Mode of delivery, childbirth experience and postpartum sexuality

Sexual health after childbirth in Dutch women: prevalence, associated factors and perceived need for information: a cross-sectional study

BACKGROUND

After childbirth, women often experience changes in sexual health. Little is known about the associated factors for the development of sexual health problems. Therefore, in this study we aim to investigate (1) how many women report changes in sexual health; (2) the prevalence and associated factors of women's postpartum sexual health problems and (3) whether women want to be better informed about postpartum sexual health after childbirth.

METHODS

From March to May 2021, 641 postpartum Dutch women participated in a cross-sectional study through an online survey, distributed via social media. At a mean time of 11.6 months (SD = 6.23) after birth, women reported information on maternal, pregnancy and childbirth characteristics and childbirth experience, sexual dysfunction (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), relationship satisfaction (Relationship Assessment Scale) and "perceived need for information" to discuss sexual health with their maternity care provider.

RESULTS

Postpartum changes in sexual health were found in 88% of women. Of the women who participated, 43.7% reported sexual dysfunction and 52.3% reported sexual distress. Overall, 46% of women perceived more need for information. Multivariable logistic regression analyses showed that negative sexual experiences were associated with increased odds of sexual dysfunction (odds ratio (OR) 1.58, 95% CI 1.04-2.40) and sexual distress (OR 1.70, 1.17-2.46). Perineal damage (OR 1.54, 1.03-2.29) was associated with increased odds of sexual dysfunction, and a BMI ≥ 30 kg/m2 (OR 0.46, 0.28-0.70) was associated with decreased odds of sexual dysfunction. A higher level of relationship satisfaction was associated with decreased odds of sexual dysfunction (OR 0.36, 0.25-0.51) and sexual distress (OR 0.47, 0.35-0.63). A positive childbirth experience was associated with decreased odds of sexual distress (OR 0.88, 0.81-0.96) and decreased odds of "perceived need for information" (OR 0.86, 0.79 to 0.94).

CONCLUSION

Sexual health problems are experienced by half of postpartum women. Midwives should inform women and their partners about these possible problems, taking into account birth-related factors, e.g. birth experience and perineal damage. Care providers should pay special attention to women with negative sexual experiences.

Women`s sexual function during the postpartum period: A systematic review on measurement tools

BACKGROUND

Sexual health is a critical component of overall well-being, yet discussions around sexual function, especially in the context of postpartum recovery, are often taboo or sidelined. The aim was to review measurement tools assessing women's sexual function/health during the postpartum period.

METHODS

We did a systematic search according to preferred reporting items for systematic reviews and meta-analyses 2020 guidelines in different databases, including PubMed, Web of Science, Scopus, Embase, ProQuest and Open Access Thesis and Dissertations, and Google scholar search engine until June 2023. Also, the reference list of the related reviews has been screened. Eligible studies included observational studies or clinical trials that evaluated women`s sexual function during the postpartum period using existing tools. Data extraction covered study characteristics, measurement tools, and their validity and reliability.

RESULTS

From 3064 retrieved records, after removing duplicates and excluding ineligible studies, and reviewing the reference list of the related reviews, 41 studies were included in this review. Tools measuring sexual function were developed from 1996 to 2017. Sexual activity questionnaire, female sexual function index (FSFI), sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, and sexual function questionnaire's medical impact scale and Carol scale.

CONCLUSION

Sexual activity questionnaire, FSFI, sexual function questionnaire, short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire, sexual health outcomes in women questionnaire, shorter version of FSFI, sexual function questionnaire's medical impact scale, and Carol scale are valid and reliable measuring tools to assess sexual function or sexual health during postpartum period, which can be used in primary studies according to the study aim and objectives.

How do new mothers describe their postpartum sexual quality of life? a qualitative study

BACKGROUND

Sexuality plays a critical role in a woman's postpartum quality of life and also has a strong impact on the quality of her relationship. Given the sparse body of published literature on the subject, we aimed to explore how new mothers explain their postpartum sexual quality of life.

