Q: My wife recently had our first baby, and I was wondering about the six-week rule regarding sex after birth. It seems that no matter what, doctors advise that couples wait six weeks or more after the baby is born to have sex. What is the reason for this apparently steadfast rule? If she's feeling good and is interested in sex, do we really have to wait the full six weeks? Should we worry about long-term physical injury if we jump in a little sooner than that?
A: Well, here's a topic I'd never really thought about before. Not having any children of my own, I lack firsthand experience in this department. However, I am fortunate enough to have a handful of girlfriends who have had babies in the past year. They were all eager to tell me that not only was post-partum sex a main topic of discussion with their ob/gyns but, in all cases, it was the doctor who brought it up first. As far as the sex goes, three out of five of these women waited until the six-week mark, with one waiting an additional two weeks just to be on the safe side. The other two jumped in at around four weeks with no pain, but both had relatively speedy deliveries without complications.
Childbirth is a wrecking ball of an event, as far as the body is concerned. After months of shifting organs around to make room for that ever-expanding fetus, the body suddenly loses that big, growing mass and undergoes no small amount of trauma. Vital organs need to settle back where they belong and the uterus and cervix need to return to their normal size. Also, the vaginal opening is prone to tearing naturally during childbirth which, of course, requires time to heal. Episiotomies (surgical snipping of the vaginal opening to widen it) are less common than they used to be, but are still sometimes performed during difficult births. They require an even longer healing time than natural vaginal tearing, so that can add weeks to the wait. Also, your wife may still be shedding lochia, which is the post-partum discharge cocktail of all the blood and tissue left behind. Depending on how cool you all were with period sex before she got pregnant, sex during lochia shedding may not be appealing, even if she's totally pain-free.
The main risk of post-partum sex is infection due to the reopening of any tears and/or incisions. I'm sure the last thing your wife wants to do after pushing out a baby is deal with an infection, especially if she is apprehensive about taking prescription antibiotics while breastfeeding. (I'll also take this opportunity to dispel the myth that breastfeeding is birth control. Your wife can certainly get pregnant right away after childbirth, which would probably piss her off a lot more than having to take antibiotics.) Also, if the placental bed is not fully healed, it is possible for air to enter the bloodstream during intercourse. Air embolisms are very rare, but they can be fatal so they deserve a mention.
Your wife almost certainly has a routine appointment scheduled for six weeks after the baby was born, so please encourage her to ask the same questions you're asking during that visit. I'm not a doctor, but I will remind you to use common sense. Pain is the body's way of telling us to stop whatever the hell it is we're doing. If your wife is having discomfort or notices that something doesn't feel right, then abort the mission and give it another week before trying again. Sex usually gets the green light once the lochia shedding has stopped and any tears are healed. Your wife should listen to both her ob/gyn and her body to determine when the light turns green for her.