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The moment you give birth, in addition to having a new member of your family, there are a number of changes that take place, including within your body. One particular change that happens quite immediately after delivery is called uterine involution, which occurs when the uterus shrinks back down toward its pre-pregnancy size. The main reasons for uterine involution are to reduce the amount of weight you have to carry, and to allow the uterus to regain fertility.
“Basically, the uterus grows over the course of a pregnancy to accommodate the fetus, amniotic fluid, and placenta; the cells of the uterus grow and expand,” explains Amanda B. Flicker, M.D., Chair of the Department of Obstetrics and Gynecology at Lehigh Valley Health Network. At the time of delivery of the fetus, there is rapid decompression of the uterus; the muscles contract in order for the placenta to separate, according to Dr. Flicker. The uterus then continues to contract in order to eventually return to its regular size, which can take about four weeks, she says.
For some people, uterine involution can be uncomfortable, and can be one more postpartum change in a period that is already difficult —here’s what to know about uterine involution and how to cope with the symptoms.
What are the symptoms of uterine involution?
Continual contractions of the uterus squeeze the uterine muscles in order to both stop postpartum bleeding and help the uterus return to its regular size, explains Dr. Flicker. Within a day of delivery, the uterus typically goes down to about the size of a 20-week pregnancy, if you have a full-term pregnancy, and moves from being behind up the belly button in the direction of the pelvic bone. However, it takes longer for the tissue around the uterus to contract and return to its size.
You might feel menstrual-like cramps as the uterus contracts, Dr. Flicker says.
It’s also common to feel the process of uterine involution physically happening if you choose to breastfeed. According to Dr. Flicker, the hormone that helps you produce milk and breastfeed your baby also causes the uterus to contract. Some patients report feelings of crampiness, pain, or a gush of bleeding as they breastfeed, she adds.
Are there any potential complications of uterine involution?
“In labor, after you deliver the baby and placenta, the uterus needs to contract and stop bleeding,” Dr. Flicker says. Occasionally, certain factors can cause the contracts to not happen as they should: For example, anything that overextends the uterus could make it more difficult for the process of uterine involution to take place. That could mean having a multiple birth, having too much amniotic fluid, having over-fatigued muscles from a long or difficult labor, or having an infection during labor, according to Dr. Flicker. In severe cases, this can result in severe bleeding, or postpartum hemorrhage.
Generally, bleeding in the postpartum period is normal for about four to six weeks after birth. The typical trajectory is bright red blood, that then lightens, and turns to brownish and then yellowish discharge before it resolves, Dr. Flicker says. You might experience an uptick in bleeding between 10 and 14 days after delivery, but it shouldn’t be more bleeding than a period for you, and shouldn’t go much further beyond four to six weeks. Here’s how to know how much bleeding should warrant calling your medical care provider: “If you’re soaking through more than one thick pad per hour, in more than two consecutive hours, or passing multiple large clots, let your obstetrical care provider know. Any bleeding that leads to lightheadedness or dizziness should also prompt a call or visit to your provider,” Dr. Flicker says.
How to manage pain during uterine involution
Since uterine involution will feel similar to bad menstrual cramps, it’s best to treat them in a similar way. Dr. Flicker recommends taking NSAIDs, such as a prescription dose of ibuprofen, which is typically 400 milligrams every four to six hours. If you can’t take ibuprofen for some reason, take acetaminophen, or Tylenol, suggests Dr. Flicker — and if you have pain beyond that, notify your provider. Stock up on heating pads too, just like you would for period pain.
One other thing to remember about uterine involution is that the cervix also dilates, especially for vaginal birth, and needs to contract back down to its regular size. The general recommendation is to refrain from using tampons for at least six weeks after birth and to avoid submerging your body in water, at least for a few days after birth to keep the cervix safe from infection, says Dr. Flicker.
In general, so many aspects of the postpartum period take time, including the process of uterine involution. “It takes nine months to grow the fetus, and it’s unrealistic that your body will go back to completely normal in just four to six weeks,” says Dr. Flicker. First, you need to be gentle with your body after going through birth, and focus on generally healthy habits as your body does what it needs, she adds: “Add calories to your regular, balanced diet, especially if you're breastfeeding, stay hydrated, and give yourself credit for what your body has done.
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.