Midwifery Education: Trauma or Transformation?

Sunday, November 14th, 2010

In the early 1990’s, two events prompted me to revise my goals as a midwifery educator. First, a prominent California midwife and dear friend who, after considerable legal harassment, felt forced to become a nurse-midwife, shared her bitter experience of retraining. She was so disheartened by the condescending tone and hazing practices of her primary instructors that she finally complained of this to the program director, who casually responded, “Why is it that midwives always eat their young?” The second event occurred during a workshop on birth and sexuality at a Midwifery Today conference in London. The instructor shared her concern that her sister, who had just given birth in hospital there, might never recover from the “brutality” of the midwife who attended her.

I have always maintained that the ultimate goal of midwifery education is to generate practitioners capable of being “with woman” (the literal translation of the old English word midwyf) in the truest, most egalitarian way. For me, it has meant creating curriculum that encourages students to discover and develop their unique capabilities, while candidly assessing their character liabilities and fears regarding the work. But in the last few years, I have become increasingly aware that the impacts of trauma on the human psyche are both insidious and nearly universal at this point in time. Perhaps more so for females than for males: in the United States, 1.3 females are raped every minute. Examples of sexual exploitation and victimization are found in virtually every culture on the planet.

Stay with me, please. I know this topic is grim and unsettling. Because it is, we tend not to identify as trauma victims unless we have blatant evidence. Our media perpetuates this disconnect by systematically bombarding us with violent images laced with banal commentary. Our children play video games where thing after thing, person after person, is blown up or otherwise destroyed—-for fun and entertainment. In short, we have normalized trauma.

As a young midwife, I became increasingly aware of the “walking wounded” who had suffered in childbirth with their stories untold. As I came across them by chance in the laundromat or in the supermarket line, I realized that a huge segment of society was hurting and unhealed, silenced and invalidated. Sharing the details of their births, they became very emotional, and sometimes, deeply agitated and upset. But it wasn’t until fairly recently, in the last decade or so, that I was able to label this behavior as post traumatic stress disorder (PTSD), the same syndrome that soldiers suffer when they return from war and find no one who will listen or can understand what they have been through. I remember a meeting some years ago with Sheila Kitzinger during which we discussed mothers who had had unhappy birthing experiences and yet, because the baby was fine, felt no right to complain. I told Sheila there was a book in this, but I was not going to write it. She went on to do research on the topic and soon began a series of workshops titled, “Birth as Rape.” She found that mothers who had suffered trauma in birthing exhibited the same behaviors as those who had suffered violent sex crimes: loss of voice; loss of boundaries; loss of trust in primary relationships; unexpected and inappropriate outbursts; misplaced anger; chronic health problems, etc.

To get to the point—-how many of us involved in midwifery had unhappy birth experiences that motivated us to do this work? How many of us who were movers and shakers in the renaissance of our practice experienced trauma in our primary relationships as we struggled to raise small children and keep our partners happy? How many of us, even with the best of birth experiences, learned exactly how terrifying harassment or investigation at the hands of our local prosecutor can be? And how many of us, with all the above combined with the demands of political activism and being on call 24/7, experienced burnout to the point of breakdown? With this in mind, it’s not so difficult to see how midwives might, out of stress, exhaustion, resentment, anxiety—-or in a word, trauma—-more or less eat their young!

This is the dark underbelly of our movement, the shadow side of our own self-sabotage. To whatever extent our traumas are unaddressed, we are likely to be reactionary, volatile, or sometimes the opposites of passive and prevaricating. I used to be perplexed by the rise and fall of independent midwifery in Europe, confounded by the advent of the “medwife” (e.g., that brutal midwife mentioned in the London workshop), but now I see this as a larger struggle of our holistic paradigm versus the technocratic paradigm of medicine, with a misguided and ultimately unsuccessful attempt at compromise.

