Dinner Plate Sized Wound

published 16 April 2022

You’ve been told there’s a dinner plate sized wound in your uterus!

And I’m telling you that is a MYTH.

“Whattttt? But I’ve seen the placenta!” you say. “It IS as big as a dinner plate!”

I’m going to explain the physiology of it in just a second (and give suggestions on when to resume sex), so bear with me, but first let me get into the heart of my message - why I’m writing this article:

We need to look at postpartum healing HOLISTICALLY, at the whole woman.

Not just your placenta.

You.

When we focus on the size of the placenta that came out as a way to measure how long a woman should rest for and abstain from sex for, we miss SO much more.

We are saying that your emotions don’t matter. That how your vagina or cesearean wound feels doesn’t matter. That your healing is only defined by whether a penis can penetrate you and not about your pleasure. We are saying that 9 months of carrying another human only takes 6 weeks to heal from. We’re saying that 6 weeks is a measure (not based in evidence) but one that is convenient to align with a postpartum check up and birth control discussion - (because women "need" to be told when they should next have another baby too.)

When I see comments in mommy groups on posts asking about resuming postpartum sex, “Wait 6 weeks - there’s a dinnerplate sized wound!”, I hear that it’s easier to continue spreading a myth about the perceived *failings* of women’s bodies and put women in boxes for medical convenience, rather than empowering them with real knowledge about themselves and their amazing bodies.

“Let’s instead focus on the amazing feat of making a human from scratch, birthing it, shrinking the uterus, accommodating for blood loss, recovering from the effort of birth, healing tears, lactating, not sleeping, adjusting to motherhood mentally and physically etc etc etc. Those are enough reasons to rest, we don’t need to make up extra scary ones!!” - Deborah Neiger, midwife  

“We do a disservice to women by focusing on the size of the placenta and not how *she* feels postpartum. Every woman bleeds and doesn't want to have sex for varying amounts of time. Telling her that she should OR should not be bleeding/resting/lovemaking ignores her intuition and individual body. We’re also inferring that she isn’t capable of understanding her own physiology and making informed decisions about her body.” - H.P, freebirther

​

“I personally like to focus on the fact that ancestral wisdom, passed down through most traditional cultures, says a new mother needs to rest from everything (including lovemaking) for 40 days.

Traditional cultures don’t talk about placenta wounds, but about how sacred her body is and how, since she “opened” to portal her baby into this world, she needs to be “closed” (body and soul) before resuming everyday life.

The “wound” language may reflect Western medicine’s obsession with pathology as well as our cultural disconnection from the body and women’s bodily processes. So we frame the need to rest in terms of something bad (the body is defective; the birth process injured it) instead of good (the body did a big job and now we honor it).

In a culture so disconnected, the fear of causing further injury seems necessary to convince women to take it easy, since women are conditioned in general to think if they feel good, they don’t need rest, and if they feel like crap, they still don’t deserve rest.” - Sharon,  freebirther

We’re also using it as a scapegoat for communication with lovers and family and friends.

“I always thought this was a way of:

1. Not wanting to just say “I don’t feel ready for intimacy”

2. The innate and deep desire we have to be witnessed in our birth can show up as seeking sympathy “I have a dinner plate sized wound” vs “here’s what happened in my birth and I really want you all to witness and honor me.” 

- Carol, Freebirther 

If you need to use the dinnerplate analogy or the 6 weeks “standard”  to *help* your baby daddy understand that you need to take it easy and abstain for a while, that’s up to you. But I really hope for your sake that you are in a relationship where you can just explain how you feel, and that you personally aren’t ready quite yet. Because you don’t need to have a reason as big as a dinner plate. Your feelings are enough. 

And I really hope you have the support you need to rest and heal at your own pace, so that you can focus on baby and not all the cooking and cleaning.

When should i resume sex postpartum?

So now you know it’s not just about the “dinner plate wound”, what about resuming sex?

"There are currently no evidence-based policies about the ideal amount of time postpartum to abstain from sexual activity. It is routinely recommended to avoid sex for about four to six weeks postpartum, mostly to prevent uterine infection or disrupting any stitches from an episiotomy, and giving the body some time to heal. However, more recent research shows that a woman can resume penetrative sexual activity as early as two weeks postpartum based on her own comfort level and desire.” Sheryl Kingsberg, Phd, OB/GYN https://www.uhhospitals.org/Healthy-at-UH/articles/2022/02/sex-after-birth-resuming-sexual-intimacy-after-having-a-baby  

​

"I'm not sure how six weeks became the magic number. Healing after giving birth is a process, and women should resume sexual activity when it feels right to them,... it's best to wait until you're no longer bleeding. Bleeding means the inside of the uterus, the uterine lining, isn't totally healed," Roseanne Seminara, director of midwifery 

https://www.webmd.com/sex-relationships/news/20190214/is-there-a-right-time-for-sex-after-childbirth 

