Midwife Laia Aguilar has accompanied pregnancy and postpartum from public health to a large number of women. She studied nursing at the University of Barcelona and says that after eight years working in the ICU she became a mother and “was lucky enough to meet wonderful midwives” who cared for her, respected her and accompanied her in the process: “In them I saw what I really wanted be”. Since 2016 she has been part of the team of midwives at LactApp, the world’s leading breastfeeding and maternity app. She not only accompanies the processes of pregnancy, childbirth and postpartum, Ella Aguilar also trains and advises on the entire sexual and reproductive life of women, “therefore from infancy to old age.” Just published know your postpartum (Grijalbo, 2022), in which, in a simple and informative way, it tells about the bodily and mental processes of pregnancy, childbirth and postpartum.
Many midwives recommend having sex during pregnancy. Why? Which has benefits?
Sex always has to be desired. Alone or accompanied, but not imposed. First of all it is a form of self-knowledge. We have a wonderful body that gives us a lot of possibilities for pleasure. And pleasure, in itself, brings health benefits. And it can also have benefits such as: it trains the muscles of the perineum and strengthens it, lubricates it and increases the vascularization of the vulva, thereby improving its elasticity. In addition, orgasm causes oxytocin to be secreted, which causes gentle uterine contractions that train the uterus for childbirth, helps to fall asleep and, in addition, increases the amount of endorphins in the blood, which give a feeling of well-being to both the mother and the baby. baby.
Why do you consider that giving birth and breastfeeding are part of our sexuality?
Pregnancy, childbirth, postpartum and breastfeeding are part of sexuality. Sexuality is a broad concept that includes sexual behaviors and intimacy. The hormones of childbirth are the same ones that are activated when we have sexual intercourse. Oxytocin is the most important at that time. It is a hormone that is activated when we have intimacy, security. And it is inhibited when we are afraid or feel insecure. Just as it happens with sex or childbirth. Oxytocin is also one of the main hormones of lactation. Having a baby on you all day also causes these types of hormones to be secreted, which means that the affective needs of many women during the first months after childbirth are fulfilled.
The puerperium is a period of adaptation. And we each need a different one. Setting limits I think always leaves someone out
Once we give birth, how long does the puerperium last? What physical and bodily changes occur?
The puerperium is a period of adaptation. And we each need a different one. Setting limits I think always leaves someone out. Physically, the body has to return to something similar to what it was before gestation. There may also be some physical injuries. The genitals return to their position after childbirth or, if there has been a caesarean section, they must heal. The abdominal muscles need to return to their starting point, as does the curve of the back. At this time, the beginning of lactation also takes place, with a rise in milk between the third and fifth day of the baby’s life. And here also begins a new relationship with our breasts. Surely, it is the emotional changes that can be more complex to manage.
After giving birth, it is considered normal to be somewhat sad, disoriented and tired. How do we detect if it is the beginning of postpartum depression?
Adapting to the new situation can be complex. In the postpartum period there is no lack of mourning and therefore it is possible that there are feelings of sadness or that it is overwhelmed. These feelings are usually mixed with feelings of joy, well-being, little moments of happiness. When this is not the case, when what you are experiencing is always hard, sad, when emotions prevent you from taking care of yourself or from taking care of yourself, it is possible that we are at the beginning of postpartum depression.
Let’s get to the physical part. About piles, why are they so common? What do we do with them?
Piles are thickened veins that are located in the anal area. Sometimes they can be seen from the outside. Others are inside. It occurs due to different factors, such as the pregnancy itself or the type of birth. And the fact that the pelvic floor muscles are flaccid and in poor condition makes them worse. Finally, constipation can also cause them.
Put local cold and, if necessary, specific ointments can relieve them. Even so, it is essential to check the pelvic floor to assess that it is in the best possible condition and avoid constipation. Another trick is to use a small stool to put your feet up when you go to the bathroom. That way you don’t usually have to do so much force to have a bowel movement.
During pregnancy and childbirth, be it vaginal or cesarean section, the pelvic floor muscles are under constant stress. For this reason, it is recommended that an assessment of your condition be made after a few weeks of delivery.
Why is it important after giving birth to go for a pelvic floor check? How is the health of the pelvic floor restored?
During pregnancy and childbirth, be it vaginal or cesarean section, the pelvic floor muscles are under constant stress. It supports the weight of the entire trunk and also has to stretch to let the baby through in a vaginal delivery. For this reason, it is recommended that an assessment of your condition be made after a few weeks of delivery. Usually, the pelvic floor has the ability to return to its pre-pregnancy state. Even so, if there has been a birth injury or contracture, care by specialized personnel may be necessary. There are certain exercises that can improve the health of your pelvic floor, but it’s important to do them well so you don’t hurt your pelvic floor further. The midwife or specialized physiotherapist are the most experienced professionals in these cases.
If a woman has had an episiotomy, how does she have to heal? What care has she to have her?
When there is a wound of any kind on the perineum, it is advisable to keep it clean and dry. It is somewhat complicated when, in addition, postpartum bleeding occurs during the first days, lochia. It is recommended to wash the area with water and neutral soap once a day and every time you have a bowel movement, and change the compress on a recurring basis, thus ensuring that the area is as dry as possible. There are certain wounds that can bother a lot when peeing because they sting. It may be a good idea to pour water on your vulva while you urinate, so that this sensation is not so unpleasant, and then dry. Take care that there are no pieces of toilet paper stuck in the area. Single-use paper towels can be good allies at these times.
When the wounds are healing, something to take care of is precisely this tissue. Especially in cases where an episiotomy has been performed, there may be difficulties at the level of the pelvic floor muscles. An assessment by a midwife or pelvic floor specialist physiotherapist is also recommended once the wounds have healed.
About lochia: what they are, why they occur.
Lochia are remnants of the tissue that lined the uterus during pregnancy and blood that comes out of the wound left by the placenta. The placenta is an organ that is usually round in shape, with a liver-like consistency. On the one hand it is intimately attached to the uterus. Share blood vessels. When it breaks off, it leaves a wound the same size in the uterus. Right after delivery, the womb contracts strongly so that there is no bleeding and stays that way for several days, until there is no bleeding.
That is why it is important to assess the lochia, that they are not very abundant and that they do not smell bad, since they are two warning signs.
When the will of the mother is not respected, she is not made a participant in the birth of her own baby and she is not treated exquisitely, there may be a situation where you feel that your birth has been stolen.
Why do many women with caesarean sections feel that their labor has been stolen from them?
When the will of the mother is not respected, she is not made a participant in the birth of her own baby and she is not treated exquisitely, this situation can occur. I know many women who feel what you describe. Not only women who have delivered their babies by cesarean section, but also women who have delivered vaginally can feel it.
When a person understands what is happening, they respect their decisions, they explain it to them and they can choose between options if there are any, the feeling of robbery does not exist. There may be a feeling of mourning for not having had the expected delivery or that the expectation around it was different. Obstetric violence exists and is felt by many women. In the same way, there are more and more teams wanting to work better, to give space and prominence to women who are in labor.
When can shared sexual activity resume and how do you advise doing it?
Here the answer is simple: it can be restarted when there is a win on both sides. If there are still lochia, it is recommended that you use a condom to avoid possible risks of infection if you want to practice penetration. Sometimes you may be afraid to restart relationships. A good idea is to start oneself, little by little and unhurriedly, rediscovering the body and giving the possibility of leaving practices such as penetration for later. If it is shared sex, it is important for the couple to know the situation they are in and to be extremely respectful of the limits that are needed.