In case you are not familiar with these paradigms, the technocratic model is based on beliefs that the body is a machine, that disease comes from without, that standardized care is best because it minimizes the risk of the unexpected, and that practitioner knows best. It is a model based on control. The holistic model redefines the patient as client and decision-maker in the healthcare experience, the authority on her own health status, responsible for educating herself on her care options and carrying out daily self care, with health a manifestation of emotional, psychological, and physical factors. It is a model based on education and empowerment. There is yet another model that falls between the two—-the humanistic model, which would modify the tenets of the technocratic model by making practices more humane, by allowing a bit of extra time for care, by emphasizing bedside manner and concern for the patient’s feelings and needs. In practice, the humanistic model may be little more than a kinder, gentler technocracy, in that the practitioner gives care rather than empowering the patient to care for herself, and is thus still in charge.

Another way to frame these differences is provided by authors Belenky, Clinchy, Goldberger, and Tarule in their book, Women’s Ways of Knowing. In it, they define a “midwife approach” to teaching, in which:

“Midwife teachers assist in the emergence of consciousness. They encourage students to speak in their own active voices. The midwife teacher’s first concern is to preserve the student’s fragile, unborn thoughts, to see that they are born with their truths intact, that these truths do not turn into acceptable lies.”[1]

In contrast, the “banker approach” to teaching, as defined by Paolo Freire, describes the teacher’s role as that of filling students with deposits of information that the teacher considers important. Students are not called upon to know but to memorize information, often without context. The teacher composes her/his thoughts in private; students are not allowed to see the process of gestation. The student can risk criticizing the teacher, but the teacher takes few, if any risks, as her/his position is already decided. “Banking-teaching anesthetizes,” says Freire, “It attempts to maintain the submersion of consciousness.”[2]

Sadly, a number of midwifery education programs employ the banker approach more than the midwifery approach, using teaching methods that are technocratic (or humanistic at best). Programs that are truly holistic in content and approach are rare. In moderating countless education roundtables for Midwifery Today in both the U.S. and Europe, student participants have made clear their frustration with education that discounts their knowledge and instincts, forcing them to ignore their physical and emotional well-being in order to complete their training. They end up feeling not only powerless but also unprepared to practice autonomously.

So what is a student to do? Best to investigate programs thoroughly before making a decision. Take a look at the curriculum—-not only content but design. Are there learning activities that promote self-knowledge, personal growth, and critical thinking—-not just at the end of the course (when banker-style programs have their “integration”), but from day one? Is student feedback actively encouraged from beginning to end? I had an interesting conversation with a graduate of a school that offered a weekly support group for students, and I immediately wondered, support for what? As she shared her experience of instructors that were domineering and dismissive, it became clear that the group was more for damage control than for cultivating student growth and transformation.

Let’s focus on the aspect of transformation. For most students, this is a necessary component of preparation for the work. One the first day of class, I warn my students not to be surprised if during the course of study, they feel compelled to make changes in their primary relationships, their current way of making a living, or their style of communication (which can affect everything else). I also let them know that midwifery academics and skills are relatively easy to acquire compared to the realignment of one’s personal life that walking the path of the midwife requires.  From the very first day, they learn to be counsel to each other, to check in at the beginning of each meeting from the heart, in truth-telling mode versus talking-head processing, so the air may be cleared to focus on the work at hand.

Ultimately, this is important in that when we midwives go to births, we take two bags—-one with our equipment, the other, an invisible bag with unprocessed recent birth experiences including disappointments, unmet needs, or expectations that could affect the birth we are about to attend. There is no way to be rid of this invisible bag—-but we had better know what is in it if we want to provide care that is truly motherbaby centered.

