Even though you're relieved to have a baby, it's normal for your body to feel a little tired for a few days, right? Especially since your uterus, which has been carrying the baby for months, needs to shrink back to its original size. Today, we're going to talk about this important process.
What is Uterine Involution?
Simply put, uterine involution is when your uterus shrinks back to the size it was before you had a baby. This happens soon after you have your baby and lasts for about six weeks. This is when you will experience postpartum bleeding and discharge, or what we call lochia .
Imagine, your uterus has been growing for months, ready to provide protection and nourishment for your baby. So, after the baby comes out, it's normal for it to take some time for it to return to its original size. This shrinking of the uterus is an important part of the postpartum healing process .
So what's the point of this? Your menstrual cycle will start again once your uterus returns to normal. This process also helps remove all the extra blood and tissue that accumulated in your uterus during pregnancy.
How does this process happen?
This process of uterine contractions begins as soon as you deliver the placenta. That is, in the third stage of labor. Then your uterus starts to contract again. Imagine, these contractions are what reduce the bleeding from the place where the placenta was attached to the uterus. This is actually a wonderful defense mechanism that our body has, to stop excessive bleeding (postpartum hemorrhage) .
These contractions cause the uterus to shrink again and the extra tissue, called lochia, is expelled. These uterine contractions are very regular and strong for the first 12 hours after delivery. During this time, you may feel pain in your lower abdomen, which is what we call 'afterpains' .
This 'butt pain' usually subsides within a few days. However, you may feel this pain more when you are breastfeeding or pumping. Also, if you have had babies before, you may feel this pain a little more.
It takes about six weeks for the uterus to fully return to its normal size. As the weight of your uterus decreases, so does the space in your pelvic cavity. You may still feel a little 'belly-like' for a few days after giving birth. This is because your uterus still takes up a significant amount of space in your abdomen, even though your baby is out.
Does breastfeeding have any effect on this?
Yes, absolutely! If you breastfeed your baby, your uterus will contract more quickly . This is because when your baby sucks (or when you pump), your body produces a hormone called oxytocin . This hormone causes the uterus to contract. So, breastfeeding is a great help in this process.
How do doctors check that the uterus is returning to normal?
While you're in the hospital, a doctor or nurse will often come in to check how your uterus is contracting. They'll place their hands on your belly and look at the top of your uterus, called your 'fundal height' . They'll also check to see if your uterus feels hard. They'll also pay attention to your lochia (wax) during this time.
For example, if your uterus is not contracting as expected, or if it feels soft, you may be at increased risk of postpartum hemorrhage . In this case, your doctor will often massage your uterus (fundal massage) to help it contract. Sometimes, you may be given a drug called Pitocin® , which is an artificial hormone, to stimulate uterine contractions.
How does the uterus change during this time? (Size and weight)
Although everyone's uterus contracts on a similar schedule, the size and weight of your uterus before you get pregnant can vary. There are several factors that can affect this:
- Whether you have had babies before (many women have a slightly larger uterus after a previous birth).
- How many babies did you have, like twins?
- At what point in your pregnancy did you deliver the baby?
Typically, the weight of the uterus changes after childbirth as follows:
- Immediately after birth: About 1000 grams (about 2 pounds).
- In a week: about 500 grams.
- In two weeks: about 300 grams.
- In four weeks: about 100 grams.
- At eight weeks: about 60 grams (about 2 ounces).
Do you understand? During this contraction, the uterus shrinks from the size of a grapefruit , which filled the entire pelvic cavity, to the size of a pear . The schedule for the uterus to descend back into the pelvic cavity is as follows:
- About an hour after delivery, the top of the uterus (fundus) should be at your belly button.
- After that, the top of the uterus should descend about 1 centimeter into the abdomen every 24 hours.
- After about a week, the top of your uterus should be near the pubic bone (symphysis pubis) in your lower abdomen.
- By 10 to 14 days, the top of the uterus should be back inside the pelvic cavity.
What problems can arise in this process?
There are two main problems that can arise during the recovery of the uterus: the uterus not contracting properly and excessive bleeding after childbirth.
Subinvolution of the uterus
Subinvolution is when your uterus doesn't contract properly, meaning it doesn't contract. Doctors sometimes call this "placental subinvolution." This is when the spiral arteries, where the placenta was attached to the uterus, don't close properly and are delayed.
Your doctor may suspect this after examining the top of your uterus (fundal exam). Also, a dark red, bloody discharge ( lochia rubra ) that lasts more than a week after giving birth is a sign of this condition. If this happens, your doctor may order an ultrasound to see what's really going on.
Sometimes, the uterus may not be able to continue contracting, or other problems may interfere with this process. Here are some reasons why subinvolution may occur:
- Infections of the uterus, such as endometritis .
- Things like pieces of the placenta remaining inside the uterus.
- Prolonged labor or prolonged exposure to Pitocin®, which causes the uterus to contract.
- Having a baby by cesarean section (C-section) .
- Giving general anesthesia, such as for 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 PPH cases occur because the uterine contractions are not strong enough after childbirth. PPH usually occurs within 24 hours of delivery. However, it can occur up to 12 weeks after delivery.
While you are recovering in the hospital, the medical staff will regularly check you for bleeding ( lochia ). If you have heavy bleeding, they will treat it immediately.
The most important thing is, if you are bleeding heavily while you are at home, go to the nearest hospital's Emergency Department (ETU) as soon as possible.
How do you take care of yourself? (Back pain management)
After having a baby, it's important to take care of yourself and rest as well as taking care of your baby. Find time to think about yourself and ask for help from family and friends to take care of the baby.
The 'back pain' that comes with uterine contractions can sometimes be intense, especially when breastfeeding. The pain may last for about five minutes and then gradually subside. Here are some things you can do to manage this back pain:
- Breathing and relaxation exercises (like exercises for labor pains).
- Lie down on your stomach with a pillow under your lower abdomen.
- Taking an over-the-counter pain reliever recommended by your doctor. Ibuprofen may work better than acetaminophen .
- A little walk.
Finally, the most important thing (Take-Home Message)
The uterus returning to its normal size is a very important, natural process. However, sometimes your uterus may need a little help on this journey. That's why the medical staff will check you regularly after you have your baby. While these checkups may seem like a bit of a hassle when you're just getting used to your new family member, they're essential for early detection of complications like postpartum hemorrhage . If they have any concerns about how your uterus is contracting, they'll let you know. So, don't worry, everything will be fine!
` Uterine contractions, postpartum, lochia, postpartum hemorrhage, breastfeeding, uterine size, recovery
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