Braxton hicks third trimester

Braxton Hicks Contractions - StatPearls

Deborah A. Raines; Danielle B. Cooper.

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Last Update: August 8, 2022.

Continuing Education Activity

Braxton-Hicks contractions, also known as prodromal or false labor pains, are contractions of the uterus that typically are not felt until the second or third trimester of the pregnancy. Braxton-Hicks contractions are the body's way of preparing for true labor, but they do not indicate that labor has begun. Because many pregnant patients have not been educated about Braxton-Hicks contractions, they often seek care and undergo unnecessary evaluation for these contractions. This activity reviews the evaluation and management of patients with Braxton-Hicks contractions and highlights the role of the interprofessional team in educating the patient about the condition.

Objectives:

Describe the etiology of Braxton-Hicks contractions.
Review the presentation of a patient with Braxton-Hicks contractions.
Explain how to evaluate a patient with Braxton-Hicks contractions.
Employ strategies to improve interprofessional communication, which will improve outcomes in patients with Braxton-Hicks contractions.

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Introduction

Braxton Hicks contractions are sporadic contractions and relaxation of the uterine muscle. Sometimes, they are referred to as prodromal or “false labor" pains. It is believed they start around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy. Braxton Hicks contractions are the body's way of preparing for true labor, but they do not indicate that labor has begun or is going to start.

Braxton Hicks contractions are a normal part of pregnancy. They may be uncomfortable, but they are not painful. Women describe Braxton Hicks contractions as feeling like mild menstrual cramps or a tightening in a specific area of the abdomen that comes and goes. [1][2][3]

Braxton Hicks contractions can be differentiated from the contractions of true labor. Braxton Hicks contractions are irregular in duration and intensity, occur infrequently, are unpredictable and non-rhythmic, and are more uncomfortable than painful. Unlike true labor contractions, Braxton Hicks contractions do not increase in frequency, duration, or intensity. Also, they lessen and then disappear, only to reappear at some time in the future. Braxton Hicks contractions tend to increase in frequency and intensity near the end of the pregnancy. Women often mistake Braxton Hicks contractions for true labor. However, unlike true labor contractions, Braxton Hicks contractions do not cause dilatation of the cervix and do not culminate in birth.

Etiology

Braxton Hicks contractions are caused when the muscle fibers in the uterus tighten and relax. The exact etiology of Braxton Hicks contractions is unknown. However, there are known circumstances that trigger Braxton Hicks contractions including when the woman is very active, when the bladder is full, following sexual activity, and when the woman is dehydrated. A commonality among all these triggers is the potential for stress to the fetus, and the need for increased blood flow to the placenta to provide fetal oxygenation.[4][5][6]

Epidemiology

Braxton Hicks contractions are present in all pregnancies. However, each woman's experience is different. Most women become aware of Braxton Hicks contractions in the third trimester, and some women are aware of them as early as the second trimester. Sometimes Braxton Hick contractions occurring near the end of the third trimester of pregnancy are mistaken as the onset of true labor. It is not unusual, especially in a first pregnancy, for a woman to think she is in labor only to be told it is Braxton Hicks contractions and not true labor.

Pathophysiology

Braxton Hicks contractions are thought to play a role in toning the uterine muscle in preparation for the birth process. Sometimes Braxton Hicks contractions are referred to as "practice for labor." Braxton Hicks contractions do not result in dilation of the cervix but may have a role in cervical softening.

The intermittent contraction of the uterine muscle may also play a role in promoting blood flow to the placenta. Oxygen-rich blood fills the intervillous spaces of the uterus where the pressure is relatively low. The presence of Braxton Hicks contractions causes the blood to flow up to the chorionic plate on the fetal side of the placenta. From there the oxygen-rich blood enters the fetal circulation.

