We imagine what giving birth will look like, we imagine what becoming parents will look like, and as a society, we are often very focused on it being a positive experience.
It is important to focus on what we can do to support ourselves to have a positive birthing experience, but some things may be out of our control, and we may experience birth trauma or neonatal care. One in three women report experiencing birth trauma, and one in seven babies need neonatal care (NICU). The process of going through something like this can have a lasting impact on us, so it is important to talk about these impacts, including the effect it can have on our relationship and intimacy.
First things first, if this article resonates with you, you are not alone. Many people have found intimacy hard after NICU/ birth trauma. I polled our community on my Instagram, and of the people who answered, 76% said they struggle with intimacy, 15% said they did a little bit, and 8% said that they didn’t. Now, I expected the numbers to be high, but that was higher than I thought. I see a lot of people in therapy where intimacy is an issue, but I guess it’s just not really something we talk about a lot in day-to-day life, so let’s talk about it…
Trauma is disconnection. From yourself, your baby, your partner, and the world. Intimacy is about connection. As you can see, it may feel that they are opposite ends of the scale, so we need to do something to make us feel connected again, both to ourselves and our partner.
The Six-Week Check: You Can Have Sex Now
Woah, woah, woah… my baby is still in NICU, or I still feel the physical and emotional impacts of my birth ... sex feels like the last thing I want to do. This conversation with our GP at six weeks after birth can be an appointment where they tell you that it is OK to be sexual again. This does not mean that you have to be. It is important to ensure that YOU feel physically and emotionally ready to be sexually active again. It may be something that you need more time to get your head around or to process. Go at your own pace.
Reasons why you may struggle with intimacy:
Fear of getting pregnant again
Feeling exhausted
Feeling disconnected from your partner
Feeling touched out
Not feeling sexy (after being covered in snot and vomit)
Being too busy with parenthood
Worry about flashbacks during intimacy
Unable to turn your brain off
Physical trauma from birth
Partner struggling with their mental health
Feeling unattractive or self-conscious
The relationship feels like it has changed to be more like “friends” or “teammates” than romantic.
Just not being in the headspace to consider it
The Physical Impact of NICU and Birth Trauma on Intimacy: What Happens When Our Body Says No
Around the time we give birth, our bodies go through a hell of a lot.
Lots of people we don’t know see our bodies; we have interventions and procedures, and we experience pain and body sensations we have possibly never felt. The body can hold onto those feelings, especially if you feel they were unpleasant or traumatic intimacy, at any level can therefore feel triggering and threatening. We can also take time to recover physically, so I would recommend considering support from a Mummy MOT, which will look at how your body is functioning post birth which can help you move back into a place where you feel able to engage in sexual intimacy.
The Emotional Impact of NICU and Birth Trauma on Intimacy: What Happens When Our Nervous System Says No
When we have been through trauma, it can often feel as if we have an overactive car alarm going off in our head, which can be triggered by intimacy of any level. I have spoken to people who feel like they freeze when their partner holds their hand, want to hit their partner off of them when they touch their back or want to run away when they have a hug. This is a common fight-flight-freeze reaction after trauma, and it is your brain telling you that it sees physical intimacy as threatening right now. Your brain is just trying to protect you from any further hurt or trauma. We often don’t want it to be that way, so I will talk through what we can do about it shortly.
The Fear of Further Pregnancies
Tokophobia is an intense fear or anxiety related to pregnancy and childbirth. It is not uncommon for individuals to have some level of apprehension or worry about pregnancy and childbirth, especially after NICU/ birth trauma, but tokophobia goes beyond typical concerns and can significantly impact a person's daily life, relationship and well-being. This appears to be quite common post-NICU/ birth trauma.
It’s not “just” fear of pregnancy. It is fear of:
The unknown, the uncertainty
The lack of control
The worry about the physical impacts
The possible threat to your life or your babies
The impact on your current child(ren)
The impact on your mental health
The impact on your relationship
The body sensed threat feeling
With this fear can come grief for your family unit not looking how you thought it was going to look. It is obviously incredibly individual, but this is something you can work through, in terms of either overcoming the fear or being able to move towards acceptance.
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What Can I Do About My Tokophobia?
We can often feel disconnected from ourselves or our partner post-birth trauma/ NICU. It is, therefore, important to start with connection in a steady, graded way that feels safe for our bodies and brains.
Acknowledge the struggle
Acknowledgement may be difficult for you and your partner. Name it together or on your own.
Write it down or talk it out. Start writing about your thoughts and feelings and exploring them a little more in a curious, non-judgmental way. Validate your feelings and know you are not alone in them. Find someone you feel you can talk to about it, a friend or family member, your partner, or a therapist.
Consider talking to your partner about your worries, thoughts or feelings if it feels OK to do so.
Connect with yourself
Start by connecting with yourself, pay attention to your needs and start meeting them, your basic needs: are you getting enough water, food, exercise, sleep.
Start to do things for yourself that are caring: engaging in hobbies, spending time on your own, and doing things that bring you joy.
It may be then that you start to explore intimacy on your own: start with something small that feels tolerable, applying body lotion or touching different parts of your body in the shower in an intentional way. Start to rediscover and connect to your changed body.
It is absolutely essential to spend time calming your own nervous system so that your body and brain recognise that it is safe now. Engaging in grounding, mindfulness, self-care, therapy etc., can all help with this.
Connect with your partner
Don't force it. Forcing sex when you’re highly anxious can lead to issues like vaginismus. It is important to not just “rip the plaster off” and be intentional about doing this in a graded way.
Remember, intimacy isn’t just sex. It’s a conversation, emotional connection, hugging, holding hands…anything that feels like a meaningful experience of pleasure.
Think about where you would like to start with intimacy and build up to where you would like to be.
Set aside time together to be intimate and create boundaries around what feels safe for you; this can help us not to become fearful of the element of escalation or surprise. For example, if you say that you are going to spend 5 minutes cuddling, try to contain it to just that. If you want to escalate further, talk about it at another time and then agree to do this together.
The truth about intimacy after the NICU is that it's a complex and deeply personal journey. As a clinical psychologist, I encourage you to approach this phase with patience, empathy, and open communication. Remember, you and your partner have already demonstrated immense strength and love during your birthing and/or NICU experience. By facing these challenges together and seeking support when needed, you can create a stronger, more resilient bond that can withstand any obstacle.