METHOD

A qualitative study was carried out in Iran and Switzerland from December 2018 to March 2019. Focus groups and semi-structured in-depth interviews (IDIs) were conducted with mothers in the first four months after parturition. Mothers who were older than 18 years, were married or in a stable relationship, and experienced a low-risk vaginal birth or cesarean section participated in the study. We used Graneheim and Lundman's approach for analyzing the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the rigor of the data.

RESULTS

We achieved data saturation after two focus group discussions (FGDs), 15 IDIs in Iran, and 13 IDIs in Switzerland. We extracted three themes for postpartum sexual quality of life: (a) sexual worldview, (b) interpersonal relationship, and (c) postpartum sex storm. The participants described sexual worldview as "sexual beliefs", "sexual perceptions", and "sexual behaviors". The interpersonal relationship consists of "changes in postpartum interpersonal relationships" and "supportive role of the husbands/partners". The last one, postpartum sex storm, has three categories including "direct changes in sexual life", "indirect changes in sexual life", and "resumption of sexual intercourse". Differences between the two cultures were identified in some subcategories such as "sexual interests", "comparable to the first intercourse in life", "negative sexual behaviors of husbands/partners", "positive sexual behavior of mothers", "helping with child care and housework", and "emotional support".

CONCLUSION

New mothers explained postpartum sexual quality of life as a three-theme phenomenon. Although most results were similar in both cultures, there were some differences. Our study's results suggest that sexual quality of life is a topic that encompasses international as well as cultural aspects.

Effect of social media-based psychodrama therapy on reduction in symptoms of postpartum depression in women with first birth experience: The contributing role of spousal support

We aimed to examine the impact of social media-based psychodrama therapy in reducing postpartum depression symptoms in first-time mothers. We conducted this study using a quasi-experiment with the use of pretest, posttest and follow-up evaluation after six months. We found a significant main effect of social media-based psychodrama therapy in reducing symptoms of postpartum depression in women F(1,503)= 713.413, p = 0.001, eta squared .441. We also found that this relationship is moderated by spousal support like physical, emotional and social support. Additionally, our results showed that first-time mothers experience PPD symptoms after childbirth more than experienced mothers. We equally found that psychodrama contributed in reducing symptoms of PPD in experienced mothers more than in first-time mothers. The implication of our result is that first-time mothers require more attention to assist them to recover from PPD symptoms than their experienced counterparts.

[An Analysis of the Resumption of Sexual Intercourse and the Occurrence of Dyspareunia Post C-Section]

Schwangerschaft und Geburt eines Kindes stellen eine prägende Erfahrung mit Auswirkungen auf das Körpergefühl und die Sexualität einer Mutter dar. Dabei wird in der Literatur bereits ein Einfluss des Geburtsmodus auf die postpartale Sexualität diskutiert. Ziel dieser Studie ist es nun, die Wiederaufnahme von vaginalem Geschlechtsverkehr (vag. GV.) und das Auftreten einer Dyspareunie in Abhängigkeit von primärer vs. sekundärer Sectio zu untersuchen. Ebenso werden ein möglicher Einfluss des Stillens, der (Still-)Amenorrhoe und hormoneller Kontrazeptiva auf die Wiederaufnahme des vag. GV näher evaluiert.

Methodik Von Oktober 2019 bis Juni 2020 wurden 525 Frauen nach erfolgter Sectio für eine prospektive, multizentrische Studie zur Erhebung von Häufigkeit und assoziierten Beschwerden bei einer Isthmozele drei (3 M. pp.) und sechs Monate postpartal (6 M. pp.) rekrutiert. Im Rahmen dieser Studie wurden die Studienteilnehmerinnen zudem mittels Fragebögen zur Wiederaufnahme des vag. GV, zum Stillen und zu potentieller Symptome wie „Dyspareunie“ und „Unterbauchschmerzen“ befragt. Eingeschlossen wurden Frauen im Alter zwischen 18 und 40 Jahren, mit Einlings- oder Geminigravidität, ohne Plazentationsstörung.

