89. How Breastfeeding Impacts Sexual Desire with Dr. Rachel Ollivier
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“I always say sexuality is an evolution throughout the lifespan and postpartum is no different,” says Dr. Rachel Ollivier. Dr. Ollivier is a Nurse Practitioner and clinician scientist, who practices both women's cardiac health and complex gynecology. In this episode, I chat with Dr. Ollivier about sexual health after birth. We discuss what impacts sexual health after birth, the fear of pain when returning to sexual activities postpartum, and the impact of birth on body image.
Episode outline:
Sexual health after birth
What impacts your sexual health after birth
Your identity of being a mother and being a sexual being
Body image after giving birth and how that impacts your
How the meaning of your parts of your can change after giving birth (i.e breasts)
The fear of pain when returning to sexual activities after birth
Using masturbation to learn what feels safe and comfortable before returning to sex, taking agency with their body to get to know their bodies again
Postpartum recovery - the importance of getting help and not thinking my body will always look and feel this way after giving birth
Taboo of masturbation for females
Pressure from your partner to have sex
Redefining intimacy and emotional closeness postpartum
Breaking down the idea of what ‘normal’ sex looks like,
Redefining what sex and pleasure actually means to you
How can people cultivate emotional intimacy if they're used to having physical intimacy as the main event?
The six week check - is it a one size fits all?
✨This episode is sponsored by Embodia https://www.embodiaapp.com/ - use code momstrength to save $20 off your first month’s Tier 3 membership.
✨Click here to learn more about How I use Embodia as a Pelvic Physiotherapist!
About Dr. Ollivier:
Dr. Rachel Ollivier is a Nurse Practitioner and clinician scientist based at BC Women's Hospital, where she practices in both women's cardiac health and complex gynecology. She completed her PhD at Dalhousie University in 2022 and received her Primary Health Care Nurse Practitioner Diploma from Queen's University in 2023.
Her doctoral research aimed to explore sexual health after birth, which is her area of expertise and what she's here to talk to us about today! Dr. Ollivier continues to be a courageous advocate for maternal and women's health both locally and globally and has also received numerous awards for her work, which most recently included being named one of North America's Top 25 Women of Influence.
Connect with Dr. Ollivier:
—Twitter: @raollivier
Connect with Surabhi:
Website: https://www.thepassionatephysio.ca
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Surabhi: [00:00:00] Hi everyone, and welcome back to another episode of Mom Strength. This is your host Surabhi Veitch and I'm really excited to have on today Dr. Rachel Olivier. Um, Rachel and I, Rachel and I connected on through email actually, and she shared with me her research, um, and I was like, this is something that my audience really needs to hear about.
She's a nurse practitioner and a clinician, clinician scientist. Based at BC Women's Hospital. So for those of you who are not in Canada, BC is British Columbia. It's in the western part of the country, um, where she practices in both women's cardiac health and complex gynecology. She completed her PhD at Dalhousie University.
In 2022 and received her primary healthcare nurse practitioner diploma from Queens in Ontario, Queens University in 2023. Her doctoral research aimed to explore sexual health after birth, which is her area of expertise in what she's here to talk to us about today. Dr. Olivier continues to be a courageous advocate for maternal and women's health, [00:01:00] both locally and globally.
And has also received numerous awards for her work, which most recently included being named one of North America's Top 25 Women of Influence, which is incredible. Congratulations on that. Welcome to Mom Strength. Um, how are you doing today?
Rachel: I am doing very well. Thank you, Surabhi, and thank you for having me.
Surabhi: So let's get right into it now. Your research is focused on focused on sexual health after birth. Um, can you talk about some of the components, components of health, um, after birth and some of the components that influence sexual health after birth?
Rachel: There really is such a spectrum of, you know, factors and things that influence sexual health after birth.
And what my research really showed was how those facets, you know, really can be. Coming from kinda that physical component, the emotional, the relational, the social, all those pieces fall into it. And when we look at the World Health Organization's definition of sexual health more broadly, it [00:02:00] includes those components that go beyond the physical as well.
Surabhi: Amazing.
Rachel: So in my research, there really were different themes that kind of touched on each of those, um, those aspects of, of sexual health, some of which included body image and how that was very connected not only to identity. About how the meaning of the body shifted and certain body functions shifted.
There's that red, you know, redefining emotional intimacy and what that looks like for people, whether it included sexual activities or not. That was something people really redefined in their relationships. And then we also saw more of the medical, the institutional, that piece with the six week mark, I.
The meaning that people ascribe to that and how that also very much varies. So there is again, a spectrum in terms of people's experiences when we look at, you know, breastfeeding at the relationship with, you know, your partner if you're in a relationship. Um, and just all those changes that are happening and sort of navigating not only kind.
This, you know, now, um, experience of being postpartum, but all the changes that that [00:03:00] means in terms of, you know, being a parent and, and navigating that role and that identity of Yes. You know, being a mother and a parent and also a sexual being, uh, so excited to kind of get into things more today. But that, yes, the synopsis, I if you would say of, of, uh, main findings.
Surabhi: I'm so excited that you mentioned that you know, the role of being a parent or mother and a sexual being, because so often, I know for myself personally, you see it as one or the other. You see yourself as a milk producing, producing machine that this baby's latched onto at all hours of the day and night.
Or you see yourself as sexual maybe when you dress up and you go out for a date night. And so seeing yourself as both is a, it's. It's important, but it's sometimes hard to navigate. So let's talk about maybe one of the first most obvious things is body image postpartum and how that changes and how that can influence, um, your libido and [00:04:00] your, just your feeling of feeling sexy in your body, um, and your desire.
