Passion can be as much a part of pregnancy as an expanding waistline, according to a review of studies on sex and its effect on a woman's womb. For low-risk pregnancies, sex is considered safe, advises a primer for doctors published this week in the Canadian Medical Association Journal. "Sex in pregnancy is normal," write the authors. "There are very few proven contraindications and risks to intercourse in low-risk pregnancies, and therefore these patients should be reassured."
But in instances where women are at increased risk of preterm labour or have complications such as placenta previa, where the placenta overlays the cervix, abstinence may be indicated. Yet even in situations where preterm labour is a consideration, a woman pregnant with multiples, for example, or one who has a history of delivering prematurely, experts are uncertain about whether sex during pregnancy can actually trigger labour.
The authors, two residents in obstetrics and gynaecology and Dan Farine, the head of the maternal-fetal medicine department at the University of Toronto, initially compiled the recommendations as part of a Grand Rounds presentation to doctors, nurses and midwives at Mount Sinai Hospital in Toronto, where they work.
They got such positive feedback that they decided to turn the data into a resource doctors could use to counsel their patients. "There's a lack of guidelines on sex in pregnancy in Canada and the US," says resident and co-author Crystal Chan. Misconceptions (pardon the pun) abound. When Farine attended a symposium in Europe, a French doctor told colleagues he instructed his pregnant patients to use condoms so that prostaglandins, a substance in semen that softens and ripens the cervix in preparation for labour, wouldn't induce an early delivery.
An Italian physician, meanwhile, shared that he advised women to avoid orgasm because the resultant uterine contractions could lead to labour. "Therefore," said the doctor, who was not without a sense of humour, "I tell patients they can have sex as much as they want, as long as they don't enjoy it." In actuality, the Toronto researchers did find a study that attempted to analyse whether orgasm provoked labour, by connecting a bunch of pregnant women to a contraction monitor and telling them to have an orgasm. Only one woman succeeded; she did have uterine contractions, but they subsided after the orgasm ended.
In any case, it's important to note that sex drive and libido fluctuate during pregnancy, says Chan. In general, as pregnancy progresses, sexual desire decreases. So what to make of that tip you read online encouraging sex near your due date in order to jump-start labour? Hogwash, say the authors, who find no evidence of an effect. That said, there doesn't seem to be an obvious downside either, apart from the fact that getting jiggy while manoeuvring a belly the size of a beach ball is not necessarily a turn-on. Studies have shown that in women who are poised to go into labour, it probably helps, but in others, it does not, says resident and lead author Claire Jones. But, she adds, "if you're feeling comfortable and you want to try, why not?"
Which positions are the most comfortable?
Here are some time-tested positions and tips for making love while you're pregnant:
• Lie sideways. Having your partner on top demands increasingly creative gymnastics as your tummy swells. But lying partly sideways allows your partner to keep most of his weight off your uterus.
• Use the bed as a prop. Your bulge isn't an obstacle if you lie on your back at the side or foot of the bed with your knees bent, and your bottom and feet perched at the edge of the mattress. Your partner can either kneel or stand in front of you.
• Lie side-by-side in the spoons position, which allows for only shallow penetration.
• Get on top of your partner. It puts no weight on your abdomen and allows you to control the depth of penetration. (Time Healthland)