​

"There is no set “waiting period” before a woman can have sex again after giving birth. Some health care professionals recommend waiting 4–6 weeks. The chances of a problem occurring, like bleeding or infection, are small after about 2 weeks following birth. If [you] had an episiotomy or a tear during birth, [you] may be told to not have intercourse until the site has completely healed." - ACOG (American College of Obstetricians and Gynecologists) https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/sex-after-pregnancy/ 

"If you had a vaginal birth, you may have had an episiotomy or a vaginal or perineal tear that's healing. If so, sex prior to four weeks postpartum could leave you susceptible to a vaginal infection." (Not uterine) - ACOG

https://www.whattoexpect.com/first-year/postpartum-health-and-care/sex-after-birth 

So, to summarise all the sites above:

You can clear yourself. You know yourself, your unique and individual body, better than a dr. Some women are healed at 4 weeks. Some take 6 months to resume (non-painful) sex.

• Before resuming penetrative sex at any point postpartum take into account ALL factors. Look at your healing holistically. (E.g. cesarean incision, tearing, stitches, pelvic floor, dryness, sensitivity, physical and nutritional depletion, libido, lack of sleep, emotions, postpartum depression)

• Has your bleeding stopped?

• Do you feel healed?

• Will you take it slow? (pregnancy changes your vagina and postpartum hormones - even without a vaginal birth you have a lot of changes down there) 

• Use lubrication if drier

• Stop or go slow if there’s pain

• Have a plan for birth control eg condoms or withdrawal

• External orgasms are an option sooner as it doesn’t harm your vaginal healing. (or get you pregnant!)

​

So, this dinner plate sized wound….

In my opinion it’s not a wound like any other. It’s designed to occur as part of the birth processes, and the uterus has protective mechanisms in place (involution and lochia) to minimise and prevent infection. It is not a "wound", not like an inflicted and dangerous one like a gunshot wound or a car accident.

The placental footprint may start off immediately “dinner plate sized”, but within minutes, it has reduced in size to a couple inches.

Prior to pregnancy, the uterus weighs just 60g. At full term, it is 1000g of muscles that wrap around in all directions and powerfully push your baby out.
Immediately after birthing the baby, the uterus continues to contract and uses those muscles to interlace special fibres to cut off the blood vessels that supplied blood to the placenta during pregnancy. Because of the dual action of the baby no longer taking up space and the contractions, the uterus shrinks in size, and this sudden change shears the placenta neatly off the uterine wall, ready to exit through the cervix. The placenta is birthed like a small squishy baby.

Imagine you blow up a balloon (baby growing and expanding the uterus) and you stick one of those rigid puffy stickers on it (placenta). When you deflate the balloon (birth the baby), that puffy sticker would come off the balloon (placenta comes off uterine wall) as the surface it is sticking to is shrinking. The sticker stays the same size. You might also be able to see that the area with the sticky residue left on the uterus balloon is massively smaller than it was when the sticker (placenta) was in place. 

Now, what had been a dinner plate sized placental footprint is shrunk efficiently down to a couple inches diameter, fibres interlaced over the vessels, and a clot forms to protect and minimise further bleeding. The cervix also begins to close after having been fully dilated.

 “Afterpains” continue to contract the uterus, and while you only feel the pains for a few days, they continue to shrink the uterus back to pre-pregnancy size, slowly shedding the muscle as well. Immediately postpartum your uterus is below your belly button. By 4 weeks the uterus is the size of an avocado, and by 6 weeks it is fully back to pre-pregnancy size like an upside-down pear. This process is called involution.

It is important to understand that the placental footprint doesn’t stay placenta sized for more than a couple minutes at most after birth. It would only be left if the placenta was removed from the uterus without the uterus contracting at all. This is impossible due to the fact that it would cause an emergency where the woman would bleed out in minutes and potentially lose her life without medical aid. After a cesarean, the obstetrician manually contracts the uterus after removing the placenta, and administers synthetic oxytocin to hormonally continue contractions. If for some reason after a hospital or home birth, the uterus is not contracting normally, there would be the need to manually contract, administer synthetic oxytocin, or herbal tinctures to assist the uterus to clamp down on the bleeding.

NOW, that being said, remember that when you give your body time to heal, the process is generally faster and less complicated. When we can see an injury, it’s much easier to understand how to treat it and to keep and eye on your healing. When the “injury” is on the inside - like most of healing is after you give birth - it’s much easier to forget about it, ignore it, and to push yourself too far. After giving birth, most women feel pretty rough for at least a few days, and often a few weeks (or more depending on how your birth went!).

The idea that we should be “bouncing back” immediately is unrealistic and in both the short term and long term, not good for you. 

​

Healing is holistic, and each part of that healing takes a different amount of time.

Prioritising your healing (and I mean both physical and emotional) will allow you to be a healthier, happier, and more present mother to your baby, mother to any other children, and partner to your spouse. And a happier you!