Which sex positions are safe? Experts explain what to expect, trimester by trimester

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You don't have to rein in your love life! Pretty much anything goes, just listen to you body, say these experts.
You don't have to rein in your love life! Pretty much anything goes, just listen to you body, say these experts.

Experts around the globe say the old wives' tale about sex "hurting the baby" is nonsense. 

As long as you're having a low-risk pregnancy, you can have sex as often as you'd like to, right up to D-day, according to these professionals.

"The baby is very well protected in utero and won't be injured. There's no need for worry," assures Dr Bronwyn Moore, an obstetrician and gynaecologist practising in Johannesburg.

You don't have to rein in your love life either: pretty much anything goes if you just listen to your body. Or, as Dr Moore puts it, "don't do anything that causes pain or discomfort".

When it's not on the table

If you're having a complicated or high-risk pregnancy, bad news: it's either limited or no sex until the baby is born.

Dr Moore advises against sex altogether if you run the risk of pre-term labour. 

"This is because the prostaglandins found in semen may increase uterine activity, which can induce early labour," she explains. "Also, orgasm causes uterine contractions, and this may trigger labour."

For pregnancies with placenta previa, a condition where the placenta is in the wrong place (too close to the cervix), the general rule is no sex after 20 weeks.

If you've had fertility treatment to get pregnant, a threatened miscarriage, or a history of miscarriages, Dr Moore says it's best to abstain for the first 12 to 14 weeks, until the pregnancy is established in utero.

Also read: 'It's normal': This study finds having less sex postpartum is a sign of a great relationship

In the mood?

Even if it's safe for you to have sex throughout your pregnancy, you may not feel like it for one, two or all three of the trimesters. Or your libido may be in overdrive. 

It differs from woman to woman, according to Dr Marelize Swart, a psychologist and sex therapist practising from Cape Town.

"Sex during pregnancy isn't enjoyable for all women, especially when they have to deal with the symptoms of fatigue, nausea and vomiting. However, some women develop a heightened need for sex during pregnancy," Dr Swart says.

Whether you can't get enough or you feel like the Virgin Mary during your pregnancy, remember that it's all normal – do what you're comfortable with, and have an open discussion with your partner about your feelings.

Below, Professor Gerhard Theron, head of the department of obstetrics and gynaecology at Stellenbosch University (Tygerberg Hospital), and Dr Marelize Swart, psychologist and sex therapist, guide you through the physical and emotional aspects of sex during pregnancy:

First trimester

In the first trimester, Professor Gerhard Theron says that sex is safe, "except when there is a threat of miscarriage", he adds.

At this stage in the pregnancy, Prof. Theron says that none of the physical changes that are taking place interfere with sex.

However, as Dr Marelize Swart explains, while some women find that they're less interested in sex during pregnancy, some may experience a heightened libido. 

"You may feel too tired, moody or nauseous to have sex. It's also not unusual to feel overwhelmed by the physical and emotional changes you're going through," says Dr Swart.

"As long as both partners are comfortable, any [sexual] position is safe," says Professor Theron, though he urges pregnant individuals to avoid all medication, including stimulants and lubricants, that does not clearly state that they are safe to use during pregnancy.

During the first trimester, Dr Swart also notes that "most partners find their pregnant lover as attractive as ever, though not all do". 

"There are all kinds of reasons your partner's desire may be dampened in the first trimester. He may be apprehensive about parenthood, and that anxiety may affect his sexual desire," says Dr Swart.

"The most common reason that men become more tentative about sex during pregnancy is a fear that intercourse could hurt the baby. If your partner needs reassurance about the safety of sex during pregnancy, bring him with you to your next prenatal appointment."

"Most importantly, talk to each other about your fears and anxieties, and your needs. Open communication can allow you to find ways to be intimate, whether or not you're having intercourse."

Also see: Relaxin, prolactin, oxytocin, oh my! A guide to those pesky pregnancy hormones

Second trimester

As the pregnancy progresses into the third trimester, Professor Theron warns that there are more exceptions to consider in evaluating the safety of intercourse at this stage, including a past history of miscarriage during this trimester, placenta previa and multiple pregnancies, though no physical changes should interfere for a healthy, "normal" pregnancy.

At this stage, Dr Swart reassures expectant couples that most sexual positions are safe.

"Experiment to find the positions that can best accommodate your growing belly," says Dr Swart.

"Any activity done in moderation is allowed if the pregnancy is normal," adds Prof. Theron.

"For many women, the second trimester is one of the best times to have sex," says Dr Swart. 

"Your bump may be showing, but it's usually not large enough to get in the way during intercourse. As the symptoms of the first trimester lessen, and your energy levels rise, you may notice an improvement in your libido. An increased blood flow to your genitals and pelvis may rekindle your desire for sex. You may also find it easier to achieve orgasm – many moms-to-be experience intense and even multiple orgasms during this trimester."

The partners, on the other hand, may be experiencing a different kind of journey.

"Many, but not all, fathers-to-be enjoy their partner’s new curves, and most are pleased that, after a sometimes difficult first trimester, their love life takes a turn for the better."

Third trimester

In the third trimester, Prof. Theron confirms that sex is still safe, "but women with histories of preterm delivery after sex should avoid it during this trimester", he adds. 

"Sex is also off the cards for a multiple pregnancy and a definite no-no for placenta previa pregnancy," warns Prof. Theron.

At this stage, women often don’t feel comfortable having sex and Prof. Theron emphasises that this needs to be respected by their partner.

However, for couples who do choose to have sex, sex positions are limited to those that don't cause pain and discomfort, which is made difficult by the large uterus. However, Dr Swart says that this is the time to get creative! 

"Try positions that put less pressure on your bump. Rather than lying on your back, it might be more comfortable for you to be on top, or to lie sideways next to your partner, facing each other. You could try spooning with both of you on your sides. Use pillows to prop yourself comfortably into any position," explains Dr Swart.

"If you're comfortable with your larger bump and still feel up to having sex, you can do so. But it's common for a woman's desire to wane in the third trimester. At this point, you may be too big, achy or exhausted to have sex comfortably. You may feel self-conscious about how your body has changed or be preoccupied with the approach of labour and birth.Let your partner know how you feel, and reassure him that you still love him. It's crucial to keep the lines of communication open and to support each other."

Must see: How to deal with these six common pregnancy aches and pains

Spotting? Don't panic

A bit of vaginal bleeding, or spotting, after sex is usually no cause for concern during the first few weeks of pregnancy, says Dr Bronwyn Moore, obstetrician and gynaecologist. 

"In early pregnancy, the cervix is very swollen from the high hormone levels and is quite fragile. Anything that causes friction against the surface of the cervix can cause a small amount of bleeding," she explains.

"This 'surface bleeding' isn't a threat to the pregnancy, but it can cause a lot of parental anxiety!" Always get it checked out to rule out infection.


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