History and Physical

When assessing a woman for the presence of Braxton Hicks contractions, there are some key questions to ask. Her response to these questions will assist the healthcare provider to differentiate Braxton Hicks contractions and true labor contractions.[7][8][9]

How often are the contractions? Braxton Hicks contractions are irregular and do not get closer together over time. True labor contractions come at regular intervals, and as time goes on, they get closer together and stronger.
How long are the contractions? Braxton Hicks contractions are unpredictable. They may last less than 30 seconds or up to 2 minutes. True labor contractions last between 30 to less than 90 seconds and become longer over time.
How strong are the contractions? Braxton Hicks contractions are usually weak and either stay the same or become weaker and then disappear. True labor contractions get stronger over time.
Where are the contractions felt? Braxton Hicks contractions are often only felt in the front of the abdomen or one specific area. True labor contractions start in the midback and wrap around the abdomen towards the midline.
Do the contractions change with movement? Braxton Hicks contractions may stop with a change in activity level or as the woman changes position. If she can sleep through the contraction, it is a Braxton Hicks contraction. True labor contractions continue and may even become stronger with movement or position change.

During the physical assessment, the provider may palpate an area of tightening or a "spasm" of the uterine muscle, but the presence of a uterine contraction in the uterine fundus is not palpable. The woman will be assessed for the presence of uterine bleeding or rupture of the amniotic membrane. An examination of the cervix reveals no change in effacement or dilatation as a result of the Braxton Hicks contractions.

Evaluation

There are no laboratory or radiographic tests to diagnose Braxton Hicks contractions. Evaluation of the presence of Braxton Hicks contractions is based on an assessment of the pregnant woman's abdomen, specifically palpating the contractions.

Treatment / Management

By the midpoint of pregnancy, the woman and provider should discuss what the woman may experience during the remainder of the pregnancy. Braxton Hicks contractions are one of the normal events a woman may experience. Teaching her about Braxton Hicks contractions will help her to be informed and to decrease her anxiety if they occur.[10][11][12]

There is no medical treatment for Braxton Hicks contractions. However, taking action to change the situation that triggered the Braxton Hicks contractions is warranted. Some actions to ease Braxton Hicks contractions include:

Changing position or activity level: if the woman has been very active, lie down; if the woman has been sitting for an extended time, go for a walk.
Relaxing: take a warm bath, get a massage, read a book, listen to music, or take a nap.
Drinking water to rehydrate.

If these actions do not lessen the Braxton Hicks contractions or if the contractions continue and are becoming more frequent or more intense, the patient's healthcare provider should be contacted.

Also, if any of the following are present the healthcare provider should be contacted immediately:

Vaginal bleeding
Leaking of fluid from the vagina
Strong contractions every 5-minutes for an hour
Contractions that the woman is unable to "walk through"
A noticeable change in fetal movement, or if there are less than ten movements every 2 hours.

Differential Diagnosis

Amenorrhea

Ascites

Full bladder

Hematometra

Nausea

Ovarian cysts

Pseudocyesis

Uterine fibroids

Vomiting

Pearls and Other Issues

In addition to Braxton Hicks contractions, there are other causes of abdominal pain during pregnancy. Some normal reasons for abdominal pain during pregnancy, in addition to Braxton Hicks contractions and true labor contractions, include:

Round ligament pain or a sharp, jabbing feeling felt in the lower abdomen or groin area on one or both sides.
Higher levels of progesterone can cause excess gas during pregnancy.
Constipation may be a source of abdominal pain.

Circumstances in which abdominal pain is a sign of a serious condition that requires immediate medical attention include:

Ectopic pregnancy.
Placental abruption. A key symptom of placental abruption is intense and constant pain that causes the uterus to become hard for an extended period without relief.
Urinary tract infection symptoms include pain and discomfort in the lower abdomen as well as burning with urination.
Preeclampsia is a condition of pregnancy occurring after 20-weeks gestation and characterized by high blood pressure and protein in the urine. Upper abdominal pain, usually under the ribs on the right side, can be present in preeclampsia.

If a woman is unsure if she is experiencing Braxton Hicks contractions or another condition, a discussion with a healthcare provider is needed. The healthcare provider may recommend a visit to the office setting or labor and delivery for an examination by a healthcare professional to determine the cause of the abdominal pain.

Enhancing Healthcare Team Outcomes

Braxton hicks contractions are fairly common and it is important for the emergency department physician labor & delivery nurse and nurse practitioner to be aware that this is not true labor. If there is any doubt, the obstetrician should be consulted. However, at the same time, the onus is on the healthcare workers to rule out true labor. Other organic disorders like appendicitis, urinary tract infection or cholecystitis must also be ruled out. With the right education, patients with braxton hicks contraction will not needlessly rush to the ED every time they sense a contraction.