Rachel: Absolutely. And with the body image piece, you know, a lot of people in my research talked a lot about, you know, of course we think of abdominal changes or breast changes, weight changes after birth. And it was also kind of one where, again, the example comes up of how, you know, identity as a mother and identities as sexual being, I think often in society.
It positioned as being an opposition to one another again, then therefore creating this assumption that you can't be both. And a lot of people said, Hey, you know, I am a mother. I'm still a business owner. I'm still a this, I'm still a, that all these roles were still part of how people define themselves.
Mother was one that was added to that list. And it's an important role. Right, but it only role, it doesn't replace the
Surabhi: other things.
Rachel: Exactly. It wasn't their only role. And so same with kind of the body. It's sort of like, okay, I'm using my body in different ways now. People might be breastfeeding, things might look different, they might feel different.
So in terms of the [00:05:00] body itself, I think a lot of people are sort of navigating. Okay, what are my expectations around this? You know, it's not necessarily that I wanna be, look like I did pre-pregnancy, you know, it wasn't necessarily something that they were expecting. Um, but in terms of say the function of the breasts, it was for some, a lot of, just like, I remember one saying, she said, you know, right now my breasts are for my baby and not so much for my husband.
I feel. Like a bit of a cow right now. She used that word. Oh, absolutely. Yeah. Um, but it is, and you know, at times you can feel touched out as well, where, you know, at the end of the day, just even having time alone with no hands on you is nice. Yeah,
Surabhi: yeah.
Rachel: Um, so that really is again, something where the breast, you're having kind of these new sensations often.
Another thing we don't talk about as well with the body is, you know, for some people, um, feelings of kind of arousal during breastfeeding, you know, those cuddle hormones coming in. Um, so things like that can, again, are normal, but we don't talk about it. So it's one of those things that's like, see,
Surabhi: I've heard of that happening.
Didn't happen to me personally, but I've heard about that happening. And yeah, there's so much taboo even [00:06:00] around that. And it, it makes sense from, you know, your breasts are being stimulated, your nipples are being stimulated. But at the same time, I also don't want people to assume that breastfeeding is sexual in any way.
Like, you know, it is a yes, yes, we, our breasts can be sexy, but they can also be milk producing. For our babies nurturing. Yes. So it can be both. Um, and I, I was like, nobody's touching my nipples. 'cause anytime anyone would come close, the milk would spurt out and it would just be a mess. And you know, that does, I found that it challenge what I would consider as sexual touch and forced us to be more creative or find different ways to connect even physically that didn't involve the same type of touch it did.
Prior to, you know, having my child, my children. So that's something that I think is really important to, um, address is like, yeah, the breast changes, the belly changes for people with pelvic floor, um, [00:07:00] perineal tears. That's a huge area of self consciousness around that as well. I don't know if your research went into any of that.
The pelvic changes postpartum.
Rachel: Absolutely. Some people talked about that for sure, and I had a few who had, you know, more severe degrees of tearing Yeah. Uh, sort of in the th third or fourth degree categories. And, um, it was absolutely something that I think with that there was sort of this shift of, okay, I see my vagina as something that sort of gave birth to the baby.
And, you know, my Volvo, my vagina, my pelvic floor. As having that function now. So then it was sort of returning to, okay, this also can be something that I can feel pleasure from, right? Rather than having it be, again, the whole childbirth experience, which is as we know very, you know, very painful, can be traumatic, um, both physically and emotionally.
So, um, that was one shift that happened for people was okay, the meaning of, you know, of that part of the body and the function of that part of the body, the multiple functions it can have. Um, and also navigating pelvic floor recovery for some was [00:08:00] absolutely on their mind because. You know, for some it was difficult.
I talked to a few who were kind of at the six month mark and still having quite a bit of pain and you know, for one it was sort of, she said, you know, I still wanna have children. Like that's my concern right now is not even the sexual activity part, but I need to be able to, you know, have sex to so I can have another child.
Yeah. So that, that was where her mind was. Yeah. And um, for others it was. Again, navigating, you know, getting care and knowing what to ask for, or not knowing what to ask for, depending on if it was kind of their first time having a baby, their second time having, um, a baby and knowing kind of what they needed around that.
Mm-hmm. Um, but you know, we're seeing it expand where now we're talking about pelvic floor, which is so wonderful. Um, but still those expectations can kind of again, be, be shifted for sure. So there was, you know, that and then. The feeling of fear a little bit. People talked about that of being fearful of pain.
Yeah. Um, when returning to sexual activities after birth. So one thing that people talked about in my research, um, was actually using [00:09:00] masturbation as a way to kind of learn their bodies in a way that felt safe, that felt comfortable, um, you know, even before necessarily engaging sexually with their partners again.
That was a way that some people kind of said, okay, you know, this is really helpful for me to just see where we're at. Um, and rightly so, right? It's again, that fear of pain is absolutely, you know, you can, you can see that's, again, this has been a lot of changes. So, um, that was, I think a way that was very interesting in terms of yeah, how people sort of navigated that and took agency and, and got to know their bodies again.
Surabhi: That's fantastic. I definitely, and this is kind of a, a plug for pelvic floor physiotherapy during pregnancy, even prior to conception, if you want, if you want that. Yes, absolutely. Um, because I find that the clients that I've worked with during pregnancy tend to have better. Birth outcomes in terms of re reduced risk of tears, even if they have a C-section or an emergency C-section, they've already practiced connecting to their core and pelvic floor.
