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Braxton Hicks Contractions - StatPearls

Deborah A. Raines; Danielle B. Cooper.

Author Information

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.

Access free multiple choice questions on this topic.

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.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

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]

Training bouts: sensations | How long do training contractions last during pregnancy

PreviousNext

Contents:

1. What are practice bouts?
2. Why are they happening?
3. What week do training bouts start?
4. How long do practice bouts last?
5. How does it feel during training bouts?
6. Are training fights dangerous?
   • How to distinguish training contractions from contractions before childbirth?
   • Is it possible to calculate training bouts somehow easier?
   • What to do?

“I started having contractions, hurry to the maternity hospital!” yells the wife early Saturday morning. A sleepy husband drives a car through the streets of the city, and... at the next traffic light, it turns out that everything has passed. A happy but slightly bewildered couple stops by a nearby cafe for breakfast. Similar situations happen quite often, and training bouts are to blame. Let's figure out what they are and how to distinguish them from the real ones.

What are practice bouts?

As the name suggests, they are not real. These contractions of the uterus are not directed to the beginning of the birth process. Usually they are irregular, rare and do not bring significant pain ¹ .

This phenomenon has other names. Sometimes they are called even more obviously - false, as opposed to true labor pains. In specialized literature, you can find the term "Braxton-Hicks contractions" after the name of an English obstetrician-gynecologist ² , who first drew attention to them and described them.

Why do they happen?

Medicine has no exact answer to this question. There is not even a consensus on whether they are part of the normal pregnancy process or a deviation from it. Most experts adhere to the first version, considering them to be a warm-up of the body before a real birth ³ .

It is assumed that false contractions are needed to maintain the tone of the uterus - she, like any other muscular organ, requires periodic exercise. On the other hand, the time of arrival and the frequency of training contractions are very different for different women, and for some mothers who have successfully given birth, these sensations are not at all familiar.

What week do practice bouts start?

They can start already in the middle of pregnancy - from the 20th week ¹ , in rare cases even earlier. 2–3 weeks before the planned date, their frequency often increases. In this period, they are called precursors, emphasizing that it is not long before the birth. However, even in the later stages, training contractions do not cause the cervix to open and continue to be only a preparation of the body for the main event.

Beginning of training bouts by weeks of pregnancy.

How long do practice bouts last?

Contractions last a few seconds, rarely up to 1 minute, and end as suddenly as ¹ comes. Further, the expectant mother begins to listen to her feelings and wait for new ones, but they do not repeat. When the woman has already completely calmed down, the contractions can return after a considerable time - 4-5 hours.

After several unexpected cases, false contractions become habitual, and the expectant mother ceases to be afraid of them. However, in the last weeks until X hour, they can again surprise you - often training contractions before childbirth become longer and more intense.

In order not to confuse training contractions with real ones, you need to know about the harbingers of childbirth. We share all the necessary information here.

How does it feel during training bouts?

False contractions are not painful, but unfortunately, if this is your first pregnancy, you have nothing to compare. But there is another sure sign: all the muscles of the uterus participate in labor pains, and during training pain sensations are localized only in one area ⁴ .

Frequency and localization of training contractions of the second and the beginning of the third trimester, premonitory contractions, labor pains. Example.

False contractions usually present as muscle spasm in the back, front, or top of the uterus. The intervals between them are irregular, and it is impossible to predict where the attack will move next time. A few weeks before the birth, training contractions, which are now called precursor contractions, will become more frequent, but will retain their character - an attack localized in one area of ​​​​the uterus. During labor pains, all the muscles of the uterus contract at the same time.

To know exactly how labor begins, read the signs and symptoms of labor.

Are training contractions dangerous?

There is no evidence that training contractions have any effect on fetal development. Their only danger is psychological. Some women, having felt unexpected contractions of the uterus, fall into a panic, and in this state they can do stupid things.

Remember that the beginning of any contractions, even labor, does not mean that you will give birth in the next few minutes. There is time, so you need to calm down, take a deep breath, and listen to your feelings. If you're not sure if it's practice or real contractions, call your doctor and describe your symptoms. After listening to your answers, he will tell you what to do - go to the hospital or stay at home.

How to distinguish training contractions from labor contractions?

Expectant mothers almost accurately identify training contractions during the second and subsequent pregnancies. While you still have no experience, we recommend paying attention to the following signs ⁵ :

• Training contractions are rarely painful, rather unexpected. What can not be said about labor - many women compare these sensations with very severe pain during menstruation.

• Training contractions can usually be stopped. Leisurely walking around the room, breathing exercises and other calming exercises can completely eliminate discomfort in the uterus.

• They do not differ in regularity and do not have obvious dynamics. In real fights, on the contrary, there is a regularity, a gradual increase in duration and a decrease in the interval between them.

For simplicity, we have collected the distinguishing features of false and true contractions in a table:

Is it possible to calculate training bouts somehow easier?

It just won't work. You still have to listen to your feelings and fix them. But you can get yourself an assistant - a special mobile application for calculating the duration and intervals between contractions. All of these apps work intuitively - all you have to do is press the big button each time an attack starts or ends.

Mumlife contraction counter.

In addition to recording and visualizing contractions, the application has useful additional functions. It tracks the dynamics of seizures and will tell you if it looks like a birth. And it will even show how much time you have left to get to the hospital.

What to do?