Coming back to the theme of trauma: apart from choosing an educational program unlikely to cultivate this, you can and should do whatever work you can to address previous traumas on your own. Keep in mind that abuse takes may forms—-physical, sexual, emotional, gynecological, and obstetrical (to name a few). In terms of healing, the process is more than thinking things through. Indeed, evidence suggests that as trauma typically forces us into a heightened state, we may need to reach a similar state to reprogram our beliefs and responses. Look for therapies that induce this state, such as Eye Movement Desensitization Reprogramming (EMDR), which takes you rapidly into very deep meditation in which your emotions flow freely, and yet you can observe and learn from them with relative detachment. With the right practitioner, hypnotherapy can render similar results. For more details on this, see my new book (co-authored with international doula trainer, Debra Pascali-Bonaro), Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth Experience.[3]

Note that labor is also a heightened state in which imprinting and reprogramming can occur. Thus if you have unidentified or unprocessed trauma, you are likely to be activated by birth, particularly if it becomes complicated. If you find yourself struggling with unpleasant feelings as you assist births or find yourself wanting to bring birth under control, you have work to do on trauma. Another sign is a pattern of behavior in relationships typical of trauma and abuse victims—-the Rescue Triangle, in which we play roles of Perpetrator, Victim, and Rescuer, round and round in a circle.[4] If you find yourself in a situation like this, the only thing you can do is step out of it! In doing so, you clear the field to be fully present to whatever is happening in the moment, and the opportunities for growth and transformation fan out like the rainbow feathers of a peacock’s tail. Again, there is no shame in needing healing—-in many indigenous cultures, you cannot be a healer without a major wound—-but the key is to be aware of it as you surrender to the healing process.

What is this like? It is like being taken apart and put back together. It is the process of descent—-the dark night of the soul. It is akin to transition in labor, when women feel they are dying. As student midwife, be prepared to shed your skin, to transform into something you may not be able to envision in your ordinary mind. This is because birth is not ordinary, it is not “normal”—-it is extraordinary, and in order to assist it you must come in contact (and come to terms) with this part of yourself.

To sum up: the only midwifery education program worth its salt is one that “midwifes” you in a way that readies you to midwife the mothers you will serve. For all the time and money you will invest, this program should not only provide you with state-of–the-art midwifery knowledge and skill but must: 1) support you in developing an awareness of your strengths and weaknesses; 2) encourage you to develop your unique style and voice, and; 3) support your process of becoming from the inside out. When you choose a program that does these things, you are well on your way to practicing in a fashion that is not just autonomous but also sustainable. And you make a personal contribution to keeping true midwifery alive and well, not only in the U.S. but also internationally. From Western Europe, where midwifery has been subsumed by medicine, to Eastern Europe, where midwifery is just emerging, midwives and mothers are counting on you to make the right choice. Midwifery is the ground whereby revolution in female leadership and the primacy of the family may be realized in our world. Don’t take your decision lightly! Every step in this direction counts.


Renowned expert Elizabeth Davis has been a midwife, educator, and international consultant for over 35 years. She is co-founder of the National Midwifery Institute, Inc., an apprenticeship-based MEAC accredited program. She holds a degree in Holistic Maternity Care, and is certified by the North American Registry of Midwives.

In addition the new, Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth Experience, she authored the classic Heart & Hands: A Midwife’s Guide to Pregnancy and Birth (now in its 5th edition). Her mission is to promote an integrated view of birth, sexuality, family, and ecology.

[1] Belenky, M. F., Clinchy, B. M., Goldberger, N. R., Tarule, J. M., Women’s Ways of Knowing: The Development of Self, Voice, and Mind (New York: Basic Books) 218, 1986.

[2] Freire, Paulo, Pedagogy of the Oppressed (New York: Seaview) 63-68, 1971.

[3] Davis, Elizabeth, Pascali-Bonaro, Debra, Orgasmic Birth: Your Guide to a Safe, Satisfying and Pleasurable Birth Experience (New York: Rodale Press) 116-119, 2010.

[4] Karpman, S., “Fairy tales and script drama analysis,” Transactional Analysis Bulletin, 7(26), 39-43, 1968.

Intuition and Birth

Thursday, August 12th, 2010

An excerpt from Orgasmic Birth: Your Guide to a Safe, Satisfying, and Pleasurable Birth Experience, by Elizabeth Davis and Debra Pascali-Bonaro, Rodale Press: New York, 2010.

“I love and respect birth. The body is a temple, it creates its own rites, its own prayers…all we must do is listen. With the labor and birth of my daughter I went so deep down, so far into the underworld that I had to crawl my way out. I did this only by surrendering. I did this by trusting the goddess in my bones. She moved through me and has left her power in me.”