We've had some of these conversations during [00:10:00] pregnancy, so it doesn't come as a shock postpartum, and so I. If they do have any tears that they're dealing with postpartum, they also know that this isn't how it's always going to be. Sometimes when you're dealing with it, dealing with all of this by yourself, without any support, you think, oh my gosh, this is how my vagina looks at three months postpartum.
It's how it's always gonna look and feel. It poops. Or when I'm, uh, pooping, it hurts. So it's always gonna hurt when I'm pooping, when I, you know, touch my clitoris, it hurts or I don't feel anything. It feels numb. It's always gonna feel like this, and. Through pelvic floor physiotherapy virtually or in person.
I work with clients all over the world virtually as well. There's so much progress we can make. And so I love that from, even from what your research is sh saying, there are people who are six months postpartum that are still experiencing these issues. So it's not just a first few weeks postpartum thing.
This is a longstanding, it can persist into the first couple years postpartum and, and even more if you've never gotten help. Um, and masturbation is such [00:11:00] a. It's an interesting topic because some of, many of the people that I work with, they have never masturbated or they, they find that it's uncomfortable to talk about because they think that there's something inherently wrong with it, but only if they're female.
For males, masturbation is totally normal, right? It's normalized in our society and for females, it's not. There's almost a sense of sex is for my partner. Sex is something that my partner does to me. It's not something that I can do for myself. And there, this ties into the cultural part. I don't know how much, um, your research considered that, you know, just the cultural influences or religious influences of perceptions of masturbation or self touch, um, or self-pleasure because the people who are unable to or unwilling to explore self touch.
It took a little longer getting better because their, their partner is having to do all that work for them rather than them having to do that, that [00:12:00] initial legwork. Right.
Rachel: Absolutely. It is, it brings up, I mean, again, an important conversation in society, more general, um, but also power of that personal knowing.
And that was one of kind of the sub-themes in this work as well, was that theme of trust your gut. So even though kind of, you know, they were having certain messages from say, society or their healthcare provider or whatever it was. There was still that theme of, okay, I know my body best. At the end of the day, you're the only one who can feel what that's like and who has that sensation.
And with that it it is, but it can be difficult because it's, again, it comes into so much. Um, we don't talk about these things enough pregnancy, you know, prior to pregnancy, postpartum, as you're saying. And it is, it's so powerful having, you know, for the participants who did seek pelvic floor physiotherapy, their experience with that was so positive.
Because not only did they give them information about their bodies, but they felt it was really powerful. Being able to kind of have that assessment of, okay, this is exactly where perhaps the issue is or [00:13:00] where the weaknesses mm-hmm. Or
Surabhi: why I have pain here,
Rachel: or why exactly. And it validates that experience.
Yeah. And gives them tools to, you know, again, be able to see the light at the end of the tunnel in a way. Um, especially those postpartum days where there's so many ups and downs and Yeah, it's, it's something that really everyone found was so positive. Um. In terms of their experience. So it's, yeah, I, I support it to the end of the earth.
Surabhi: I know, I, and I wish it was more accessible to everyone. Right. And um, you know, right now in Canada there is no, like I know in some countries there's like six physio, you know, pelvic physio sessions. Postpartum public,
Rachel: public funded. Yeah.
Surabhi: Publicly funded. Here it isn't. Um, I'm actually applying for a grant to see if I can do some prenatal education.
'cause I think that. Like what you're saying, the education and empowerment of like, this is what's happening. The knowledge of understanding helps ease some of those fears. Um, especially postpartum when you're so sleep deprived. Every small worry can [00:14:00] seem huge when you're not sleeping well. So having someone remind you that, okay, this is normal for where you're at, but this will improve, this is how it's going to improve, can help.
Ease some of those worries. Can you talk about some of the relationship stuff? Because I know that many people are concerned if I don't give my, you know, spouse this, you know, sex three times a week or once a week, or whatever it is, you know, I'm a bad wife or I'm a bad, uh, you know, yada yada, and this, you know, they might go seek this elsewhere.
Like there's this societal pressure I've never felt in my relationship and I think that if you felt that in your relationship. There's some issues there or there's some societal issues there that are, you know, stimulating those types of thoughts. But what, did anybody share any thoughts around that in the research that you've done?
Rachel: They did. And with that it was about really define, redefining kind of what intimacy looked like to them. So we know, and it's well evidenced in the literature [00:15:00] that generally there is a decrease in sexual desire after birth. Um, but what the participants in this study showed that was new was how they redefined intimacy within their relationship and still valued intimacy.
So that emotional connection. For the people I interviewed was still very important as is, was maintaining that emotional closeness and connection with their partners. However, they redefined kind of what that looked like for them and it didn't necessarily need to include sexual activities, which is kind of something that again was, you know, shifting after, after, you know, from pre-pregnancy to postpartum.
And it was something that kind of, it was a way of them ensuring that their needs were met while also, you know, respecting their boundaries and kind of the time that they needed or whatever that was. Um. I remember one participant really kind of honing in on that and she said, you know, I think for some, you know, people, she said, I would be embarrassed to say, you know, we're at two months and we haven't had sex yet because people naturally assume that there's something wrong with the relationship or there's something wrong with me.
Yes.
Surabhi: Yeah.
Rachel: That was really powerful [00:16:00] because she really illuminated some of those social discourses that exist and persist in society about what's expected within relationships. You know, we have these discourses that shape sexual activity. Sexual intercourse is sort of the best way or most valid way of, um, you know, being intimate or showing affection.
