If you’ve recently given birth, you may be wondering how to tell if your uterus is healing properly. The uterus goes through a lot during pregnancy and delivery, so it’s normal to have questions about the recovery process. Here’s what to know about how your uterus heals after having a baby and signs that it may not be healing as expected.
What happens to the uterus during pregnancy and childbirth?
During pregnancy, the uterus expands dramatically to accommodate the growing baby. This expansion causes the muscular walls of the uterus to stretch and thin out. By the time you reach full term, your uterus has grown from the size of a pear to around the size of a watermelon.
During a vaginal delivery, the cervix must open to 10 cm to allow the baby to pass through. This causes additional stretching and thinning of the cervical tissue. Powerful contractions of the uterine muscles are needed to push the baby out. All this places incredible strain on the uterus.
After delivery, the stretched-out uterus and cervix must contract back to their non-pregnant size. This is called uterine involution. Here’s a timeline of how uterine involution typically progresses:
- Immediately after delivery: The top of the uterus is typically felt around the level of your belly button.
- 1 week postpartum: The fundus (top) of the uterus drops to about halfway between your belly button and pubic bone.
- 2 weeks postpartum: The fundus continues descending and can be felt about midway between your pubic bone and belly button.
- 4 weeks postpartum: The uterus is back to around its pre-pregnancy size and position in the pelvis.
- 6-8 weeks postpartum: The uterus has completed the involution process, weighing about 2 ounces compared to around 2.5 pounds immediately after giving birth.
Keep in mind every woman’s timeline is slightly different. But in general, it takes 4-6 weeks for the uterus to shrink back down and heal after the strain of pregnancy and childbirth.
Signs your uterus is healing well after giving birth
Here are some good signs that indicate your postpartum uterus is recovering well:
- Fundus height descending on schedule: At each postpartum visit, your provider should measure the height of the top of your uterus (the fundus) to ensure it’s shrinking down appropriately. If the fundus seems high for how far out you are from delivery, it could signal poor uterine involution.
- Lochia tapering off: Lochia refers to the vaginal discharge you have after giving birth, containing blood, mucus, and uterine tissue. In the first 1-2 weeks, the flow is typically heavy like a heavy period. It should steadily lighten and change color over 2-4 weeks until it goes away completely. Persistent heavy lochia can mean delayed healing.
- Minimal bleeding: You can expect some bleeding and spotting for up to 6 weeks after delivery as the uterus sheds its thick pregnancy lining. But heavy bleeding that soaks a pad in an hour or less may indicate problems with uterine contraction or healing.
- No signs of infection: Signs like fever, foul-smelling lochia, uterine pain/tenderness could signal an infection preventing proper healing.
- Incision healing well (c-section): If you had a c-section, check that your incision site is healing cleanly without redness, swelling, oozing, or opening up.
- Perineum healing well (vaginal delivery): After a vaginal birth, swelling and bruising are common as the perineum heals. But significant pain, foul odor, or pus could indicate infection.
- No abdominal pain: Mild cramping is normal. But severe cramping or pain in your lower abdomen may mean the uterus isn’t contracting down normally.
- Breasts softening: Breast engorgement in the early postpartum period is caused by hormones and blood flow stimulating milk production. As these taper off and milk regulates, your breasts should start feeling softer and less tender/full.
Keep in mind each woman’s healing timeline is unique. Discuss any specific concerns with your provider. But in general, if your lochia flow, vaginal bleeding, and abdominal pain are decreasing appropriately each week, these are good signs your postpartum recovery is on track.
Signs of potential problems with uterine healing
Contact your healthcare provider right away if you notice any of the following potential red flags that could indicate impaired postpartum uterine healing:
- Heavy vaginal bleeding: Saturating more than one pad per hour or passing large clots may signal problems with uterine contraction and bleeding.
- Severe cramping/pain: Mild cramping is expected as the uterus contracts down. But severe cramping or pain could indicate incomplete involution.
- Fundus higher than expected: If the fundus feels higher than normal at your postpartum visit, your uterus may not be shrinking down on schedule.
- Foul-smelling lochia: A bad odor can be a sign of infection which can impede healing.
- Fever/chills: A fever of 100.4°F (38°C) or higher could point to a uterine or other postpartum infection.
- Incision problems: With a c-section, watch for increased pain/tenderness, redness, swelling, oozing, or opening of the incision site.
- Pain or burning with urination: This symptom may indicate a uterine or bladder infection.
- Fainting/dizziness: These symptoms combined with heavy bleeding could signal obstetric emergency conditions like uterine atony where the uterus fails to contract down firmly.
If you have any of these symptoms or other concerns about your postpartum recovery, call your healthcare provider without delay. They can assess your uterine involution progress and check for potential complications like infection or hemorrhage.
What causes impaired uterine healing after delivery?
Certain factors can disrupt the normal process of uterine contraction and healing after giving birth. These include:
- Uterine atony: This is failure of the uterine muscle to contract down firmly after delivery. It’s a leading cause of postpartum hemorrhage because bleeding isn’t controlled.
- Retained placenta: When fragments of the placenta remain in the uterus, it can prevent contraction and encourage bleeding/infection.
- Hematoma: A pooling of blood inside the uterine wall can inhibit healing and contraction.
- Infection: Postpartum endometritis (uterine infection) can cause impaired healing, bleeding, and sepsis if severe.
- Uterine rupture: Rarely, a tear in the uterine wall during delivery may cause delayed healing.
- Blood clotting disorder: For women with clotting problems, bleeding may continue unchecked after delivery.
- Multiple gestation pregnancy: Carrying more than one baby over-stretches the uterus and can affect postpartum healing.
Plus risk factors like an over-distended uterus, long labor, operative delivery, and placental abnormalities can predispose some women to impaired uterine involution after childbirth.
Treatments for uterine problems after delivery
If your provider determines your postpartum uterus is not healing normally, possible treatments may include:
- Medications to encourage contraction: Drugs like oxytocin, methylergonovine, carboprost may help shrink the uterus.
- Manual removal of clots/placenta: This may be done during an inpatient stay to clear out anything preventing contraction.
- Curettage procedure: Scraping the uterine lining can help remove any retained tissue or clots.
- Antibiotics for infection: Postpartum endometritis or UTI will require antibiotic treatment.
- Blood transfusion: This may be necessary for significant blood/iron loss from postpartum hemorrhage.
- Hysterectomy: As a last resort with uncontrolled bleeding, the uterus may need to be surgically removed.
The good news is most women’s uteruses heal normally with time, rest, and care after giving birth. But be sure to monitor for any red flag symptoms and discuss any concerns with your provider.
Conclusion
After pregnancy and childbirth, the uterus must undergo the crucial process of involution to return to its non-pregnant state. Track your fundus height, vaginal bleeding patterns, pain levels, and other symptoms in the postpartum period. Lightening lochia, shrinking fundus, and decreasing cramping are positive signs your uterus is contracting down and healing as expected. But be sure to contact your provider promptly for heavy bleeding, foul lochia odor, fever or any other concerns about your postpartum recovery. While some complications like infection or hemorrhage can disrupt uterine healing, most women’s uteruses recover fully with time.