–Lea B., Fairfax, CA

Changes to personality with pregnancy, such as the disruption of linear thinking, are due largely to hormones. I think the reason hormones prompt forgetfulness is to encourage the cultivation of “mother-mind,” a highly intuitive way of thinking and being that tunes us in to the body so we may be in optimal health when labor begins, ready to surrender to the challenges of giving birth and the tasks of caring for a newborn without stress or fear.

Over the years, I have done a good bit of research into the nature and cultivation of intuition, particularly as applied to birth, and have found it a fascinating and rich area of exploration. Intuition is defined as knowing directly, without inference, and is characterized by perceptions clean and unexpected in their arrival. It comes through best when we are relaxed and receptive—-in contrast to fears or projections, which are associated with frazzled or agitated states. In fact, intuition is thought to be linked to brainwave frequency: in beta (stress-related or goal-oriented thinking), our brainwaves are rapid and jagged, whereas in alpha (as induced by meditation or rhythmic activities), our brainwaves slow, become higher in amplitude and more synchronous with those around us; we literally tune into the bigger picture.

“My spiritual awareness changed during pregnancy. I suddenly knew things I did not know before. My dreams were clear lessons. I think my baby’s soul prepared me through dreams and meditations.

–Saskia S., Oak Grove, KY

Why should pregnancy prompt the development of intuition? For one, intuition helps us to perceive and respond to our babies’ needs before they can be verbalized. Knowing directly is undeniably timesaving, and time is at a premium when caring for a newborn. Intuition also supports mothers in self-care during the demanding years of growing a family. In fact, here is where the cultural formula of “do more, be more successful” begins to unravel—-with intuition in the equation, doing less actually leads to being and knowing more.

“After the birth, I am much more confident with other tasks in life. I know I have strong will and amazing intuition. I feel so connected to this baby, I understand her without even saying anything, and I want to be close to her as much as possible.”

–Michael R., Norwich, CT

Returning to the role of hormones in heightened intuition: oxytocin, known as the “love hormone” because it is released not only with sexual activity but also with arousal (even at the mere thought of a lover), is never at higher levels than during labor, reaching a peak at the moment of birth. There is a critical link between oxytocin and brainwaves that are even deeper and more synchronous than alpha—-the theta frequency. This is the deepest level we can experience in a waking state (we move into delta with sleep). Theta is associated with extrasensory perception, creative inspiration, and spontaneous problem solving. In theta, time becomes relative and elastic. Anyone who has given birth (or who has attended one) can attest to points in the process when minutes seemed like hours, and vice versa.

More than that, oxytocin facilitates bonding through entrainment. In this physiologic process, the heartbeat and breathing rhythms of lovers become synchronized. The slower the brainwave, the more likely entrainment is to occur. Thus a mother laboring in theta can entrain attendants to her frequency, as long as they are loving, open and unafraid.

“We held one another in our candle-lit lounge and swayed back and forth. Our hips danced together. My face buried into his body during the rushes, and when they subsided we embraced, foreheads touching …the only two in the world.

“The line between pleasure and pain is very fine indeed. I sang my birth song, a low moan, and he sang with me. I was surprised by how much birth sounded like sex! But birth is part of the lovemaking continuum.

“When I scooped my baby up from the water my partner wept tears of joy, and my friend’s breasts burst forth with milk. That’s what I remember most. Not the posterior back pain. Not the 58 hours of dilation. The intimacy.”

–Sarah L., Melbourne, Australia

Theta brainwaves are also triggered by life-threatening or traumatic situations. Thus the intensity of birth can reactivate previous trauma, which is why healing from sexual or other abuse prior to labor is ideal. Yet high intensity situations also offer the opportunity for reimprinting. Whoever is present at a birth—-mother, partner, siblings, and attendants—-may spontaneously replace negative imprints (whatever the source) with positive ones. Rebonding also can occur at this time: siblings separated from their mother at birth can bond anew in witness to the process, and partners kept apart or disconnected during previous births have possibility for healing.

