But while this is biological fact, there’s something about mixing sexual pleasure with birth that seems to rub people the wrong way. The same can be said about intercourse during pregnancy, which can be awkward due to both physical and emotional logistics.

What is it about childbearing that seems to necessitate de-sexualization? There are, of course, the physical and emotional realities of pregnancy and new motherhood that often change dynamics and interest in sexual relationships.

But need they?

It may well be that for some, pregnancy and sexuality can complement one another beautifully. When one considers anatomy, and the reliable presence of the immovable clitoris, sexual pleasure becomes a possibility not just throughout pregnancy but also during childbirth. If it seems counterintuitive, ask yourself why. Anatomically speaking, it shouldn’t exactly be shocking that women have experienced orgasms while giving birth. The head of a baby passing through the birth canal is likely to bump against the clitoris more directly than anything ever has before, given the angle. There may even be a palliative effect to this contact; studies that sought to prove the existence of the vaginal orgasm found that the pressure of the baby’s descending head through the vagina may have pain suppression qualities due to its proximity to the clitoris, whether it’s experienced as sexual or not.

But given that many women labor and deliver babies in spaces that afford them very little privacy, and they are overwhelmed by feelings of shame if they so much as defecate on the bed, it’s not surprising that these fleeting moments of conflicting sensations are stifled. Perhaps even more so if they do provide relief from pain.

There are certainly people who have sex throughout pregnancy, as well as others who have embraced the art of the “orgasmic birth.” But popular culture still seems to be unaware of the phenomenon. Even though many contemporary writers and filmmakers have set out to talk to mothers about the experience, it’s still referred to as women’s “best-kept secret.” However, it’s hardly a new concept. Ina May Gaskin, the pioneering midwife whose book Spiritual Midwifery is regarded as a seminal text on the topic, has written extensively about the phenomenon of sexuality in pregnancy, including orgasmic births, since the 1970s.

So maybe this “secret” is one being kept out of shame. Many doulas, including Gaskin, argue that orgasmic birth is possible for anyone, and that it comes down to creating the right environment, both internally and externally, to facilitate the experience. A woman in England recently made headlines when she admitted that not only had she orgasmed during the births of all four of her children, but that the most recent one left her with orgasmic sensations for three weeks, postpartum. She said hypnobirthing, a technique that employs self-hypnosis to control pain, allowed her to fully experience the more pleasurable aspects of labor and delivery.

Many women, however, balk at the idea and wonder why anyone would even be thinking about sexual pleasure while giving birth — if not due to the inherent conflict of sexuality and motherhood, then due to the often grueling nature of childbirth itself.

“I was in excruciating pain for 12 hours, sex never crossed my mind,” said a 37-year-old mother of one in a response to an anonymous questionnaire. She added, “I didn’t feel comfortable with my body during the whole pregnancy.” This is a sentiment echoed by many who responded to this online survey, administered through Typeform, which asked participants about age, number of pregnancies, and their sexual preferences and behaviors during pregnancy, which can often be a taboo topic.

“I hated it, to be honest,” said one 26-year-old mother of one. “I felt like my body wasn’t my own and experienced dysphoria so crippling that I dissociated and still don’t remember 90% of my pregnancy that led to me giving birth.”

“I felt physically, mentally, and emotionally impaired,” said a 36-year-old mother of one, who reported that for her the changes weren’t just physical, but emotional. “I imagined I would be active and glowing, but I couldn’t think clearly, I was too exhausted to accomplish anything, and I felt like my brain was underwater all the time.”

But some wrote that they actually felt great throughout their pregnancies, maybe even better than before. “I loved my body during pregnancy more than I usually do,” said a 26-year-old mother of two. For some, pregnancy can feel pretty good overall due to an elevated dose of progesterone, a hormone that’s produced in smaller amounts throughout the menstrual cycle, but skyrockets during pregnancy, bringing along all its PMS symptom-reducing benefits.

Of course, how one feels physically paired with how they feel about themselves emotionally certainly can have an impact on sexuality. Many women who responded to the questionnaire said that they had sexual intercourse throughout their pregnancies, and one woman, a 27-year-old mother of two, said her second labor started directly after intercourse (à la Rachel in that episode of Friends). While sex drives waxed and waned for many, those physical changes of pregnancy definitely impacted whether sex was going to happen. As that 27-year-old mom put it rather succinctly, she felt, “Sometimes drained, sometimes really horny.”

This begs the question of masturbation. Some women have discovered that even if their partner is unavailable, or unwilling, to participate in sexual activity throughout pregnancy, solo sex can provide a temporary reprieve from the discomfort. Masturbation can also be used as a form of relief during labor and delivery. Angela Gallo made headlines earlier this year when she penned a blog post explaining why she masturbated throughout labor. And why not? As Gallo pointed out, masturbation not only provides a flush of feel-good sensations, it also directs focus to the vagina, where all the action is. In the same vein as self-hypnosis, anything that can redirect the focus from the chaos of childbirth, whether it be external or internal, to the center itself seems like an incredibly useful technique, even if it might freak some people out.

It’s also one that is probably far more innate than we realize. Some studies have found that the neurobiology of pain and pleasure are remarkably similar, and much of this relates to motivation. The motivation to pursue pleasure versus the motivation to avoid pain can be at odds but often overlap, and the hierarchy will change, given the circumstance. Sometimes, in order to survive, the avoidance of pain will outrank the pursuit of pleasure. But sometimes, in the face of pain, the analgesic effect of pleasure can be worth the risk.

Viewed in the context of labor and delivery, which is a well-known painful but temporary experience, it doesn’t seem so outlandish for that pleasure center of the brain to be stimulated in multiple ways, not just with medications or anesthetics. While these pain-relieving tactics, like epidurals, are relatively commonplace in hospital births, they don’t always appeal to every patient, and they may not work for every birth. Neither, of course, would masturbation during labor be appealing or possible for everyone, but unlike epidurals, which are just part of the childbirth lexicon now, many probably don’t even realize they have the option.

When asked if they would consider using masturbation or intercourse as a pain relief technique during labor, one 17-year-old respondent said, “I’m giving birth in a few weeks, but honestly, it’d be too weird for me to masturbate or have sex during labor. I’d only masturbate if I knew the orgasm would help ease my pain.” The majority of the respondents said they would not masturbate, even if they were given the privacy to do so.

While many found the question jarring, one mother seemed to get to the root of the resistance. “I feel that most people tend to compartmentalize their bodies’ many functions, but I feel comfortable that we are sexual beings at the same time that we are mothering/fathering/feeding/caring/washing/needing beings,” she wrote, adding that while she and her partner didn’t engage in intercourse throughout her pregnancy or delivery, she would hardly begrudge anyone who wanted to give it a try. “For couples who are more open and comfortable, I think it’s great.”

The orbiting questions of sexual morality, shame, biology, social mores, and purpose continue to define the experience of childbirth, whether it be orgasmic or not. But wouldn’t it be marvelous if, one day, a woman could define the experience for herself?