Your Uterus after Birth
Your uterus has stretched to many times its normal size to accommodate your growing baby, but now that your baby and the placenta are vacated the premises, your uterus must shrink back to its prepregnancy size and position. This is called involution. During the first few hours postpartum, a nurse or midwife will feel your belly regularly to check the size and position of the uterus. If it feels soft or saggy to your nurse or midwife, he or she will massage it to help it contract and firm up again.
If the uterus isn't shrinking as quickly as it should be, it could indicate that a piece of the placenta didn't come out, or that there are large blood clots in the way. For more information on retained placenta, excessive postpartum bleeding, and large blood clots, see Chapter 6.
You should feel your own belly from time to time to make sure your uterus (also called the fundus) is staying very firm. It should be about the size of a grapefruit and be in the middle of your belly, and at or lower than your bellybutton. If your uterus feels like it is up and off to the right, it means your bladder is filling and getting in the way, and you should use the bathroom. If you aren't sure how to find your uterus, ask your care provider to show you where it is and where it should be.
You'll want to get to the bathroom as soon as possible after the baby is born so that you can empty your bladder. If your bladder is full, your uterus won't be able to contract as well, and you'll bleed more and be more uncomfortable. Immediately after birth, your urethra — the opening through which you urinate — may be swollen, sore, or even feel numb, making it difficult to go. Turning on the water faucet and using a squirt bottle, often called a peri bottle, to splash warm water on the area may help. If you are still having a hard time, try putting your hand in a bowl of warm water, or try to urinate in the shower or even in a tub of water. Since it's so important that you urinate often after giving birth, your care providers may recommend a catheter if you aren't able to urinate on your own. Be aware, though, that catheters can be uncomfortable, limit your mobility, and increase your risk of developing a urinary tract infection. Ask your nurse to let you try all of the previously mentioned techniques before going the catheter route.
It's a good idea to regularly massage your own uterus by stroking your fingers firmly over your lower abdomen. After the massage, your uterus should contract and then stay firm. If it doesn't contract or goes right back to being squishy, let your care provider know.