For more, read Orgasmic Birth: Your Guide to a Safe, Satisfying, and Pleasurable Birth Experience by Elizabeth Davis and Debra Pascali-Bonaro, Rodale Press, 2010. Find it on Amazon.

Blood Mysteries

Tuesday, July 27th, 2010

Excerpted from:The Women’s Wheel of Life

by Elizabeth Davis and Carol Leonard

Blood Mysteries | Menarche Rite | Order

Mystery is defined as that which is beyond understanding, that which baffles or perplexes, that which is profound and known only by revelation. When we speak of the Blood Mysteries, we are referring to the biological events of Menarche, Childbirth, and Menopause that are accompanied by changed perspective and the influx of knowledge beyond reason. We don’t know why we change and grow and acquire knowledge so dramatically at these times, but we do—this is the Mystery. And as we share this knowledge, the revelations linked to changes in our bodies, we reclaim the power and wisdom inherent in the female body.

Menarche is a prime example of how mystery has accorded females power and respect. Before the advent of science, menstruation was biologically confounding—how could females bleed thus, and not be injured? This must be magic, this ability to bleed and yet be well! Long before conception was understood to require fertilization, females were thought to generate life simply by withholding their menstrual blood in some autonomous process. The sexual act was not linked to conception. Females were apparently stirred by spirit, then retained their blood, gestated and brought forth new life. Thus menopause was viewed not as a loss, but as an increase of power—older females permanently retained their blood and so transcended the cycle of death and rebirth; they became as the source of creation.

But when Christianity recast the female body as evil, the source of original sin, the womb ceased to be a sacred temple and the Blood Mysteries were no longer acknowledged. And as science deconstructed human beings to a set of physiological functions, medical technology developed to further separate body and spirit. Now we have tools to “aid” the birth process, medications to “ease” menstruation or override the effects of menopause, surgery to remove the womb. We seek to tame and dominate the forces of nature: we plant crops that deplete the soil, we raze our forests and pollute our waters. This would be unthinkable in a world that reveres the feminine aspect.

This is not to deny that technology has its benefits—contraception has been a boon, and lives have been saved in complicated childbirth or pathological gynecological situations. But we have lost the Mystery. Reclaiming our blood rites as profound psychological turning points is the foundation of revealing new, empowering archetypes and rediscovering the most ancient ones we already share.


For those in a female body, physiologic milestones herald major life transitions. There was a time when these transitions were held holy, and served to connect us with the rhythms and cycles of the seasons and the moon. The first of these milestones is the Menarche Initiation Rite, held at the time of first menses to honor the crossing from childhood to adulthood.

In the past, it was customary to mark this major change in life with a special observance or celebration. Anticipation of this honoring helped a young one greet her first bleeding with joy and triumph; it was the most essential of all initiation rites.

In non-industrial societies, seclusion is a nearly universal response to menarche, not out of fear but in reverence for the sacred power of menstrual blood. In some indigenous cultures, isolation goes on for several years. Young Dyak daughters in southeast Asia spend a year in a white cabin, wearing white clothes and eating white foods only (thought to ensure good health.)1 While alone, they contemplate their physical transformation to adulthood and consider what society expects of them. Elders visit periodically to teach the arts and crafts of reproductive life, including the responsibilities of sexuality and child rearing. This has enormous impact on their personal growth.

One of the most beautiful examples of menarche initiation is the Apache rite of “Changing Woman.” In this solemn ceremony, the daughter becomes the primordial Apache mother, “White Painted Woman.” She reenacts the story of Changing Woman who, impregnated by the sun, gave birth to the Apache people. On the first day, she is sprinkled with yellow cattail pollen to symbolize fertility, and is taught by elders of the “fire-within,” her sacred sexuality. The ceremony lasts for four days, in honor of the Four Directions. On the final night, the initiate must dance from sunset to sunrise for the well-being of her people. At dawn, this song is sung to her:

“Now you are entering the world.