You can do nothing - after a while, the training bouts will pass by themselves. However, there are several proven methods ⁵ that help reduce the discomfort during false contractions and make them disappear faster. Here are some of them:

• Walk around the house.

  Calm, slow walking in most cases allows you to get rid of unexpected uterine contractions. If the weather is good outside, and there is a place suitable for exercise nearby, you can get some fresh air at the same time - this will not be superfluous.

• Lie down and relax.

  If you are not in the mood for walking right now, lie down on the couch or bed, take a comfortable position and think of something good. It is noticed that the best results are obtained by lying on the left side.

• Take a bath or shower.

  Water relaxes and is just what you need for training bouts. Fill the tub with water or stand under the shower and wait for the contractions to end there - most likely, this will happen very soon. But remember: only warm water, no hot baths and contrast showers!

• Drink some water.

  Dehydration can cause muscle cramps and is therefore also considered a factor in false contractions. Pour a glass of water and drink it slowly, alternating sips, inhales and exhales. Water can be replaced with some other drink, but only with a useful one, for example, berry juice or rosehip broth.

• Do breathing exercises.

  Proper breathing techniques are useful not only during training bouts. Before childbirth, they help to calm down, during childbirth - to relieve pain and better control your body. While the body is training the uterus, you are training your breathing.

• Go to the toilet.

  A full bladder is considered one of the culprits of false contractions: it puts pressure on the uterus, provoking its contractions. So before you settle into bed or go for a walk, do not forget to visit the toilet.

• Walk around the house.

  Calm, slow walking in most cases allows you to get rid of unexpected uterine contractions. If the weather is good outside, and there is a place suitable for exercise nearby, you can get some fresh air at the same time - this will not be superfluous.

• Go to the toilet.

  A full bladder is considered one of the culprits of false contractions: it puts pressure on the uterus, provoking its contractions. So before you settle into bed or go for a walk, do not forget to visit the toilet.

Links to sources:

1. Leah Hennen; Murray, Linda; Jim Scott (2005). The BabyCenter Essential Guide to Pregnancy and Birth: Expert Advice and Real-World Wisdom from the Top Pregnancy and Parenting Resource. Emmaus, Pa: Rodale Books. ISBN 1-59486-211-7.

2. John Braxton Hicks (1823-97) and painless uterine contractions.

3. Bhattacharya, Deepamala. Braxton Hicks Contractions.

4. The Physiological Difference Between Braxton Hicks and Labor Contractions.

5. Braxton Hicks or True Labor Contractions?

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Braxton Hicks contractions - symptoms

A few weeks before the birth, the expectant mother may begin to feel slight stretching in the lower abdomen and lower back, as well as petrification of the entire abdomen. As a rule, these sensations are painless, but they cause some anxiety - what if childbirth has begun, and is it time to get ready for the hospital?

Such sensations really indicate the approach of labor, and are called false contractions of Braxton Hicks. However, while this is not the birth itself, which means that you do not need to go to the hospital. How Braxton Hicks contractions manifest themselves, the symptoms of which can be quite diverse, we will tell right now.

Signs of training contractions

False contractions can be distinguished from real contractions as follows:

• false contractions do not have a certain frequency of onset;
• false contractions last no more than a minute;
• false contractions are almost painless and deliver a minimum of discomfort;
• false contractions are felt as a petrification of the uterus and light pulling in the lower back and lower abdomen;
• Braxton Hicks contractions (training contractions) are easily relieved by a change of position, a walk or a warm shower;
• false contractions do not intensify and become more frequent over time, as is the case with real contractions;
• False contractions are not accompanied by other symptoms of impending labor, such as cork discharge, bowel movements, and so on.

If these are Braxton Hicks contractions, the symptoms will be exactly that. False contractions can begin as early as the 20th week of pregnancy and even last for several months. During this time, you can easily learn how to evaluate how training contractions manifest themselves and, relying on familiar sensations, you will know that the time for childbirth has not yet come.

The exact reasons for which false contractions occur have not yet been established, perhaps this is how the uterus prepares for the upcoming birth, the hormonal background may change, and perhaps the increased sensitivity is associated with a significant increase in the size of the uterus and the activity of the baby.

False contractions can last long enough and exhaust the mother, who is already in tense expectation. However, sooner or later, training contractions before childbirth will turn into real ones. They also have several important symptoms that help to understand that labor has already begun.

How to recognize real contractions?

• real contractions increase both in intensity of pain sensations and in duration of the contraction itself;
• real contractions occur with the same frequency (from 20-30 to 10-15 minutes) and it is gradually reduced;
• contractions are aggravated by active walking, and a warm shower only slightly reduces the sensitivity;
• during real contractions, the mucous plug may come off and slight spotting may appear.

If the contractions have been going on for several hours and correspond to all of the above symptoms, then the harbingers of childbirth - false contractions have turned into real ones - and you can go to the maternity hospital. This is especially true for the second and subsequent births, since the period of contractions can be very short.

The signs of false contractions are quite transparent, and the intuition of the expectant mother can easily tell whether the birth has already begun, or there is still some time before it. However, the expectant mother may not feel the preliminary contractions at all.

Labor can begin immediately with intense and frequent, and most importantly, productive contractions in terms of opening the uterus. This does not mean that the uterus will not prepare for childbirth with the help of "training", so there is no need to worry about this. The body will be able to cope with the task of giving birth to a baby without prompting. Every pregnancy and every birth is different, so we recommend that you just enjoy the anticipation of meeting your baby.

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