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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.

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

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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 contractions | Pregnancy Birth and Baby

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Key facts

  • Braxton Hicks contractions are a normal part of pregnancy.
  • Braxton Hicks contractions feel like the muscles across your belly are tightening.
  • Braxton Hicks contractions are irregular, usually lasting for about 30 seconds — while they can be uncomfortable, they aren’t usually painful.
  • Braxton Hicks contractions don’t mean that you’re going into labour.
  • If you’re not sure if you are having Braxton Hicks or labour contractions, contact your doctor or midwife.

What are Braxton Hicks contractions?

If you feel tightening or pressure in your abdomen (tummy) during your pregnancy, you may be having Braxton Hicks contractions. Braxton Hicks are sometimes called ‘false’ or ‘practice’ contractions. They’re a normal part of pregnancy that can come and go.

Braxton Hicks contractions prepare your body for giving birth by toning the muscles in your uterus.

Braxton Hicks contractions don’t cause labour and aren’t a sign that labour is beginning.

If you’re not sure whether you’re experiencing Braxton Hicks contractions or actual labour, contact your doctor or midwife.

What do Braxton Hicks contractions feel like?

Braxton Hicks contractions feel like the muscles across your belly are tightening.

Braxton Hicks contractions come irregularly and usually last for about 30 seconds. However, they can last for up to 2 minutes. While they can be uncomfortable, they usually aren’t painful.

When do you get Braxton Hicks contractions?

Braxton Hicks contractions can occur from early in your pregnancy, but you may not feel them until the second trimester. They are most often felt in the third trimester.

In late pregnancy, you may experience Braxton Hicks contractions more often.

How are Braxton Hicks contractions different from labour pain?

There are some differences between Braxton Hicks contractions and true labour contractions. Your doctor or midwife will consider these differences when deciding whether you’re in labour.

Braxton Hicks contractions:

  • don’t open or dilate your cervix
  • usually last for about 30 seconds
  • can be uncomfortable, but usually aren’t painful
  • come and go at irregular times
  • usually occur no more than once or twice an hour, a few times a day — until late in your pregnancy
  • usually stop if you change position or activity or go for a walk
  • usually stop if you have a warm bath or shower

Real labour contractions:

  • open or dilate your cervix
  • last 30 to 70 seconds
  • are painful or require all of your attention
  • become very regular, and get closer together as time passes
  • last longer as time passes
  • get stronger or come more often when you walk
  • get stronger over time

Should I call my doctor or midwife?

Call your doctor or midwife or go to the hospital if:

  • your waters break
  • you have contractions that are getting stronger, closer together and more regular

If you’re less than 37 weeks pregnant, contractions can be a sign of premature labour. Contact your doctor or midwife immediately if you feel pain, pressure or discomfort in your:

  • pelvis
  • abdomen (tummy)
  • lower back

You should also contact your doctor or midwife immediately if you have any signs of labour.

At any stage of pregnancy, you should contact your doctor or midwife immediately if you:

  • have persistent pain in your abdomen (tummy)
  • have vaginal bleeding
  • are concerned about your baby’s movements
  • feel very unwell

If you’re in doubt, don’t hesitate to call your doctor or midwife for advice.

How can I ease the discomfort?

Braxton Hicks contractions are normal and don’t need treatment. But if you feel uncomfortable, you can try:

  • lying down or changing position
  • taking a walk
  • relaxing in a warm bath
  • having a massage
  • staying hydrated
  • urinating (weeing)

It may help to practise your breathing exercises during your Braxton Hicks contractions.

Resources and support

For more information about Braxton Hicks contractions speak to your doctor or midwife.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Mater Mothers' Hospital (Labour and birth information), QLD Health (Journey of labour), Tasmanian Government Dept of Health (Your health during pregnancy), RANZCOG (Labour and birth), Western Sydney Local health district (How will I know I’m in labour? Fact Sheet), Queensland Government (Preterm labour and birth)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: December 2022


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  • Health professionals involved in your pregnancy
  • Giving birth - stages of labour
  • Premature baby

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