You will become an adult with responsibilities…

Walk with honor and dignity.

Be strong!

For you are the mother of our people…

For you will become the mother of a nation.” 2

Although a four-day ritual may seem excessive in the context of our busy lifestyles, its purpose of facilitating heightened awareness of new status and power is highly relevant. Menarche rites of today can range from formal ceremony to a simple gathering of special friends and relatives for a wonderful meal together. The main idea is to distinguish this milestone event from everyday life. Mothers everywhere are currently recreating or inventing these ceremonies for their daughters. But it is crucial that daughters themselves participate in the design and content of their celebrations, choosing what is comfortable for them. Here are some suggestions for a memorable event.

The place where the celebration will be held can be decorated with candles and flowers of red and white, red symbolizing blood and life force, white representing innocence, strength and reproductive health. The daughter may wish to sit at the place of honor, the head of the table perhaps, with her chair decorated like a throne. The centerpiece might be red roses, one for each year she has lived. She may also want to wear a crown of flowers, signifying her flowering adulthood.

To begin, the group can acknowledge and invoke her ancestors, all those in her family line who have crossed this threshold before. This affirms her place in the community, her procreative potential, and the natural beauty of her menarche experience.

The body of the rite involves sharing information on menstruation through story-telling and first-person accounts. Each participant is given the opportunity to describe her menarche experience. Not all of these stories will be joyous; some participants may become emotional as they recall feeling ashamed of their first blood. Yet this creates even stronger intent within the circle to honor the daughter currently engaged in this Blood Mystery. The group can balance feelings of grief with praise for her strength, courage and beauty.

An ancient form of honoring menarche is the Clay Rite, similar to the Apache use of cattail pollen. This is only appropriate if the daughter feels comfortable enough to be nude in the presence of her friends. Those who have not yet started bleeding cover her with wet, red clay, to symbolize her connection to the earth. This can be fun—a playful, messy act of saying farewell to childhood. If they are in a rural setting, the group may wish to construct a sweat lodge for the daughter, where she may spend a certain amount of time in seclusion. As an alternative, she might spend a night alone in a tent or cabin with her friends close by, singing or drumming to give her courage. Or she might simply go off by herself for a time to a place of total privacy.

After her time alone, several elders can instruct her regarding her fertility and responsibilities in the next stage of life. When they are finished, she returns to the larger group. Her friends may wish to form a birth arch at this point, lining up and passing her through their legs until she finally comes to her mother, who brings her out and into her embrace. As with actual birth, there is a moment in this act where time seems suspended—the power of this ritual is tangible. The “newborn” may then be washed clean of remaining mud by her friends who have already begun bleeding; thus they welcome her into the adult community. She should be dressed in new, beautiful clothing she can treasure for years to come, fussed over and adorned like the Goddess herself!

The group may then make some final comments or affirmations regarding the power of menstruation and appropriate use of this power in today’s society. Each participant may also wish to confide her own special ways of honoring her menstrual period. To close, the daughter’s mother may give her some jewelry, perhaps a family heirloom piece, or anything featuring red stones. She may also want to formally present her to whatever higher power they recognize, asking for protection and guidance.

When the ritual ends, feasting begins. Red foods represent fertility; guests may wish to toast the daughter with red wine. Perhaps other family members will choose to participate at this point. Male friends and relatives often find it hard to stay away during the ceremony and are very pleased when finally welcomed to join the festivities.

If such a formal ritual seems too complex or inappropriate for your family, simple variations may suffice. One mother told her daughter that when she got her period, she could choose any three things to do in celebration. On the first day of her bleeding, she opted for: 1) a shopping trip; 2) total silence from Mom for the entire day; 3) a steak. The last was somewhat controversial for this vegetarian family, but as her mother observed, “Eating a steak was my daughter’s ultimate statement of adult decision making power.”

Another option is for mother and daughter to go off together to some favorite outdoor place, reconnecting with nature and each other. They may want to go hiking or canoeing, or perhaps just build a campfire together, as long as they spend time alone and make it a celebratory day. The mother could use this time to review her daughter’s birth and tell her of her childhood—what her daughter was like when she was younger and all the great things she’s done in her life thus far. She might also share visions and hopes for her daughter’s future.