Ergebnisse 66,4% der befragten Frauen gaben 3 M. pp. an wieder vag. GV aufgenommen zu haben, zu 6 M. pp. 79,7% (p<0,001). Unter Einbeziehung des Sectio-Modus (primär vs. sekundär) ergab sich weder ein signifikanter Unterschied bezüglich der Wiederaufnahme von vag. GV (Aufnahme vag. GV: 3 M. pp. p=0,843, 6 M. pp. p=0,236) noch bezüglich einer Dyspareunie (3 M. pp. p=0,645, 6 M. pp. p=0,187). 6 M. pp. litten 41,5% der Frauen nach primärer Sectio unter einer Dyspareunie und 50,0% nach sekundärer Sectio. Interessanterweise zeigten sich „Stillen“ und „Ausbleiben der Regelblutung“ als signifikante Einflussfaktoren auf das Auftreten einer Dyspareunie 3 und 6 Monate postpartal (Stillen: 3 M. pp. p<0,001; 6 M. pp. p=0,010; Regelblutung: 3 M. pp. p<0,001; 6 M. pp. p=0,006). So zeigte sich bei Frauen, die stillten, häufiger eine Dyspareunie. Ebenfalls häufiger trat eine Dyspareunie bei Frauen auf, die „Ausbleiben der Regelblutung“ angaben. Die logistische Regression ergab 3 M. pp. für Frauen, die nicht mehr stillten, ein geringeres Risiko für eine Dyspareunie (OR=0,46; 95%-Konfidenzintervall: 0,26–0,83; p=0,010), sowie ein höheres Risiko für das Auftreten einer Dyspareunie bei Ausbleiben der Regelblutung (OR=1,98; 95%-Konfidenzintervall: 1,15–3,43, p=0,014). 6 Monate postpartal ergaben sich diese Zusammenhänge in der logistischen Regression nicht mehr.

Schlussfolgerungen Auch wenn sekundären Sectiones oftmals verzögerte Geburtsphasen vorangehen und der Eingriff unter erschwerten Bedingungen durchgeführt werden muss, zeigt sich in dieser Studie kein Einfluss auf die postpartale Sexualität. Eine (Still-)Amenorrhö wurde hingegen als Faktor identifiziert, der vermehrt zu einer Dyspareunie führen kann.

Effect of the maternal childbirth experience on a subsequent birth: a retrospective 7-year cohort study of primiparas in Finland

OBJECTIVE

To study the effect of the childbirth experience on the likelihood and interval to a subsequent live birth.

DESIGN

Retrospective analysis of a 7-year cohort.

SETTING

Childbirths in Helsinki University Hospital delivery units.

PARTICIPANTS

All parturients giving birth to a term and living baby from a single pregnancy in Helsinki University Hospital delivery units from January 2012 to December 2018 (n=120 437). Parturients delivering their first child (n=45 947) were followed until the birth of a subsequent child or the end of 2018.

MAIN OUTCOME MEASURE

The interval to a subsequent childbirth connected to the experience of the first childbirth was the primary outcome of the study.

RESULTS

A negative first childbirth experience decreases the likelihood of delivering a subsequent child during the follow-up (adjusted HR=0.81, 95% CI 0.76 to 0.86) compared with those experiencing the first childbirth as positive. For parturients with a positive childbirth experience, the median interval to a subsequent delivery was 3.90 years (3.84-3.97) compared with 5.29 years (4.86-5.97) after a negative childbirth experience.

CONCLUSION

The negative childbirth experience influences reproductive decisions. Consequently, more focus should be placed on understanding and managing the antecedents of positive/negative childbirth experiences.

The Effect of Type of Delivery on Female Postpartum Sexual Functioning: A Systematic Review

Female sexual function could be considered as multifactorial. Specific physiological structures and hormonal fluctuations postpartum, along with the psychological adjustment of women, could result in altered sexual function. The primary aim of this review was to systematically appraise the existing data on the effect of mode of delivery on female sexual function. This review was designed based on the PRISMA statement guidelines. An extensive literature search was performed in the Pubmed, Scopus, and PsycInfo databases, using prespecified inclusion/exclusion criteria, between the 20 September and 10 October 2021. Studies’ quality assessment was conducted using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. The initial search involved 1592 studies. The last step of the screening procedure yielded 16 studies, including 41,441 subjects with a mean age of 29.9 years. Studies included groups with spontaneous and assisted vaginal and C-section delivery modes. No statistically significant difference between groups was found. The type of delivery appears to be irrelevant regarding this relationship. Moderating factors seemed to indirectly influence this relationship. Health professionals should educate expectant mothers and be aware of the possibility that delivery method could affect sexual function.

