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Postpartum

Following doctor’s orders

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I love when little statistics pop out at me when I am reading medical journals. My most recent experience: in one study, post partum women were instructed to abstain from sexual intercourse until 6 weeks post partum. Of these women, 45% had unprotected intercourse before that time. So, basically, 45% of women did not follow the instructions of their doctors.

I tell my patients the same thing as this study. My usual instructions (said in front of their partner, if at all possible): “no intercourse until you see me at your post partum visit in 4-6 weeks”.

You have an increased risk of infection if you put anything in your vagina after childbirth (that includes tampons, fingers, penises). Your cervix is open from giving birth, your uterus is enlarged, and your vagina likely has tears, even if they are small. This increased risk decreases with time. To my knowledge, the time frame of increased risk is not exactly known: some people say 1-2 weeks and your risk is back to baseline, and some say 4-6 weeks. I err on the side of 4-6 weeks for the reasons below as well.
By your post partum visit, your vagina should be well on its recovery path. Those stitches and tears should be healed. I do a full exam to double check and then give the green light to resume normal activity again (any sort of exercise and activity, and that includes intercourse).

Additionally, you can ovulate as early as 25 days after delivery. Ovulation = possibility of getting pregnant with intercourse. You need birth control if you don’t want to get pregnant again (please say you already know this!). Your post partum visit can be a good time to decide on a type of birth control, and some types of birth control (like pills) are not ideal before that time anyway. If you have had unprotected intercourse, it can be several weeks before you can verify you are not pregnant again, which can post pone the use of birth control even longer (you shouldn’t start taking birth control pills if there is a real chance you are already pregnant, obviously).

So overall the safest way to allow your body time to heal, decrease risk of infection, and not get pregnant? Abstinence.

It’s for a brief period of time. You can do it, I know you can!
Sources: Brito MB, Ferriani RA, Quintana SM, Yazlle ME, Silva de Sa MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception 2009;80:519–26

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Jul 31, 2012

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