In addition to the aforementioned gift of jewelry, some mothers allow their daughters to pierce their ears on this day, presenting them earrings with red stones. Another precious keepsake is a “Menarche Book,” comprised of photos of all the women in the family and suitable for passing on to the next generation.

The day could end with the mother drawing a bath for her daughter, perhaps placing flower petals on the water. When it is over, the two can decide how to share the news with the rest of the family, and whether an special event of some kind would be desirable. Again, the most important thing is the daughter’s comfort; if she happily participates in planning a larger celebration, she will joyfully remember it for the rest of her life.

1 Cohen, David, ed. The Women’s Wheel of Life (New York, Harper Collins, 1991), page 64.

2 Ibid, page 62.

Other Blood Mystery rites may be found in The Women’s Wheel of Life by Elizabeth Davis and Carol Leonard.  Find it on: Amazon

The Sexuality of Pregnancy & Birth

Tuesday, July 27th, 2010

An excerpt from The Rhythms of Women’s Desire: How Female Sexuality Unfolds at Every Stage of Life by Elizabeth Davis, Hunter House Publishers, 2013

The First Trimester | The Second TrimesterThe Third Trimester
Birth as a Sexual Event

Chapter Four: The Sexuality of Pregnancy and Birth (abridged)


Increased circulation in pelvic tissues as a means for uterine growth can lead to pelvic engorgement, similar to that in premenstrual or ovulatory phases of the cycle. This may cause the mother to wonder what’s hit her, and whether her desire for deep and forceful penetration is really safe. There is no doubt that orgasm causes uterine contractions, but to a degree so minor as to have no serious impact on placental circulation.

If there is a history of miscarriage or episodes of bleeding in the current pregnancy, sexual activity should probably be curtailed, at least for the first trimester. Barring these exceptions, sex brings physiological benefits of increased pelvic circulation, release of tension, and internal muscle toning particularly helpful in preparation for birth. Many couples describe their sexual encounters in pregnancy as re-bonding experiences, akin to those in the initial phase of their relationship. No wonder, for both partners are assuming new roles, and are discovering aspects of one another heretofore unknown.

A mother’s level of desire in the first trimester may also have something to do with the sex of the child she is carrying. At about six to eight weeks, when the baby’s brain is developing, male fetuses are exposed to an enormous dose of testosterone, the level of which is four times that of infancy and childhood.1 This undoubtedly has some impact on the mother, quite possibly increasing her libido. By the same token, it may be that a mother’s ability to recognize the sex of her unborn has a hormonal basis, since surges of testosterone continue to occur in male fetuses at regular intervals during gestation.

For more on the sexuality of pregnancy: The Rhythms of Women’s Desire: How Female Sexuality Unfolds at Every Stage of Life, by Elizabeth Davis, Hunter House Publishers, 2013. Find it on Amazon.


Throughout pregnancy, oxytocin levels continue to rise. Oxytocin initiates Braxton-Hicks contractions, which tone the uterus and prepare it for labor. In large amounts, oxytocin has also been shown to cause mood elevation and alleviate depression–perhaps this accounts for feelings of joy and well being often experienced at this stage of pregnancy. Take ample amounts of oxytocin, mix with high levels of estrogen, blend with vaginal engorgement, and no wonder many mothers in their second trimester find themselves sexually insatiable, surprising both themselves and their partners.

Let’s take a closer look at male reactions to sex in pregnancy. If there is concern about jeopardizing the pregnancy during the first trimester, feeling the baby move in the second may further compound this fear.

A surprising number of males struggle with conflicting images of Madonna/Whore, the Mother versus the Lover, unable to blend the two and hence uncertain of how to relate to their pregnant partner sexually. That a mother might also be blatantly lustful and erotic is a powerful merger of two culturally disparate aspects of femininity.

