The 18 Month Postpartum Marital Disaster Area

by Dr. Perle Feldman

The most important determinant of child health in Canada is poverty, and one of the most important determinants of poverty is the growth of single parent families and family breakdown. Yet there has been very little emphasis in family medicine research and teaching on those factors which physicians can employ to help couples stay together. I believe there is a simple anticipatory guidance strategy, which can help couples at one important developmental stage in their marriage. This stage I call the Eighteen Month Post-Partum Marital Disaster Area.

Somewhere between 1-2 years after the birth of their first baby, patients who have been previously happy and functioning couples come into the office with a complete dissatisfaction with their marital relationship. Statistically, 2 years after the birth of the first child is a peak in marital breakups and divorce.

What is happening here? How can couples who were so in love turn to enemies or strangers after the birth of their much beloved child? There are many reasons. Firstly, having a baby is a huge change in the dynamics of a relationship. Once the child is born many of the couple’s affilative and dependency needs shift in balance.

Sexuality also changes after childbirth. When a couple has only themselves to please, opportunity for intimacy and privacy for intercourse are practically unlimited and spontaneity is the norm. Once the baby is born sleep deprivation is a huge issue. There are also postpartum physical changes making intercourse painful. Many women are shy to ask their physicians for help unless directly questioned. This sets up a situation where intimacy may be avoided

Many men, being initially rebuffed, do not want to risk rejection by approaching their wife again. Some men are turned off by the changes in their partners’ bodies after pregnancy; some men have psychological issues with the change of roles. However, far more women feel ugly and unlovable, with their birth scarred bodies. This leads to a decrease in sexual activity in the couple and a decrease in intimacy and satisfaction.

Suddenly, at around a year or eighteen months a couple looks at each other and tries to remember who they are. It takes a year of hard work, to get through the demands and stresses of a new baby. It is only once that year is over, the baby sleeping more or less through the night, the physical problems resolved that people have the leisure to re-examine their marital relationship.

It is useful for the physician to reassure couples that this is a normal developmental stage and to suggest some strategies to deal with it. I find the 12 month and 18 month baby check up an ideal time to broach the subject of marital satisfaction.

At this stage it is very helpful to devote a little time each week for marital maintenance, to give the marriage as an entity a little quality time. It is important for any couple to have some time alone with each other, to think of themselves as a couple. This is often difficult to arrange. One suggestion is to have a standing babysitter for an evening every 1-2 weeks.

Another useful suggestion is to encourage couples to plan their intimacy in advance. While it seems a little cold blooded to pencil in time for intercourse for many young parents that is the only way it is going to happen. You can call the arranging, verbal foreplay.

It is important to encourage parents to believe that a good couple relationship takes work and dedication. A marital relationship saved is an important determinant of the future health of all members of the family, particularly the children.


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Jay Belsky, Ph.d. & John Kelly 
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Belsky,Jay; Hsieh, Kuang-Hua, 
Journal of Family Psychology. Vol 12(4), Dec 1998, 511-528.

Joint custody of infants and toddlers 
Fay, Robert E. 
Medical Aspects of Human Sexuality. Vol 19(8) Aug 1985, 134-39