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References

1.: Hanghøj S. When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy. Women Birth. 2013 Sep;26(3):190-4. [PubMed: 23711581]
2.: MacKinnon K, McIntyre M. From Braxton Hicks to preterm labour: the constitution of risk in pregnancy. Can J Nurs Res. 2006 Jun;38(2):56-72. [PubMed: 16871850]
3.: Dunn PM. John Braxton Hicks (1823-97) and painless uterine contractions. Arch Dis Child Fetal Neonatal Ed. 1999 Sep;81(2):F157-8. [PMC free article: PMC1720982] [PubMed: 10448189]
4.: Lockwood CJ. The diagnosis of preterm labor and the prediction of preterm delivery. Clin Obstet Gynecol. 1995 Dec;38(4):675-87. [PubMed: 8616965]
5.: Arduini D, Rizzo G, Rinaldo D, Capponi A, Fittipaldi G, Giannini F, Romanini C. Effects of Braxton-Hicks contractions on fetal heart rate variations in normal and growth-retarded fetuses. Gynecol Obstet Invest. 1994;38(3):177-82. [PubMed: 8001871]
6.: Kofinas AD, Simon NV, Clay D, King K. Functional asymmetry of the human myometrium documented by color and pulsed-wave Doppler ultrasonographic evaluation of uterine arcuate arteries during Braxton Hicks contractions. Am J Obstet Gynecol. 1993 Jan;168(1 Pt 1):184-8. [PubMed: 8420324]
7.: Lockwood CJ, Dudenhausen JW. New approaches to the prediction of preterm delivery. J Perinat Med. 1993;21(6):441-52. [PubMed: 8006770]
8.: Rhoads GG, McNellis DC, Kessel SS. Home monitoring of uterine contractility. Summary of a workshop sponsored by the National Institute of Child Health and Human Development and the Bureau of Maternal and Child Health and Resources Development, Bethesda, Maryland, March 29 and 30, 1989. Am J Obstet Gynecol. 1991 Jul;165(1):2-6. [PubMed: 1677235]
9.: Oosterhof H, Dijkstra K, Aarnoudse JG. Fetal Doppler velocimetry in the internal carotid and umbilical artery during Braxton Hicks' contractions. Early Hum Dev. 1992 Aug;30(1):33-40. [PubMed: 1396288]
10.: Oosterhof H, Dijkstra K, Aarnoudse JG. Uteroplacental Doppler velocimetry during Braxton Hicks' contractions. Gynecol Obstet Invest. 1992;34(3):155-8. [PubMed: 1427416]
11.: Bower S, Campbell S, Vyas S, McGirr C. Braxton-Hicks contractions can alter uteroplacental perfusion. Ultrasound Obstet Gynecol. 1991 Jan 01;1(1):46-9. [PubMed: 12797102]
12.: Hill WC, Lambertz EL. Let's get rid of the term "Braxton Hicks contractions". Obstet Gynecol. 1990 Apr;75(4):709-10. [PubMed: 2314790]

Braxton Hicks | Tommy's

Tommy's PregnancyHub

Braxton Hicks contractions are the body’s way of preparing for labour, but if you have them it doesn’t mean your labour has started. Here, we explain more about Braxton Hicks.

What are Braxton Hicks?

Braxton Hicks are when the womb contracts and relaxes. Sometimes they are known as false labour pains.

Not all women will have Braxton Hicks contractions. If you do, you’ll usually feel them during the second or third trimester.

Braxton Hicks are completely normal and many women experience them during pregnancy. Your midwife will probably talk to you about them at some point, and you can ask questions at any time. You may also learn more about them during antenatal classes.

What do Braxton Hicks feel like?

They may be uncomfortable, but they are not painful. Women often describe Braxton Hicks contractions as feeling like mild menstrual cramps or a tightening in a specific area of the stomach that comes and goes.

"I find them like a mild stitch that goes almost as quickly as it comes. Not painful but you're definitely aware it's there. You will soon realise when you do go into labour that Braxton Hicks cannot be mistaken for labour pains."

Claire

"I have had Braxton Hicks, but I didn't know I was experiencing it - it was only because I was at the day assessment unit because I was concerned with the movements of baby that the midwife told me I was experiencing them. I asked the midwife that saw me if they were 'practice contractions' and she said they weren't contractions."