Um, and that's not necessarily true for all people at all stages of life. You know, I always say sexuality is, you know, an evolution throughout the lifespan and postpartum is no different. Um, so I think again, it was really powerful to hear about some of the changes that people made in terms of just redefining how they kind of, again, kept that intimacy, kept that closeness.
Um. But knew that it didn't necessarily need to include sexual activities at that time.
Surabhi: Yes. Um,
Rachel: yeah. So no, it was, it was interesting to hear about it from, from some people for sure.
Surabhi: And that part alone, that like intercourse. Even without intercourse, if you have a vulva, you can experience fantastic, great pleasure.
You don't need intercourse. So if you're, yes, if you have fear of [00:17:00] penetration, if you have scar tissue, you can still have sex that. It is pleasurable for you if you have a partner with a penis and they. You know, typically get off of penetration. There's other ways to have pleasure, even for someone with a penis.
So sometimes I think we live in such a heteronormative socio conditioning of like, this is what sex is like, and unless you've gotten back to penetrative sex, you haven't had sex postpartum. Mm-hmm. And there are people who are having oral sex, you know, they're, they're. Doing other, all sorts of other things, but they still feel unsuccessful as if there's some benchmark or you know, gold standard for what sex is.
And I think that whole piece of redefining intimacy can also be redefining what sex actually means to you and what pleasure means to you. Because let me tell you, it can change through all mm-hmm. Throughout our lives and. For me personally, it's changed through both my pregnancies and both my, after both my babies.
You know, the things that you found pleasurable before, you [00:18:00] may still find pleasurable, but you might find other things more pleasurable now. So, um, there's nothing wrong with that and that's, that's absolutely okay. Um, and I also think that there's this stigma, not stigma, but people don't talk about it.
But because I work with these, this population, most people are not having sex at six weeks postpartum. Yes. Yeah. Most people are waiting for months, three months, six months. Sometimes people are waiting for nine months and that is okay. There's no rush to get back to it. And it doesn't mean your relationship is failing, um, or that it, there's a problem with your relationship.
Right. And can you talk about some of the ways people can cultivate emotional intimacy if they're used to having physical intimacy as the, you know, the main event?
Rachel: Absolutely. And you know, there were kind of examples in my research of, um, people just sharing, you know, even just kind of that flirting, that sense of humor cooking together, uh, having time that was that quality time together.[00:19:00]
Um, being able, one was saying, she said, you know, even when, you know once the babies are down and just having time to just sit together on the couch and silence Yeah. And just talk Yes. Was very nice.
Surabhi: Yeah.
Rachel: Um, and yeah, again, it's sort of just again, sort of keeping that, um. That sense of partnership. I think for a lot of people it was feeling like they had a partner in this experience and, you know, could still have someone to talk to and to, you know, um, do dishes, do laundry.
It's, you know, sounds like it's, again, not, uh, not something very sexy per se, but it, it was that piece of support and feeling supported through everything, so that was important for people. And um, yeah, I remember one kind of joking how she said, yeah, you know, we cook together in the kitchen. That's only my, honestly, my favorite time together is cooking in the kitchen and like spanking each other on the bum.
And that's just, you know, that's how they interact and it's funny and they still have that, you know, again, that show way of showing love and affection to each other. So everyone kind of had different examples that they shared of ways that they're kind of like, oh, you know, I enjoy that. I enjoy that we do that.[00:20:00]
Um, in terms of kind of what was best for them in their relationship. So it's all, yeah, all about kind of, you know, again, the rollercoaster of ups and downs and, um, hopefully being able to laugh at it a little bit as well. So,
Surabhi: yes. 'cause it is, you, you have to have humor, otherwise you're gonna go like nuts.
And yes, there is a sense of, um, there's an expectation that as men, they'll be so, like, not on board with that, right? That they're gonna need sex, otherwise they're gonna like det like. Are understanding, you know, like, again, depends who you're with, but like having these open conversations and sometimes they're too exhausted too 'cause they've been up with the baby, they've been sleep deprived for just as long.
Um, you know, depending on the partnership that you have as parents, you know, there's this expectation that. I don't even, I think sometimes it's people who don't even have children who have this, they have this fear of this is what's gonna happen after having kids. But the reality isn't that, right. The reality is you are, you're in a relationship.
You're [00:21:00] on the same team instead of like one versus the other. You're both working on this. This together. So I, I like that, you know, cooking together, sitting on the couch. I can vouch for that. Sometimes you put the kids to bed and you're like, I just wanna sit for 10 minutes before doing the dishes or folding the laundry or working or whatever else that needs to happen the rest of the day.
Um, okay. So let's talk about this six week check. Why is that a thing in our society?
Rachel: So how and why became a thing is still in a way elusive to me, um, because in the, in the research and in the evidence that we have, there actually isn't a ton of reason for the six week check, uh, medically, besides the fact that it's sort of is something that tends to coincide with when that check is happening for other reasons.
So to assess physical healing, to assess mental health, to assess baby's health, all those things. And it kind of tends to be, again, a convenient time, so to speak, what to bring. [00:22:00] Sexual health up if it comes up at all. So here's
Surabhi: Yeah, that, that too.
Rachel: Here's the, um, if and when it comes up, based on what we know in the literature, it tends to be a conversation about contraception.
