Dear mom, you are probably very happy with your new baby these days, but also a little tired, right? After having a baby, your body goes through a lot of changes. Among them, the process of the uterus returning to its original shape, called `(Uterus Involution)` , is very important. Let's talk about this today.
What is Uterus Involution?
Simply put, `(Uterus Involution)` is when your uterus shrinks back to the size it was before you had a baby. It's like a balloon deflating. This happens about six days to six weeks after you have your baby. Remember how big your uterus got during pregnancy to accommodate your baby! So it's normal for it to take a while to get back to its original size. This is an important part of the postpartum healing process.
What is the significance of `(Uterus Involution)`?
This causes your uterus to return to the size it was before you were pregnant. Think about it, during pregnancy, your uterus expands several times its normal size. It also accumulates extra blood and tissue. All of this is done to create a safe, nurturing place for your growing baby. After the baby is born, your body no longer needs that extra space or tissue.
This process of ``involution'' allows your body to begin its monthly menstrual cycle again.
How does this process of uterine regeneration occur?
This starts as soon as you deliver the placenta . That is, after the third stage of labor. Then your uterus starts to contract again. These contractions reduce the amount of blood flowing to the area where the placenta was attached to the uterus. This is actually the body's natural way of preventing excessive bleeding, or postpartum hemorrhage .
These contractions help the uterus shrink back down and expel the extra tissue. We call this discharge lochia . These uterine contractions are very regular and strong for the first 12 hours after delivery. During this time, you may experience lower abdominal pain, similar to menstrual cramps (afterpains) .
These ``afterpains`` usually subside within a few days. However, you may feel this pain more when you breastfeed or pump milk. Also, mothers who have had children before may feel this pain a little more intense.
It takes about six weeks for the uterus to fully recover. The weight of the uterus decreases day by day, and the space in the pelvic cavity to accommodate it decreases. Even after the baby is born, you may feel like you have a "baby bump" for a while. This is because even though the baby is out, the uterus still takes up a lot of space in your abdomen.
How does breastfeeding affect `(Uterus Involution)`?
If you breastfeed your baby, your uterus contracts more quickly . When your newborn sucks milk (or when you breastfeed), your body produces a hormone called oxytocin . This hormone causes the uterus to contract. So breastfeeding is a great help in this process.
How can I monitor the progress of my uterus healing?
While you are in the hospital, a doctor or nurse will regularly check the progress of your uterine contractions. They will place their hands on your belly and feel the top of your uterus, called your `fundal height` . They will also check to see if your uterus feels hard. They will also pay attention to your `lochia` (postpartum discharge) at this time.
For example, if your uterus doesn't contract as expected, or if it feels soft to the touch, you may be at increased risk of postpartum hemorrhage . If this happens, your doctor may perform a fundal massage to help your uterus contract. Sometimes, you may be given artificial oxytocin, also known as Pitocin® , to stimulate contractions.
How does the uterus change throughout the process of `(Involution)`?
Most of the time, the weight and size of your uterus decrease on a similar schedule. However, the size and weight of your uterus before pregnancy depends on a number of factors. For example:
- Whether you have had children before (many women have a slightly larger uterus after a previous birth).
- Whether you are having a multiple pregnancy, such as twins.
- At what point in the pregnancy did you deliver the baby?
Typically, the weight of the uterus changes after childbirth as follows:
- Right after birth: About 1000 grams (about 2 pounds). Think about it, this is a big deal!
- In a week: about 500 grams.
- In two weeks: about 300 grams.
- In four weeks: about 100 grams.
- In eight weeks: About 60 grams (about 2 ounces). Now it's almost back to normal.
During ``involution``, your uterus shrinks from the size of a grapefruit , filling the entire pelvic cavity, to the size of a pear . Here is the timeline for the uterus to descend back into the pelvis:
- About an hour after delivery, the top part of the uterus (the `fundus`) is at your navel.
