Involution and Lochia

Many women are surprised when they still have contractions AFTER the baby is
born.
The process of involution, the process by which the uterus attempts to return to its
prepregnancy size and condition. The involution state is assessed by looking at the
fundal height and consistency of the uterine fundus plus the character and amount
of lochia every 4-6 hours postpartum.

The uterus is obviously stretched during pregnancy. Once finished with the birthing
process, the fundus of the uterus may rise but them decreases in height by 1 cm
per day. By one week postpartum, the fundus may no longer be palpable through
the abdomen and the entire size of the uterus is about the size of a grapefruit,
round and smooth but firm. A "boggy" uterus may indicate potential hemorrhage.
Care providers may choose to kneed the uterus to stimulate it back into the desired
"grapefruit" position or give some pitocin, which can also stimulate the uterus. The
bladder should be empty for accurate assessment as a full bladder will displace the
uterus (similar to the way the bladder will displace the baby/uterus during labor)
and raise the height of the fundus.

Lochia, the discharge during the first weeks following birth, indicates the process of
uterine lining healing and the amount gradually decreases over time. During the
first few days postpartum, new mothers can expect a moderate amount of dark red
discharge. This is called lochia rubra. If abnormally heavy, persistent (doesn't vary
in color or amount), and having an odor, and if the mother has a fever, there may
be an infection or retained placental fragments. During the next few days, the lochia
becomes more serous and pink and decreases in amount. This is called lochia
serosa. Finally during 7-10 days postpartum, the lochia becomes pale yellow-white
and is even in a more decreased amount. This is called lochia alba and may
continue for 2-3 more weeks. The recurrence to bright red bleeding after
progression to either lochia serosa or lochia alba may be a sign of infection or
delayed hemorrhage.

Lochia flow may increase temporarily after getting up when the mother has been
sitting or laying for a long time or after prolonged ambulation. New mothers should
be aware that lochia flow should not be managed with a tampon or panty liners.
Peripads from the hospital or birth facility may be used as can be large overnight
absorbent pads. Frequent pad changes will make mothers feel fresh and reduce
irritation.

Many cultures, including some Asian and Mexican cultures, restrict bathing during
the postpartum period, however showers are acceptable. When caring for a woman
during the postpartum period, ask if there are any cultural considerations of which
you need to be aware. This will make the transition period easier for all involved.