Sexual life after childbirth and aspects of midwives´counselling at the postnatal check-up

Sammanfattning: The overall aim of this thesis was to explore and describe how sexual life after childbirth is communicated, addressed and reflected upon among new mothers, fathers and midwives and the impact of leaving first and minor second degree tears after childbirth unsutured. Specific aims were to compare two groups of women with minor lacerations (first and second degree) after a vaginal delivery, with respect to the healing process and experience when the lacerations were sutured or left to heal spontaneously (I); to elucidate women s experience of their sexual life after childbirth (II); to describe fathers' reflections about sexual life 3-6 months after the birth of their child (III); to describe midwives reflections on counselling women at their postnatal checkups, with a special focus on sexuality (IV). Methods: Study I: A randomised controlled trial (RCT) with 80 term pregnant primiparas with minor perineal lacerations of first and second degree, were randomised in to nonsutured (experimental group) and the control group (sutured) in the study after childbirth in 1997-1998. A follow up examination was performed at 2-3 days and 8 weeks after delivery, with observation protocols and questionnaires and at 6 months after delivery with only a questionnaire. Study II: Twenty-seven women participated in six focus group discussion (FGDs), 3-24 months post delivery. Study III: Five men participated in two FGD and five interviews that were tape recorded and transcribed verbatim. Study IV: Thirty-two midwives participated in five FGDs. The discussions were tape recorded and transcribed verbatim. Descriptive statistics were used to analyse quantitative data (study I) and content analysis were applied to qualitative data (study II-IV). Results: Study I: Minor lacerations (first and second degree) could be left to heal spontaneously or sutured according to the choice of the woman. The lacerations healed within the same time frame and with similar amount of discomfort but the type of pain differed. Sixteen percent of the women in the sutured group, but non in the nonsutured group (p=0,0385), considered that the laceration had had a negative influence on the breastfeeding. Study II: Women s thoughts about sexual life after childbirth were represented by four themes; stresses of family life alters sex pattern, discordance of sexual desire with the partner, body image after childbirth and reassurance. The women did not feel comfortable with the physical changes that had taken place and their body image and that as well as fatigue affected sexual desire after childbirth. Study III: Men s thoughts about sexual life after childbirth were represented by one overarching theme; transition to fatherhood brings sexual life to a crossroads and three categories; struggling between stereotypes and personal perceptions of male sexuality during the transition to fatherhood ; new frames for negotiating sex and a need to feel safe and at ease with sex in the new family situation . To get sexual life working, issues as getting involved in the care of the baby and the household and getting in tune with their partners had to be resolved in regard to sexual desire. Tiredness and lack of time due to the baby altered sexual activity and made men prioritise sleep rather than to have sex. Study IV: Midwives reflections on counselling women at their postnatal visit were represented by two themes, the first Balancing between personal perceptions of the woman s needs and health system restrictions with two categories; Forming a picture of the woman coming for the postnatal visit guided the counselling and Lack of knowledge and time-limits restricted the counselling about sexual life after childbirth . The second theme; Strategies for counselling about sexual life after childbirth , included another two categories, Task-oriented approach in counselling about sexual life after childbirth and Getting in tune to approach the topic of sexual life after childbirth . The midwives tried to identify distinctive features related to the woman s childbirth experience. The strategies used to individualise the visit depended on the context and how the midwife understood the woman s problems (IV). Conclusions: The results of this theses suggest that midwives and other health care providers should invite/initiate discussions on sexuality during pregnancy and postnatally. The midwives own cultural and gender reference points influence their approach toward the mothers and fathers when counselling. Midwives need to be aware of the diversities within female and male sexuality, develop their knowledge around what factors that influences the view and 'norms' about sexuality and gain insight into there own values and assumptions about sexuality. Counselling about health requires a positive and respectful approach to sexuality and sexual relationships.