After birth, the uterus gradually shrinks and descends into its prepregnancy position in the pelvis; termed involution.

Palpation of the uterine fundus postpartum helps to determine uterine size, degree of firmness, and rate of descent, which is measured in fingerbreadths above or below the umbilicus.

The involuting uterus should be at the midline.

The fundus is usually midway between the umbilicus and symphysis 1 to 2 hours after delivery, 1 cm above or at the level of the umbilicus 12 hours after delivery, and about 3 cm below the umbilicus by the third day after delivery.

The fundus will continue to descend about 1 cm/day until it isn’t palpable above the symphysis (about 9 days after delivery).

The uterus decreases to its prepregnancy size 5 to 6 weeks after delivery, not from a decrease in the number of cells but from a decrease in their size.

Gloves

Perineal pad

Urinary catheter (optional)

Before palpating the uterus, explain the procedure to the patient and provide privacy.

Wash your hands and put on gloves.

Ask the patient to urinate. If she’s unable to urinate, anticipate the need to catheterize her.

Lower the head of the bed until the patient is in a supine position or her head is slightly elevated.

Expose the abdomen for palpation and the perineum for inspection.