Patient-Reported Health Outcomes and Quality of Life after Peripartum Hysterectomy for Placenta Accreta Spectrum

OBJECTIVE

Short-term morbidity of placenta accreta spectrum (PAS) is well described, but few data are available regarding long-term outcomes and quality of life. We aimed to evaluate patient-reported outcomes after hysterectomy for PAS.

STUDY DESIGN

This is a prospective cohort study of women with risk factors for PAS who were enrolled antenatally. Exposed women were defined as those who underwent cesarean hysterectomy due to PAS. Unexposed women were those with three or more prior cesareans or placenta previa, but no PAS, who underwent cesarean delivery without hysterectomy. Two surveys were sent to patients at 6, 12, 24, and 36 months postpartum: (1) a general health questionnaire and (2) the SF-36, a validated quality of life survey. Aggregate scores for each questionnaire were calculated and responses were analyzed.

RESULTS

At 6 months postpartum, women with PAS were more likely to report rehospitalization (odds ratio [OR] 5.83, 95% confidence interval [CI] 1.40-24.3), painful intercourse (OR 2.50, 95% CI 1.04-6.02), and anxiety/worry (OR 3.77, 95% CI 1.43-9.93), but were not statistically more likely to report additional surgeries (OR 3.39, 95% CI 0.99-11.7) or grief and depression (OR 2.45, 95% CI 0.87-6.95). At 12 months, women with PAS were more likely to report painful intercourse, grief/depression, and anxiety/worry. At 36 months, women with PAS were more likely to report grief/depression, anxiety/worry, and additional surgeries. Women with PAS reported significantly lower quality of life in physical functioning, role functioning, social functioning, and pain at 6 months postpartum, but not in other quality of life domains. Decreased quality of life was also reported at 12 and 36 months in the PAS group.

CONCLUSION

Women with PAS are more likely to report ongoing long-term health issues and decreased quality of life for up to 3 years following surgery than those undergoing cesarean for other indications.

KEY POINTS

· Long-term placenta accreta spectrum data to guide peripartum patient education.. · This study addresses a critical knowledge gap.. · Women affected by PAS report long-term morbidity..

Putative Mental, Physical, and Social Mechanisms of Hormonal Influences on Postpartum Sexuality

Purpose of Review

Much research has documented changes in postpartum sexuality, including changes in sexual functioning and satisfaction for both the birthing parent and their partner(s). These changes are often linked to postpartum changes in hormonal and immune responses, which can have both direct and indirect effects on sexuality.

Recent Findings

Here, we review how postpartum sexuality may be changed via mental, physical, and social/relationship effects of a variety of hormones, including estrogens, progestogens, androgens, cortisol, and oxytocin. We also review the ways in which inflammation may act alongside hormones to influence postpartum sexuality.

Summary

We argue that, as each of these factors strongly influence the action of others, the next phase of research in postpartum sexuality must examine the bidirectional interactions of hormones and their effects on behavior, cognition, and social relationships.

[French linguistic validation of the Index of Sexual Satisfaction (ISS)]

INTRODUCTION

The objective of this study was to propose a French version of the Index of Sexual Satisfaction (ISS).

MATERIAL AND METHOD

The translation from English to French of the ISS was performed independently by three pediatric surgeons whose mother tongue is French. Then, an English speaker, fluent in French, who was unaware of the original questionnaire, translated the reconciled French version of the ISS into English.

RESULTS

The final French version was successfully tested on 25 French-speaking volunteers.

CONCLUSION

We present a validated translation of the Sexual Satisfaction Index.

Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women's Postpartum Sexuality

BACKGROUND

Sexual health has been identified as an important factor for postpartum quality of life. Although pregnancy-related changes in anatomy and metabolism return to their prepregnancy state, female sexual function may not be at the level it was before birth because of physical and psychological changes.

AIM

The goal of our study was to explore the influence of the mode of delivery, perineal injury, and peripartum expectations on postpartum sexual function.