- After that, the top of the uterus should descend into the abdomen by 1 centimeter every 24 hours.
- About a week after your baby is born, the top of your uterus should be at the level of your pubic bone (symphysis pubis).
- After about 10 to 14 days, the top of the uterus should have descended back into the pelvic cavity.
What problems can occur with `(Uterine Involution)`?
There are two main problems that can occur during the return of the uterus to its normal position: subinvolution (the uterus not contracting properly) and postpartum hemorrhage.
`Subinvolution` (the uterus does not contract properly)
Subinvolution is when your uterus doesn't shrink as much as it should. Sometimes doctors call this a "placental subinvolution." This means that the spiral arteries where the placenta was attached to the uterus don't close properly.
Your doctor may suspect this when they examine your abdomen (fundal exam). Also, if you have lochia rubra (red, bloody discharge) for more than a week after giving birth, it is also a sign of subinvolution. Your doctor may also order an ultrasound to see exactly what is happening.
Sometimes the uterus can become too 'tired' to continue contracting. Or other problems can interfere with this process. Some things that can cause `subinvolution` are:
- Infections of the uterus, for example endometritis (inflammation of the inner lining of the uterus).
- There are things like pieces of placenta left inside the uterus.
- Prolonged labor or prolonged exposure to oxytocin (Pitocin), which causes the uterus to contract.
- Having a baby by cesarean section (C-section) .
- Administering general anesthesia, such as in an emergency cesarean section.
`Postpartum Hemorrhage (PPH)`
Postpartum Hemorrhage (PPH) is excessive bleeding from the uterus after childbirth. This can be life-threatening, so you need to be very careful.
About 80% of cases of PPH occur after the baby is born because the uterine contractions are not strong enough. PPH usually occurs most often within 24 hours of the baby being born. However, it can occur up to 12 weeks after the baby is born.
While you are recovering in the hospital, doctors and nurses will regularly monitor your bleeding (`lochia`). If you start bleeding heavily, they will treat it immediately.
If you are bleeding heavily at home (for example, so much that you have to change a pad every hour), go to the nearest hospital emergency room as soon as possible. Be sure to keep this in mind.
How do I take care of myself?
After having a baby, it's important to take care of yourself and rest as well as your baby. Make time for yourself, and get help from family and friends to take care of your baby.
The pain that comes with uterine contractions (`afterpains`), especially when breastfeeding, can be quite intense. It can last for about five minutes and then gradually subside. There are a few things you can do to manage these `afterpains`:
- Doing breathing and relaxation exercises to help with labor pain.
- Lying on your stomach with a pillow under your stomach.
- Using a pain reliever recommended by your doctor (for example, ibuprofen may work better than acetaminophen ).
- Walking a little can sometimes help.
The uterus returning to its normal position is an important natural process. But sometimes it needs a little help on this journey. That's why your medical team will check on you regularly after you have your baby. These regular check-ups can be a nuisance, especially when you want to be with your new family member. But these check-ups are essential to help you identify complications like postpartum hemorrhage early. If they have any concerns about how your uterus is contracting, they'll let you know.
The most important things to remember (Take-Home Message)
Okay, so here are some things you need to remember from what we've talked about today:
- It is normal and natural for your uterus to shrink back to its original position after you have a baby (`uterus involution`).
- This process takes about six weeks to complete. So don't rush it, give your body time.
- Breastfeeding helps speed up this process.
- Abdominal pain called ``afterpains'' is common during this time, and there are things you can do about it.
- At the hospital, doctors and nurses examine your uterus for your safety.
- If you are bleeding heavily (especially at home), go to the hospital immediately without delay. This is very important.
- During this time, don't forget to get plenty of rest, eat nutritious foods, drink water, and do things that make you happy.
If you have any questions or concerns, never be afraid to ask a doctor. You are not alone, we are all with you!
` Uterine contractions, Uterus Involution, postpartum recovery, postpartum care, lochia, afterpains, breastfeeding and the uterus
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