Some mothers feel this too and may manifest it either by avoiding sex or by wanting to focus exclusively on the baby. Resulting problems may be considerable; disrupted intimacy in a rapidly changing relationship will breed estrangement and mistrust unless lines of communication are kept open. In my practice, I remind my clients of the sexual nature of birth, and use it as a reference point to encourage them to stay open to their partners as much as possible. Labor is, after all, an intensely physical experience; the estimated caloric output of the first birth is equivalent to that of a 50-mile hike! And it involves the same kind of emotional surrender as spontaneous orgasm.

An important aside here about physical and sexual abuse: more and more of us are becoming aware of forgotten or repressed experiences now that support is available. For some, the emotional vulnerability of pregnancy may trigger recollections for the first time that are doubly difficult to handle if parents or other relatives are implicated. The accompanying sorrows and fears may interfere with the mother’s primary relationship. But wherever possible, it is better to bring these to the surface while pregnant than to have them arise and interfere with labor or mothering. Precisely because pregnancy is such a labile state, I recommend hypnotherapy, as it can be especially useful for reactivating and healing the past.


By overview, the first trimester is initiation into pregnancy; the second, integration and equilibrium; and the third, completion and transition to labor and parenting. Sexuality is often disrupted at this stage by the physical discomforts of extra weight. Sleep may be sporadic, especially if heartburn is a problem, and urination becomes frequent again as the baby moves low. None of this is particularly conducive to amour, but a midday rendezvous can help. These inconveniences promote readiness to give up pregnancy and get on with labor, simultaneously preparing a mother for the challenges of caring for her newborn.

Emotionally these are trying times, with mixed feelings in relationship. Sometimes a mother wants to cling to her partner and hold back time, aware that the baby will soon be out in the world (or in the middle of the bed) and nothing will ever be the same again. Sometimes she wants the privacy just to be with the baby, trying to get to know it as well as she can before it is born, so that sex seems extraneous, or more for her partner than for herself. Especially when she is thinking of the challenges ahead and her ongoing need for support, she may be demanding, moody, or fearful.

But in the last week or so, a drop in progesterone often leads to loss of water weight, and a feeling of lightness and well-being. Substances called prostaglandins, found in the brain as well as seminal and menstrual fluids, may also be responsible for labor’s onset. Or it may be the fetus that is responsible; it too releases prostaglandins as its brain matures. Prostaglandins soften the cervix and cause uterine contractions.

This is why many care providers now encourage intercourse at term, especially if the baby is overdue. Seminal fluid is extremely high in prostaglandins and thus may help trigger labor. (A substitute may be found in evening primrose oil, reputed to have a similar effect when rubbed gently on the


Is birth really a sexual event? How can this be, when it’s reputed to be so painful?

Let’s consider these questions one at a time. Birth as a sexual event—-however can we doubt it? After all, it is an intensely physical experience centered in the vagina. In fact, the entire pelvic area is highly stimulated in labor: not just the vagina, but the clitoris, rectum, anus, the supporting tissues and musculature. We can compare the sensations of labor contractions to those of strong menstrual cramps, but with one important difference—contractions come in waves, they build up steadily instead of taking hold abruptly. Those who have learned to cope with menstrual cramps by relaxing and letting go have a distinct advantage in labor. And here is where the parallels to sexual intercourse begin. Particularly when sex is very passionate and forceful, there may be moments of pain or cramping discomfort with deep thrusting and intense pelvic movement. Relaxation, rhythmic breathing, and a change of position help us ease through these sensations without losing momentum, as we would if we tightened up or shut down emotionally. Especially with orgasm, the ability to surrender and diffuse sensation throughout the body is critical.

Deep relaxation, surrender, letting go: when midwives are asked to disclose the secret of giving birth with relative ease, these are the words we choose. More than metaphors for coping, these responses are based on physiological imperatives, as we will see in the forthcoming section. We will also look closely at how environment affects the spontaneity of the birth process.

For more read The Rhythms of Women’s Desire: How Female Sexuality Unfolds at Every Stage of Life by Elizabeth Davis, Hunter House Publishers, 2013. Find it on Amazon.