And so with the six week check in discussing that in my research, it was interesting how it came up. When people ask me, what most surprised you about your findings? I always say this because it was, it came up when I ask people, what was a moment when you thought about your sexual health postpartum, whether that was, you know, when you were in the shower or in the drugstore, whatever it was, and every single one said, you know what?
Six week check. The six week mark. So it was a really meaningful Yeah, probably because I was like, I don't even remember thinking actually.
Surabhi: Yeah, it's, I'll tell you my story after, but I, I wanna hear, hear what you're saying.
Rachel: Okay. Sounds good. And so it was, I mean, I, not that I expected it to not be a thing, but it was really such a strong theme in the, in the findings.
So, um, with that, the six week check was defined [00:23:00] differently by people, I think. Mm-hmm. For some, it felt like a bit of a deadline. Where it felt rushed, it felt like it was too soon. It felt very arbitrary. That was definitely something that came up in the themes. And for other people it was kind of, you know, I think could feel like a milestone where it was sort of like, okay, we made it this far, we're at the six week mark.
Um, so it could have that positive or kind of more negative meaning to it, and that also shifted as kind of as people made their way through the postpartum period. But Right. Um, the six week check again had that meaning of. I think for some feeling like, okay, am I supposed to be feeling ready because I'm not?
Right. Um, and also navigating kind of that what we call like sort of a bit of a medical discourse or that norm that exists both socially and I think within medical practice as well of sort of seeing the healthcare provider as. Wanting that green, that green check mark, that approval of, okay, things are safe.
People did value that from their healthcare providers. So whether that was, you know, an OBGYN midwife, a nurse practitioner, um, whoever it was, [00:24:00] pelvic physiotherapist. Mm-hmm. They did value that kind of, that green check mark from their healthcare
Surabhi: provider. Yeah. Because you wanna make sure you're not gonna get an infection or you know, that things, things are used.
Yeah. You wanna feel safe.
Rachel: Yeah, exactly. You wanna feel safe. But it was still again, okay, so this is what I'm hearing from my healthcare provider. Back to that theme of trust your gut, this is kind of what I'm feeling, you know, internally, emotionally, or you know, in terms of kind of fear of pain or what, what those things might be.
So it was sort of that navigation of kind of balancing that, which can be difficult when, you know, you're kind of, I remember once you saying, you know, I just really felt going to that appointment, such a sense of dread in a way, or that kind of category of emotions, because she really was like. Please, can I have a few more weeks?
You kind of, it was sort of like, okay, I'm not ready for this. Um, and then, you know, what am I gonna tell my partner? Sort of that was on her mind of, okay, after this appointment, you know, what am I, how am I gonna navigate that conversation also with my partner? Because I feel like that's being expected in a way.
And not that she felt pressured at all by [00:25:00] anybody. Um, it was, it was, but it was just these norms that, these norms, yeah. You know?
Surabhi: Yeah. I find anytime we give numbers. Like, this is what an average baby should weigh. So you know that every mom who has a baby slightly less than the average feels like a failure, right?
Like it's these like, oh, and if you didn't have this, then you, you just automatically are against this benchmark. So there's no six weeks. The, I think the reason the six week check is there is because tissue healing, soft tissue healing on average takes six weeks. But that's it. It's not even, even if you do an internal check as a nurse practitioner or a midwife or an ob, you're not evaluating.
What sexual health sexual penetration will actually feel like. Because unless you're inserting something that's about the average size of a penis or the partner's penis, you actually have no idea. In a pelvic floor physiotherapy examination, we assess deep pelvic fluoro musculature, superficial pelvic floor musculature and endurance strength, mobility, pain, all of those things.
So and so, this is where. Often if you're able [00:26:00] to see a, um, somebody at six weeks postpartum or six to eight weeks postpartum for that internal check that can help you give, that can help you feel a bit more prepared. Um, and the other thing is, many times it's closer to that three month mark, right? And yes, definitely just because six weeks is barely just.
Yeah, barely just scraping the surface. It's if you've had any tearing or any complication.
Rachel: Physical, yeah. Assessment, physical recovery, as you're saying. But the sexual piece, the sexual health piece is totally different.
Surabhi: It is. Yeah. And sexual health is, it's, it's one thing to say you have the all clear on masturbation at six weeks 'cause that's you and that's you and you.
Mm-hmm. But if it's you and a partner, there's so many other layers. Like you've already mentioned the emotional piece. Yes. The, you know, the wellbeing that, that piece as well. I know that for me, the first time I thought about sexual anything was when I was on the, I was on my way to home sense. My husband and I.
He was on, he took Pat leave for the first couple weeks and we were on the way to hol Sinces [00:27:00] buy like a picture frame or something for my newborn's photo. And I'm getting outta the car and I get this call and it's from Toronto public health nurse, and she's like, Hey, um, just wanted to see how you're doing.
I have a questionnaire. I'm like, okay. That's fine. She's asking me these questions like, are you depressed? All right. And I'm like, no. Like, it's so direct that you're like, no, I guess not. Like, but if she had asked me and then she's like, just so you know, um, if you're exclusively breastfeeding, you don't need contraception because that's, um, you know, you can't get pregnant if you're exclusively breastfeeding, which I knew at that point was false, thankfully.
But I'm like, you are gi This was in 20. 18. This was not that long ago. Okay. Yeah. Yeah. So I'm getting a call from a public health nurse telling me that, and that was at like 10 days postpartum, 12 days maybe. I wasn't thinking about sex, and I'm like, is this really the priority of the conversation right now?
