from early pregnancy until four years after the birth of a first child.Methods/designThe Maternal Health Study is a longitudinal study designed to fill in some of the gaps in current research evidence regarding womens physical and psychological health and recovery after childbirth. A prospective pregnancy cohort of >1500 nulliparous women has been recruited in early pregnancy at six metropolitan public hospitals in Melbourne, Australia between April 2003 and December 2005. In the first phase of the study participants are being followed up at 30–32 weeks gestation in pregnancy, and at three, six, nine, 12 and 18 months postpartum using a combination of self-administered questionnaires and telephone interviews. Women consenting to extended follow-up (phase 2) will be followed up six and 12 months after any subsequent births and when their first child is four years old. Study instruments incorporate assessment of the frequency and severity of urinary and bowel symptoms, sexual health issues, perineal and abdominal pain, depression and intimate partner violence. Pregnancy and birth outcome data will be obtained by review of hospital case notes.DiscussionFeatures of the study which distinguish it from prior research include: the capacity to identify incident cases of morbidity and clustering of health problems; a large enough sample to detect clinically important differences in maternal health outcomes associated with the method of birth; careful exposure measurement involving manual abstraction of data from medical records in order to explore mediating factors and possible causal pathways; and use of a variety of strategies to improve ascertainment of health outcomes.

Fear of an Intimate Partner and Women’s Health in Early Pregnancy: Findings from the Maternal Health Study

BACKGROUND Intimate partner violence affects 1 in 4 women at some stage in their lives. Exposure to violence has short- and long-term consequences for women themselves and their children. The objective of this study was to examine associations between fear of an intimate partner and maternal physical and psychological morbidity in early pregnancy. METHOD This paper reports baseline measures from a prospective pregnancy cohort study of 1,507 nulliparous women recruited at six public hospitals in Melbourne, Australia. RESULTS The study showed that 18.7 percent (280/1,497) of women reported being afraid of an intimate partner at some stage in their lives; 3.1 percent (47/1,497) were afraid in early pregnancy and 15.6 percent (233/1,497) had been afraid before but not during the current pregnancy. Compared with women who had never been afraid of an intimate partner, women who reported being afraid of an intimate partner in early pregnancy (< or = 24 wk gestation) were at increased risk of urinary incontinence (adjusted OR = 1.64, 95% CI 0.9-3.1), fecal incontinence (adjusted OR = 3.32, 95% CI 1.2-9.2), vaginal bleeding (adjusted OR = 2.84, 95% CI 1.5-5.5), anxiety (adjusted OR = 10.22, 95% CI 5.0-21.2), and depression (adjusted OR = 4.43, 95% CI 2.1-9.7). Women afraid of an intimate partner before but not during pregnancy experienced a similar pattern of morbidity. CONCLUSIONS Women afraid of an intimate partner both before and during pregnancy have poorer physical and psychological health in early pregnancy.

Dyspareunia and childbirth: a prospective cohort study

To investigate the relationship between mode of delivery, perineal trauma and dyspareunia.

Women's experiences of sex and intimacy after childbirth: making the adjustment to motherhood.

The aim of this study was to explore women’s experiences of changes to their sexual relationship, sexuality and intimacy, as a result of pregnancy, childbirth and parenting. A sub-sample of women was purposively selected from a larger prospective pregnancy cohort study of nulliparous women in Melbourne, Australia. Eighteen women (including a mixture of parity, birth methods and relationship status) were interviewed 2.5–3.5 years after a first birth. Interviews were transcribed verbatim and analyzed using interpretive phenomenological analysis. Women identified numerous factors affecting sexual and intimate relationships including extreme tiredness, changing lifestyles and body image issues, leading to changes in libido and intimacy in relationships. Of particular note were feelings of guilt and failure women experienced as a result of a lowered libido. Finding ways to stay connected – whether through sex, quality time together or working as a team – helped women and their partners navigate the transition to parenthood. This study demonstrates that pregnancy, childbirth and parenting can bring about significant changes to women’s experiences of sex and intimacy. Women who experience significant reductions in their libido may be vulnerable to feelings of guilt and failure, connected with high expectations that they should be able to “do it all”.

Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study.

To investigate the extent to which primary‐care practitioners routinely inquire about postpartum urinary and faecal incontinence, and assess the proportion of women who disclose symptoms.

Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort

To investigate frequency, severity and risk factors for urinary incontinence and faecal incontinence 4 years after a first birth.

Frequency, severity and persistence of postnatal dyspareunia to 18 months post partum: A cohort study

OBJECTIVE to describe the frequency, severity and persistence of dyspareunia in the first 18 months after the birth of a first child. DESIGN prospective pregnancy cohort study. SETTING Melbourne, Victoria, Australia. POPULATION 1507 nulliparous women. METHODS women ≤24 weeks gestation were recruited from six public hospitals. Self-administered written questionnaires were completed at recruitment and at three, six, 12 and 18 months post partum. OUTCOME MEASURES study-designed self-report measure of dyspareunia on first vaginal sex, and on second and subsequent sex at all time-points, utilising the rating scale from the McGill Pain Intensity Scale. FINDINGS overall, 961/1122 (85.7%) of women experienced pain on first vaginal sex postnatally. The proportion of women experiencing dyspareunia reduced over time, from 431/964 (44.7%) at three months post partum to 261/1155 (22.6%) at 18 months post partum. Of the women who reported dyspareunia at each time-point, around 10% of women described the pain as׳distressing׳,׳horrible׳ or׳excruciating׳. Women who had a caesarean section were more likely to report more intense dyspareunia at six months post partum (aOR=2.35, 95% CI=1.2-4.6). CONCLUSIONS postnatal dyspareunia decreases over time, but persists beyond 12 months for one in five women. Caesarean section appears to be associated with more intense dyspareunia.

Sexual pleasure and emotional satisfaction in the first 18 months after childbirth

OBJECTIVE to investigate the experiences of first time mothers with regard to emotional and sexual intimacy in the period from birth to 18 months postpartum. DESIGN prospective pregnancy cohort, with follow-up at 3, 6, 12 and 18 months postpartum. SETTING AND PARTICIPANTS first-time mothers were recruited in early pregnancy at 6 public maternity hospitals in Melbourne, Australia. FINDINGS 1239 women who completed the baseline questionnaire and all follow up questionnaires were included in the sample for analysis: 78% resumed vaginal sex by 3 months postpartum, 94% by 6 months and 98% by 12 months postpartum. Emotional satisfaction with intimate partner relationships declined over time, from 67.3% reporting high satisfaction at 3 months to 53.9% at 18 months postpartum. In contrast, sex was described as extremely or very pleasurable by 40.1% of women at 3 months postpartum, compared with 49.1% at 18 months postpartum. There was a strong association between emotional satisfaction and the degree to which women experienced physical pleasure in their sexual relationship. Women who were happy with their partners contribution to household tasks were markedly more likely to report high emotional satisfaction (OR 10.31, 95% CI6.7-15.9) and somewhat more likely to report greater physical pleasure in their sexual relationship (OR 2.32, 95% CI 1.5-3.5). KEY CONCLUSIONS women experience profound changes in their sexual and intimate relationships in the first 18 months postpartum. While sex appears to improve over time, emotional satisfaction appears to decline. Partner involvement in household tasks is associated with greater emotional satisfaction. IMPLICATIONS FOR PRACTICE pregnant women and their partners may benefit from information and discussion about the likelihood of changes to their emotional and sexual relationships after childbirth.