Kim

"For me the Braxton Hicks make my bump feel really tight as if my skin is being stretched, my bump also goes solid! Although not painful they can feel intense when I am out on a long walk with my family!"

Sarah

Why will I get Braxton Hicks?

We don’t really know why women get Braxton Hicks contractions. But we do know some of the things that trigger them, such as:

being very active
having a full bladder
having sex
being dehydrated.

What’s the difference between Braxton Hicks and labour contractions?

Unlike labour contractions, Braxton Hicks contractions:

vary in length and strength
happen infrequently, are unpredictable and non-rhythmic
are more uncomfortable than painful
do not increase in frequency, duration or intensity
lessen and then disappear, only to reappear at some time in the future.

Compared with Braxton Hicks, labour contractions:

are noticeably, and increasingly, longer
are more regular
are more frequent
are painful
increase in intensity.

Nearer the end of your pregnancy, Braxton Hicks contractions may form more of a pattern and increase in frequency and intensity. Lots of women often mistake Braxton Hicks contractions for the start of labour. But, unlike labour contractions, Braxton Hicks contractions do not cause the cervix (the entrance to the womb) to open (dilate).

How are Braxton Hicks contractions treated?

There is no treatment for Braxton Hicks contractions. But there are things you can do to ease them, such as:

changing position
lying down if you’ve been very active – find out more about exercise in pregnancy
going for a walk if you’ve been sitting down for a long time
relaxing, such as taking a warm bath, having a massage, or having a nap
drinking some water to rehydrate.

When should I contact my midwife?

It’s always best to contact your midwife or maternity unit for advice if you are not sure whether you are having Braxton Hicks or labour contractions.

It’s also a good idea to call them if the tightenings continue, especially if you are less than 37 weeks pregnant.

Call your midwife or maternity unit straight away if:

you have any vaginal bleeding
your waters break
you have strong contractions every five minutes that last 30-60 seconds)
these twinges become very painful
you have any concerns about your baby’s movements.

Review dates

Reviewed: 03 July 2019 | Next review: 03 July 2021

This content is currently being reviewed by our team. Updated information will be coming soon.

90,000 Braxton Hicks contractions. How to distinguish between false and real contractions?

Braxton-Hicks contractions or false labor contractions are irregular contractions and relaxation of the muscles of the uterus as a way of preparing for true labor. They are thought to start around 6 weeks of gestation but are not usually felt until the 2nd or 3rd trimester.

False contractions are a normal part of pregnancy. They may be uncomfortable, but not painful. Women describe them as a feeling that feels like mild menstrual cramps or tightness in a specific area of the abdomen that quickly resolves.

They are also irregular in duration and intensity, occur infrequently, are unpredictable and not rhythmic, and are more uncomfortable than painful.

Braxton Hicks contractions tend to increase in frequency and intensity towards the end of pregnancy. Women often mistake Braxton Hicks contractions for real labor. However, unlike real contractions, they do not dilate the cervix and result in the birth of a baby.

Braxton Hicks contractions occur when the muscle fibers of the uterus contract and relax. The exact etiology of Braxton Hicks contractions is unknown. However, there are circumstances that can cause them:

when the woman is very active,
when the bladder is full,
after sexual activity,
when the woman is dehydrated.

Common among all these circumstances is the potential stress on the fetus and the need for increased blood flow to the placenta to provide oxygen to the fetus.

Change position or activity level: if you were very active, lie down; if you have been sitting for a long time, go for a walk.
Relax: take a warm bath, massage, read a book, listen to music or take a nap.

If you have Braxton Hicks contractions or if they continue and become more frequent and intense, you should see your doctor.

When assessing for Braxton Hicks contractions, there are a few key questions to ask yourself. We have prepared a table for you with questions, the answers to which will help you understand what kind of contractions you have:

	Braxton Higgs contractions	Real labor pains
How often do contractions occur?	Irregular and do not increase over time.	Occurs at regular intervals and gets stronger over time.
How long do contractions last?	Unpredictable. They can last less than 30 seconds or up to 2 minutes.	Lasts 30 to 90 seconds and gets longer over time.
How strong are the contractions?	Usually weak and either stay the same or get weaker and then disappear.	Increase over time.
Where do contractions feel?	Often only felt in the front of the abdomen or in one specific area.	Begin in the middle of the back and wrap around the belly towards the midline.
Do abbreviations change with movement?	May stop if activity level changes or if woman's position changes.	Continue and may even get worse with movement or change of position.

