Uterine Contractions

Uterine contractions are the tightening and relaxing of the uterine muscles. While most commonly associated with labor and delivery, contractions can occur throughout pregnancy as Braxton Hicks contractions, during menstruation, or due to various medical conditions. Understanding the different types of contractions, their patterns, and warning signs is crucial for pregnant women and anyone experiencing uterine cramping. Knowing when contractions are normal and when they require immediate medical attention can help ensure the best outcomes for both mother and baby.

🚨 Seek Immediate Medical Care If:

You have regular contractions before 37 weeks pregnant (more than 4-6 per hour), contractions with vaginal bleeding, fluid leaking, decreased fetal movement, or severe abdominal pain. Also seek urgent care for contractions every 5 minutes lasting 60 seconds if you're full term, or any contractions with heavy bleeding, fever, or severe pain that doesn't ease between contractions.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

Types of Uterine Contractions

Braxton Hicks Contractions

  • Characteristics:
    • "Practice" contractions
    • Irregular pattern
    • Usually painless
    • Don't increase in intensity
    • Often stop with movement
    • Start around 20 weeks
  • What they feel like:
    • Tightening sensation
    • Abdomen becomes hard
    • May be uncomfortable
    • Last 30-60 seconds
    • Don't get closer together

True Labor Contractions

  • Characteristics:
    • Regular pattern
    • Progressively stronger
    • Closer together over time
    • Don't stop with movement
    • Radiate from back to front
    • Cause cervical changes
  • Progression pattern:
    • Start 15-20 minutes apart
    • Gradually increase in frequency
    • Become longer and stronger
    • Eventually 2-3 minutes apart

Prodromal Labor

  • Also called "false labor"
  • Regular contractions that stop
  • Can last hours or days
  • May happen repeatedly
  • Doesn't dilate cervix significantly
  • Exhausting but not productive

Menstrual Contractions

  • Monthly uterine cramping
  • Helps shed uterine lining
  • Prostaglandin-induced
  • Usually in lower abdomen/back
  • Vary in intensity

Causes During Pregnancy

Normal Pregnancy Contractions

  • First trimester:
    • Implantation cramping
    • Uterus stretching
    • Round ligament pain
    • Usually mild
  • Second trimester:
    • Braxton Hicks begin
    • Growth-related stretching
    • After intercourse
    • With full bladder
  • Third trimester:
    • Increased Braxton Hicks
    • Nesting contractions
    • Pre-labor preparation
    • Engagement contractions

Preterm Labor Warning Signs

  • Concerning patterns:
    • Regular contractions before 37 weeks
    • More than 4-6 per hour
    • Increasing in intensity
    • Don't stop with rest/hydration
    • Accompanied by pressure
  • Associated symptoms:
    • Pelvic pressure
    • Low back pain
    • Menstrual-like cramps
    • Vaginal discharge changes
    • Fluid leaking
    • Bloody show

Risk Factors for Preterm Labor

  • Previous preterm birth
  • Multiple pregnancy (twins, etc.)
  • Uterine abnormalities
  • Cervical insufficiency
  • Infections
  • Placental problems
  • Chronic conditions (diabetes, hypertension)
  • Smoking or substance use
  • Extreme stress
  • Short interval between pregnancies

Non-Pregnancy Related Causes

Gynecological Conditions

  • Endometriosis:
    • Severe menstrual cramps
    • Pain throughout cycle
    • Deep, aching contractions
    • May worsen over time
  • Uterine fibroids:
    • Heavy, painful periods
    • Pressure sensations
    • Prolonged cramping
    • May cause bulk symptoms
  • Adenomyosis:
    • Severe menstrual pain
    • Enlarged, tender uterus
    • Heavy bleeding
    • Chronic pelvic pain
  • Pelvic inflammatory disease:
    • Infection-related cramping
    • Fever
    • Abnormal discharge
    • Pain with intercourse

Medical Procedures

  • IUD insertion:
    • Cramping during/after insertion
    • May last days to weeks
    • Usually improves
  • Endometrial biopsy:
    • Procedure-induced cramping
    • Usually brief
    • May have spotting
  • D&C or abortion:
    • Post-procedure contractions
    • Help expel tissue
    • Medication-enhanced

Other Causes

  • Ovulation pain (mittelschmerz)
  • Ovarian cysts
  • Urinary tract infections
  • Constipation
  • Gastrointestinal issues
  • Exercise-induced
  • Dehydration

Contraction Characteristics

How to Time Contractions

  • Duration: Start to end of one contraction
  • Frequency: Start of one to start of next
  • Intensity: Mild, moderate, or strong
  • Pattern: Regular or irregular
  • Use timer or contraction app
  • Record for at least one hour

What Contractions Feel Like

  • Early labor:
    • Menstrual-like cramps
    • Low back ache
    • Pressure in pelvis
    • Can talk through them
  • Active labor:
    • Strong cramping
    • Waves of intensity
    • Can't talk during peak
    • Need to focus/breathe
  • Transition:
    • Very intense
    • Little break between
    • Pressure to push
    • May feel overwhelmed

Location of Pain

  • Lower abdomen (most common)
  • Lower back
  • Thighs
  • Entire abdomen
  • Pelvic pressure
  • Rectal pressure (late labor)

When to Seek Medical Care

During Pregnancy - Call Immediately

  • Regular contractions before 37 weeks
  • Contractions every 5 minutes for 1 hour (if term)
  • Water breaking (gush or trickle)
  • Vaginal bleeding
  • Severe pain that doesn't ease
  • Decreased fetal movement
  • Fever with contractions
  • Visual disturbances or severe headache

Non-Pregnant - Seek Care For

  • Severe pelvic pain
  • Heavy vaginal bleeding
  • Fever with cramping
  • Fainting or dizziness
  • Suspected ectopic pregnancy
  • Post-procedure complications

5-1-1 Rule (Full Term)

Go to hospital when contractions are:

  • 5 minutes apart
  • Lasting 1 minute each
  • For at least 1 hour
  • Or as directed by your provider

Managing Contractions

For Braxton Hicks

  • Change positions
  • Walk around
  • Rest if active
  • Drink water
  • Empty bladder
  • Take warm bath
  • Practice breathing

Early Labor Comfort

  • Stay home as long as possible
  • Alternate activity and rest
  • Eat light meals
  • Stay hydrated
  • Use comfort measures
  • Time contractions periodically
  • Try to sleep if nighttime

Natural Pain Relief

  • Breathing techniques
  • Position changes
  • Massage
  • Hot/cold packs
  • Hydrotherapy (shower/bath)
  • Movement and walking
  • Birthing ball
  • Relaxation techniques
  • Support person presence

Medical Interventions

  • For preterm labor:
    • Tocolytic medications
    • Corticosteroids for lung maturity
    • Magnesium sulfate
    • Bed rest (controversial)
    • Hydration
  • For labor pain:
    • Epidural anesthesia
    • IV pain medications
    • Nitrous oxide
    • Local anesthetics

Prevention of Preterm Contractions

  • Regular prenatal care
  • Stay hydrated
  • Avoid overexertion
  • Manage stress
  • Treat infections promptly
  • Avoid smoking and substances
  • Maintain healthy weight
  • Follow activity restrictions if given
  • Know your risk factors
  • Report concerning symptoms early