Like, yes. Yeah, totally. So it just seems so I think that a better way [00:28:00] to approach it, instead of saying you have the all clear on sex, is asking the person, like, how do you feel about. Your sexuality, is this something you're interested in? Yes. Because that's what I usually ask. And then a lot of the times they're like, nah, not really.
Yeah. And that can be the case for months. And I don't think there's anything wrong with that because we've already identified you're touched out, you're exhausted, you have new demands, but if the person is interested but they're not having sex 'cause of fear, pain, you know, all of these, these other things.
And those are things we can, we can talk about during our session. So, um. Yeah, the anyone who's listening don't feel pressure at six weeks. It's not a benchmark, it's not a gold standard. It's just a guideline. And if you wanna tell your partner that your doctor said no, then that's fine. You can say that.
But I would say it's ideal if you can have an open conversation with your partner that you don't feel ready. And there should not be any pressure if it's, you know, hopefully there's no pressure. And sometimes, um. I've worked with [00:29:00] an sec, or one of the, one of my interviews with a was with an intimacy coach and she works with moms, new moms and it was a really great conversation because she talked about how intimacy does shift postpartum and that many times the men, the male, if there's a male spouse.
Partner doesn't understand that because they haven't experienced that in their bodies. So to them they've, they're experiencing the same things. You are sleep deprivation, exhaustion, but they don't understand all the physical changes that your body's gone through. And often as women, we don't feel comfortable talking about those changes to our partners.
We don't feel comfortable saying, oh my gosh, my loose skin makes me feel so unsexy. We internalize that. We keep it in. So these conversations never come out in the open. So I think that for people who are really, uh, struggling with that, exploring an intimacy coach might be a great idea too.
Rachel: Definitely.
Definitely. Yep. And again, that six week is my main message always is it is not a one size fits all. [00:30:00]
Surabhi: What, um, in your research, I'm curious if you did any interviews on the partners, if they, if the. New moms had partners on like what their view on all this was, or maybe if the people shared themselves, if they had any, um, interactions with their partners and spouses.
Rachel: Some talked about yeah, kind of interactions with their, their partners. I interviewed people who had had a postpartum experience. Um, just in the literature, uh, I'll actually, when there is, you know, research on sexual health after birth, it does actually tend to explore things in the context of couples.
And so I kind of wanted to do something a little bit different and really delve deeper into sort of the individual experience. Yeah. Um, again, not to say the partners are not relevant at all. Yeah. Yeah. Obviously a very important component of it. Um, but yeah, that was, that was my approach in terms of filling the gap.
That was there a bit, but that's true. But absolutely talked about it. Yeah. That's a huge gap, right? Yeah, it is. Yeah. Um, with that, so some people did talk about kind of the interactions they had. All of the participants in my study, [00:31:00] thankfully, did feel very supported by their partners through everything.
Surabhi: That's awesome. Um,
Rachel: and some kind of, yeah, mostly when they did share it, it was sort of about learning to laugh about things. I remember one, uh, sharing a story about. They were sort of re exploring things in terms of sexual activities and um, there was kind of one point where, um, I think his fingers were almost stuck a little bit in terms of, um, internally.
Um, and uh, they were sort of laughing, oh my goodness, we're gonna have to go to EMERG or something like that. Um, they were laughing, but she kind of came up because she was like, you know, my pelvic floor, which is another myth. That I'm sure you've talked about, you know, what, lots with, with clients and on the podcast as well, but um, you know, there's a lot of that tension, that pelvic floor, so much tightness, lesser tension, you know, there as well.
So it was something where just like, yeah, I think his fingers were struck, stuck for a bit and we were freaking out. So, um, yes, again, kind of laughing, um, about things like that. But, um, yeah, it was one, she kind of an example she used to talk about again, that myth that, you know, people. [00:32:00] You know, quote, loose after birth, loose
Surabhi: and wide open.
And you know what? That can happen. But I do see more often than not. While there's a little weakness, there's also tension, there's tightness. And when you just think about it from a standpoint of when you're sleep deprived alone, even if you're just haven't had a baby, you're gonna hold more tension in your body.
Nervous system's gonna be more on edge. Now, add to that, you just had a massive, um, physical trauma that you know. Came through your vagina, um, everything is stretched and now your muscles are trying to heal. Your fascia is trying to heal in the shortest way possible, so it's the quickest possible. So things can be tight.
It can be tight, even with a finger or you know, tampon cup. Yeah, tampon, nevermind penis. So a lot of people postpartum when they finally get their periods, they're like, I don't feel comfortable using tampons anymore, or I just wear pads now. Or they might not feel comfortable with a cup yet. Um, and those are things that we can work on again through pelvic physiotherapy, but such an important.
Factor is laughing about it and just letting it go. Queefing is another big thing, is like you're, [00:33:00] you're making sounds like you didn't before. 'cause things are different. Yeah, true. Things feel different.
Rachel: Yeah. Smell, smells can change all that stuffs Oh, and
Surabhi: the bo when you're breastfeeding and you're holding a baby all the time and you're body's like you're raging hormones.
So. It's all different, and you just have to understand that intimacy is sometimes messy, so you know it's okay. You know, you're not alone in any of this. For those of you who are listening, who are postpartum and feeling alone, just know that whatever you are going through someone else is also. Going through and we're just, because we're not talking about it, we assume that we're the only ones navigating this.
I had a friend who had a C-section and she had, she was like, back to having sex, had an amazing sex life, or they were having sex four times a week, and she was talking about this and I remember thinking, oh, what's what's wrong with us? Like, we're not doing that. Um, but she didn't have. Pelvic floor dysfunction.