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Braxton-Hicks contractions or false contractions

The concept of "Brexton-Hicks contractions" originated sometime in the late nineteenth century, when a physician named John Braxton Hicks described labor pains that weren't really real.

In 1872, John Braxton Hicks, a renowned British midwife, paid particular attention to the pains that pregnant women complained of during the second or third trimester. The doctor noted that these painful contractions felt by women in the pelvic area do not indicate preterm labor, but disappear if the pregnant woman changes position, drinks more fluids or does light exercise during the day. And today, pregnant women are subject to this type of uterine contractions, although the time of delivery is still far away. For this reason, these contractions are also called "false" or "trial" contractions.

There are pregnant women who do not feel such contractions at all, while in others it occurs from the very beginning of pregnancy, although mostly false contractions appear in the third trimester, more often after the 38th week of pregnancy. Unlike true labor, Braxton Hicks contractions are unpredictable, rare, irregular, do not become more intense over time, and tend to disappear suddenly. They are not accompanied by pain, you just feel that the uterus "tightened up" and became like a ball. There are times when these contractions become painful, but generally feel like muscle tension. For some women, they may look like menstrual cramps.

As there is nothing accidental in pregnancy, so these contractions do not just happen: in this way the uterus, trying to contract, is preparing for childbirth. Some doctors believe that these contractions are meant to prepare the cervix for childbirth and help dilate the cervix during the last trimester of pregnancy.

If you have contractions that are irregular in intensity, rare and unpredictable, short (30-60 seconds - maximum 2 minutes) contractions that do not have a certain rhythm (when labor begins, the contractions will occur in a certain rhythm) it is probably contractions Braxton Hicks.

Statistics show that, on average, nine out of ten women experience Braxton Hicks contractions during their first pregnancy.

For any unclear questions (especially if you are already in the third trimester), contact your doctor, only in this way you will receive reliable information!

Triggers

Cramps are caused by high levels of estrogen in the body (normal during pregnancy) and uterine contractions (30 seconds to 2 minutes) to facilitate blood flow to the placenta.
What could be the causes of contractions:

excessive activity of mother or child
various alien touches
presence of dehydration
intense sexual activity
full bladder
stressful situations.

What should I do about Braxton Hicks contractions?

body position can be changed
take a warm shower or bath (no more than 30 minutes)
drink water, herbal tea or milk
use the relaxation technique, you need to breathe calmly
can change movements
you need fluid, drink it as often as possible and in large quantities (at least eight glasses of water, milk or juice per day)
should take a walk. It happens that Braxton-Hicks contractions quickly disappear after a pregnant woman takes a walk
you can just relax or even try to get some sleep
you can ask someone to give you a massage.

How can you tell false contractions from labor pains?

Especially at the end of pregnancy, pregnant women begin to worry that these contractions are no longer trial.

labor pains are fairly easy to distinguish from Braxton-Hicks contractions by several criteria:
- labor pains occur every ten minutes, and there are more than five contractions per hour (the muscles of the uterus contract, causing considerable discomfort, and dull pain in the abdomen may also be felt )
- periodic contractions in the abdomen (lower part) or back
- Presence of pressure in the vagina or pelvis
- presence of colic similar to menstrual colic; there is bleeding
- Fluid leaks
- nausea and vomiting are observed in a pregnant woman, and the presence of diarrhea is also possible.
When should I see a doctor?
Call your doctor if you are under 37 weeks, if your contractions are increasing in frequency, more painful, or if you have any of the signs of preterm labor:
- increased vaginal discharge, spots or bleeding
- increased back pain and pelvic pressure
- frequent rhythmic contractions growing in intensity - more than four contractions per hour
- pain in the abdomen, as during menstruation, or cramps
- less than ten fetal movements in one hour
- strong feeling of nausea, vomiting, diarrhea.
Braxton Hicks contractions are a new experience for many pregnant women, but they are completely harmless. To avoid additional worries, you can discuss with your doctor all the questions that concern you (notify him as soon as you notice these abbreviations in yourself).

You can also start a small "diary" of contractions, at least for 2-3 days, so you can find out what exactly causes them (a full bladder that needs to be emptied, or, conversely, you are not drinking enough fluids), for how long they continue, and so on.
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