METHODS

Between 2013 and 2018, 522 women were enrolled in this prospective investigation. At time of recruitment during the peripartum hospitalization, patients completed a standardized questionnaire addressing expectations concerning postpartum sexuality with focus on expected influence of the mode of delivery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and Sexual Activity Questionnaire (SAQ) at time of recruitment to evaluate baseline sexual function (4 weeks before pregnancy). Follow-up assessments were conducted at 3, 6, and 12 months postpartum.

OUTCOMES

Peripartum expectations, influence of the mode of delivery, and perineal injury were analyzed for their impact on women's sexual function within 12 months postpartum by repetitive FSFI and SAQ assessments.

RESULTS

A total of 522 women with 263 spontaneous vaginal deliveries, 41 operative vaginal deliveries, and 218 cesarean sections were analyzed. Although the data demonstrate a significant postpartum decline in sexual function at 3 and 6 months postpartum, sexual functioning converges to baseline prepregnancy values 12 months postpartum. This observation was independent of the mode of delivery and perineal injuries with no significant between-group differences at any of the analyzed time points. Apart from breastfeeding, for which negative anticipations resulted in impaired sexuality, women's expectations (pertaining to quantity and quality of female orgasm, partner's sexuality, fear of altered sexuality, frequency of intercourse, the mode of delivery) do not influence female sexual function at 12 months postpartum.

CLINICAL IMPLICATIONS

Deciphering the potential influence of patient expectations as well as pregnancy- and childbirth-related aspects on female postpartum sexuality will help in the effort to improve women's postpartum sexual health.

STRENGTHS & LIMITATIONS

As a strength of this study, postpartum sexuality was independently assessed with 2 different scoring systems (FSFI and SAQ). Limitations include that our follow-up is incomplete and amounts to about 2-thirds of patients who were initially recruited.

CONCLUSION

The mode of delivery and perineal trauma do not influence women's postpartum sexual function. With the exception of breastfeeding, peripartum expectations do not result in altered sexual functioning at 12 months postpartum. Spaich S, Link G, Alvarez SO, et al. Influence of Peripartum Expectations, Mode of Delivery, and Perineal Injury on Women's Postpartum Sexuality. J Sex Med 2020;17:1312-1325.

The childbirth experience: obstetric and psychological predictors in Italian primiparous women

BACKGROUND

The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psychological variables on women's subjective experience of childbirth.

METHODS

111 primiparous Italian women completed a set of questionnaires at 38-40 weeks of pregnancy (Time 1) and 1-5 days after childbirth (Time 2). Sociodemographic and obstetric information were collected. Data about the childbirth were obtained from the mother's ward birth records. Women completed the Wijma Delivery Expectancy/Experience Questionnaire both before and after childbirth.

RESULTS

The subjective experience of birth was significantly predicted by the duration of the expulsive phase (β = .26; p < .05), the use of epidural analgesia (β = .21;  p< .05) and by fear of birth (β = .21; p < .05). The effect of mode of birth and duration of the dilatation phase on women's birth experience was not found.

CONCLUSIONS

In our study, neither instrumental childbirth nor caesarean section have a significant effect on women's birth experience. Instead, both a longer expulsion phase and epidural analgesia contribute to the negative experience. Moreover, the higher the fear of birth, the worse the women's emotional experience. These findings confirmed the role of obstetric and psychological variables on birth experience. More investigation about this topic could be useful to develop specific interventions to prepare women for birth.

Understanding women's postpartum sexual experiences

This study aimed to understand women's sexual health experiences, specifically knowledge, attitudes and norms related to sexual behaviour resumption during the postpartum period. Semi-structured, reproductive health-focused interviews (N = 70) were conducted among women aged 18 years or older (range: 19-78) residing in South Carolina. Findings demonstrated that women identified clinicians as most influential concerning when they should and could resume sexual activity. Some women noted returning to sex earlier than anticipated due to personal and partner desire and indicated achieving considerable sexual satisfaction during the postpartum period. However, other participants noted difficulties resuming sexual activity, including pain and exhaustion from caring for a new baby. Findings provide practical recommendations for health professionals to further develop tailored, timely health messaging related to safe and healthy postpartum sexual behaviours. We discuss recommendations for health professionals to bring further awareness to varied postpartum sexual experiences.