She didn't have prolapse, she didn't have leaks, so she had a different relationship with [00:34:00] her pelvic floor than I did, for example. And so a lot of my clients who have, um, who struggle are also with prolapse. So if you're listening to this and you're like, I have prolapse, is my partner gonna feel it? Is it gonna look weird?
Feel weird? Most people cannot even feel a thing. And. Sex is actually good for people with prolapse 'cause it's gonna push it back in and it's blood flow. Blood flow is so good for healing, right? So orgasms are fantastic for pelvic strengthening, fantastic for healing. Whether you have penetrative sex or not, it's really, really good for healing.
So don't feel like you have to hold off on sex or sex activity because you have a prolapse or you have, you know, anything new in your body. Um, what was the, what was, if you were, could share one thing. Like a key message for new, um, postpartum people, uh, on navigating their sexual health postpartum, what would it be?
Rachel: This is something where, you know, as the old saying goes, [00:35:00] knowledge is power. Um, I think really when I, because I kind of asked the same thing actually, uh, of my participants in, um, this study of if you could talk to yourself. Two weeks or four weeks, or, you know, your past self, whatever timeline that was.
Yeah. What would you say? And I think a lot of them really said, you know, I kind of just wish I knew I knew more about what to expect or what things would be like. Yes. Um, so they told, yeah, they were telling their old selves a no pressure. Uh, as we've kind of talked about in this, in, uh, in our discussion today.
But also kind of being, um, okay to seek out those resources early anytime. I always say it's never too soon and it's never too late. Yes. But kind of, you know, the more we have these conversations that showcase different experiences, the more we normalize those different experiences. Right? Yeah. So it's, it is powerful in that way as well.
Uh, but yeah, my message is always sexual health is a component. Of your postpartum wellbeing? Yeah, we don't acknowledge it [00:36:00] enough in society. We don't. We don't acknowledge it, I think necessarily enough as healthcare providers either. Um, especially sometimes with time constraints or whatever it is during appointments, you know, I realize there are, yeah.
Surabhi: It always seems like it's less important than, you know, maybe blood work or your iron levels Yes. Or other things that are maybe a bit more urgent like your thyroid is Right. Position
Rachel: differently Yeah. Than other aspects of health. Um, but yeah, again, that, that is my message is knowledge is power. So whatever that support looks like for you.
It's okay to seek it out. It's great to seek it out. Um, and we're having those discussions more and more about, again, things like pelvic floor, um, physiotherapy and, and all those. Yeah, so it's, it's nice to see the shift.
Surabhi: It's, and for some people, I always say, if you can't afford pelvic floor physiotherapy, even one session can do wonders because it can help with that knowledge and understanding of what's going on in your body.
Maybe a pathway of. This is how progress will look like. This is what you can do. And many people are actually doing things that impede recovery. So what I mean by that is if they have prolapse, if they have pelvic pain, they avoid sex, they avoid self [00:37:00] touch, they avoid self pleasure, they avoid activities, they avoid AC exercise 'cause things hurt and that actually makes it all worse.
And they, they think, oh, I have a prolapse. I gotta clench more to hold it all up to prevent my organs from descending down. And that tension actually worsens symptoms. So. Seeing a pelvic floor physiotherapist who can help educate you on why all this stuff is going on can change symptoms just like that.
Like it really makes, it's, it can be night or day. And I love that you said that sexual health is also part of your health. Um, I think a big part of that is we, this happened to me too, is. My body had changed. I looked different. And despite still being, you know, in a relatively thin body, I was like, I don't see many thin people looking sexy, who have a belly, who have loose skin, who have stretch marks.
We don't see billboards and posters of that. We don't see mothers being shown as sexy and. I mean, what we see is 15-year-old [00:38:00] models on billboards, right? Yes. True. And so true. That's messed up in itself. So apparently we can only be sexy for the first one quarter of our life, and then it goes downhill from that.
So, you know, this is, this is why. I start to also challenge the, like, start seeing yourself as sexy. No matter what you look like with the messy hair, with the sweat on you, like you, it's not like you suddenly become unsexy just because you've birthed the de human. In fact, there's nothing more sexy than that.
Right. Um, so yeah, a lot of rewiring, some of the thought patterns that have come to us, um, because of the way we've been conditioned and the only way we can unlearn that is by. Being aware of our own thoughts in the first place. And I like to ask my clients like, what are your, you know, what are some of your beliefs around your body?
And, um, when I've, I also see a big difference when I've worked. With them through pregnancy because they have better expectations postpartum and more realistic expectations. Um, that's something that I wish [00:39:00] everybody has an opportunity or access to. Do I have some, um, questions for you at the end of the show?
Um, some thoughts about yourself. I would love to know as you, as a PhD, as a nurse practitioner, a very busy person, you travel. Um, what do you do for self-care every day? Some three simple things that you do for yourself.
Rachel: My pretty simple things. I love to have to go for a walk or run every day. That's nice.
My time to listen to my music, just process things or check out whatever I need. Yeah. Uh, so walks or runs every day. I do also like my baths or showers at the end of the day. That is very relaxing for me.
Surabhi: Yeah.
Rachel: Um, and my tea, my, I'm my grand. My mom calls me a Tea Gro, uh, tea. Oh, nice. If everyone's looking for a new, you know, pre-B bedtime tea.
I love my sleepy time. Vanilla before bed.
