Table 1.

Guidelines for Perinatal Educators on Integrating Sex and Pregnancy in their Classes

A. The perinatal educator can begin by asking the following questions:

1. Do I have time to talk about this subject in my classes?

2. Do I feel comfortable talking about this subject?

3. If I don't feel comfortable with it, why not?

4. What do I do about my discomfort, especially if a couple has questions about their sexuality? Should I avoid the question or refer the couple to their health care provider?

B. If a perinatal educator decides to integrate more sexual content into classes, it may be helpful to reflect on the subject, because her/his attitude will influence the teaching approach used. The following questions could be considered:

1. What does intimacy mean to you?

2. What does sexuality mean to you?

3. Is there a difference between sex and sexuality? If so, what are these differences?

4. How was intimacy experienced in your family of origin?

5. What was your family's attitude towards sexuality?

6. How was intimacy demonstrated between your parents? between the parents and children? between the children?

7. What do you remember about your parents' sex life?

8. When and how did you first learn about sex? How did this influence your current attitude about sex?

9. What was your family's attitude about nudity? What is your attitude about nudity?

10. What do you remember about your first sexual experience? How has this influenced your current attitude towards sex? How have your other sexual experiences been since that first experience?

11. How you feel about sex during pregnancy?

12. If you have been pregnant, how was your sexual life at that time?

13. What is the impact of that experience on your teaching approach?

C. Once a perinatal educator has gone through self-reflection, she may feel more comfortable in broaching the subject in a more open manner in her classes. If a perinatal educator decides to expand her teaching about sex during pregnancy, several decisions will have to be made regarding the content to be presented, the time limit on teaching, and the specific subjects. These decisions depend on the fit with the characteristics of the prenatal group, the teaching activities, the teaching approach, and the educator's public comfort with the subject matter. Some in-class suggestions:

1. All or some of the same questions as in part B alone can be used in the expectant parent group setting. It may be a homework assignment. In this case, each partner can be invited to answer the questions separately, then they can compare their answers.

2. Couples can be taught to have a sexual conversation (Hooper, 1992; Pearsall, 1987) in which each conjugal partner expresses his or her sexual desires and needs. There are three areas that can be addressed:

a.) Heightened sexual awareness and intimacy—It is important for the person to know what he or she likes and to know what the partner likes, now that things have changed. Sharing this information increases partners' sexual awareness of each other.

b.) Sexual assertiveness—The couple needs to clarify which partner(s) can take the initiative during the sexual encounter. It involves touching or undressing the partner first or getting the partner to undress her. It can mean being able to give pleasure to the partner without expecting anything in return. Re-establishing confidence in oneself as a lover during pregnancy is important. This can be achieved through open communication and knowledge.

c.) Touch and massage—Conjugal well-being involves touching on a daily basis. The energy may not be available for the full sexual encounter including intercourse, so massage can be used as a compromise for both touch and sexual satisfaction. This can be more important during pregnancy, especially if complications arise. Massage techniques are usually taught in prenatal classes for the comfort of the pregnant woman and for childbirth preparation. Their context can be expanded to include sexuality. Massage can be comforting, just as it can be sensual, sexual, and erotic. Tantric lovemaking involves much stroking and this can also be included. Techniques from Kama sutra can also be explored and integrated to the couple's repertoire.