Surabhi: Sleepy time vanilla. I've never tried that because. I've never, I've actually never tried that. I'm gonna check, I'm gonna try that. 'cause I'm trying to do less caffeinated teas. Yes. Because I'm becoming [00:40:00] more sensitive to caffeine. Yeah. Listen, I dunno if this is getting older or what, but I'm way more sensitive to caffeine now than I ever was.
Yeah. And like I'll have a chai at like, I don't know. 3:00 PM which is when we, like three, 4:00 PM is when my family usually does like tiffin or like snack and we have chai and now I can't because then I'm up till 2:00 AM Like it really does keep me up. So, um, love that. What are you really passionate about right now?
Doesn't have to be work related. I mean,
Rachel: sexual health after birth is, is obviously my work, but it's really, you know, I'm passionate. I think about having that. Um, lens of being in the research and the clinical work, I feel. Yes. So lucky to be able to do that.
Surabhi: Yeah. Um,
Rachel: so you talk to me about anything, women's health and I'm right, right on it.
Love the love having the conversations. Yeah. Um, but yeah, I think, you know, professionally that is again, my area of passion and Nice. Personally, it's been a year of travel for me, so I'm really, um, yeah. Excited right now about learning, seeing new places. Um, I've been fortunate. [00:41:00] You came out of the pandemic
Surabhi: and you were like, I'm going, I'm going traveling.
Rachel: Yes. Yeah. Yeah. The past few months for me, that's been kind of this. That's awesome. This time of my life has been full of travel, so again, very lucky.
Surabhi: That's fantastic. And what you said about being a researcher and a clinic clinician is rare because we often see people who are one or the other. And so being able to actually combine that research brain with the clinic clinician brain is huge.
Uh, because research doesn't always translate to clinical. Uh, you know, exp experience and vice versa, so That's awesome. Um, if you could change one thing about the world, what would it be?
Rachel: I would have publicly funded tele physiotherapy for one.
Surabhi: Yes.
Rachel: I think it could. I really think it could change the world.
Um, I really think so too. That's, uh, that's how I pine for sure. And, um, I've read a book twice now by Bell Hooks called All About Love, which I would recommend to anyone who's looking for a good read. Yes. But she says there can be no love without justice. And that yes, um, [00:42:00] abuse and neglect to negate love, whereas care and affirmation, the opposite of abuse and humiliation are the foundation of love.
So my rule is, yeah, more empathy and more care. So that's sort of the, yes, the quote I draw on from Bell Hooks,
Surabhi: I, anything from bell Hooks is just amazing. Amazing. So, yes. Um, what do you think is your biggest strength?
Rachel: I think my biggest strength is. Hmm. I think being adaptable has been important in Yeah.
My life and in my, uh, personal life and professional life. I think that's something that I do. Yeah. And kind of like, or, um, um, I'm glad that I'm, that I have, uh, in a way and, um hmm.
Surabhi: Yeah. Adaptability is, is so key, especially if you like. Some of us are so resistant to change and so stuck in like this is how it has to be, and adaptability is also a great skill to have.
As you know, you. For people who are pregnant or [00:43:00] postpartum because the more type A and rigid and you know, I gotta do things this way, people are the harder that postpartum transition can be. And that I speak from that from a personal experience, I've become so much more chill and my friend told me this would happen.
She's like, oh, you'll become more relaxed after having kids. 'cause I'm like, how's that possible? You have more, you have more responsibilities. But it's true. True because you have to be, otherwise you go insane, right? Um, trying to have everything be perfect and tidy all the time. And you know, for those of you who are watching this, like I've got mess.
There's, there's mess around me. I've got boxes here I gotta clean up. I still have de value decorations out. Next step is gonna be Christmas. And there's both, the decorations are just all over the floor here in bins, so it's all good. Right? We, we try to have everything be perfect 'cause we, it's, we think it's supposed to be, and that's just not the reality.
Um, is there any way that people can connect with you? Do you have a social media, do you have, um, an email or website or where can people kind of [00:44:00] learn a little bit more about you?
Rachel: I am on Twitter. I will be honest, I'm not really on any other social media and don't, um, don't engage that way a ton. Nice.
That, but I'm, that's okay. But, uh, on Twitter or what is now called x, um, at Olivier and, um, yeah, we'll have kind of a few, I think things coming out in terms of trying to get, you know, what call knowledge translation, trying to get the research out there with, um, podcasts and things like that. So Nice. Um, my publications can be found as well on my ResearchGate profile as well.
So, uh, if you want, that's awesome. More academic literature, then, uh, that's where, uh, where you can find some of that.
Surabhi: Thank you so much, Rachel, for sharing your expertise with us. Also so cool that you did your PhD on this. I feel like 10 years ago, this wouldn't have even been a thought or conversation.
Like when I graduated from school and my research projects there was, it was like back pain, knee pain. There was nothing pelvic floor related. And so I really enjoy seeing more and more of this sexual health, pelvic floor health research coming out. Um, helps [00:45:00] all of us clinicians as well do better care for our clients.
So thank you again. This episode will likely come out either late December or early January. So for those of you listening, I will share all of the links, um, that Rachel shares with me in the show notes. And if you found this episode helpful, please share this with a new mom in your life because, um, even though you might not be talking about your sex lives, chances are that some people are struggling and you don't even know it.
And so this conversation can shed light. To them on what's going on, why they're, why they're normal, and where they can get help, then, um, that's amazing.
Rachel: Definitely. Thank you for having me, Surabhi.
Surabhi: You're so welcome.
