As a pregnant woman approaches her due date, she may begin to experience various signs and symptoms that labor is nearing. One common symptom is cramps and contractions in the abdomen, which can be confusing to interpret. Are these just normal pregnancy aches and pains? Or are they early signs of real labor beginning? Understanding the differences between various types of abdominal cramps and contractions can help a woman discern if she is truly going into labor.
Normal Pregnancy Cramps and Contractions
Throughout pregnancy, it is common for women to experience aches and pains in the abdomen region. As the baby grows and the uterus expands, mild cramping sensations and contractions are to be expected. Here are some normal cramping patterns that may be felt but do not necessarily indicate labor:
Round Ligament Pain
The round ligaments are bands of tissue that support the uterus on each side. As the uterus grows heavier, these ligaments can spasm and cause short, stabbing sensations on one or both sides of the lower abdomen. This type of cramping tends to come and go quickly, lasting just a few seconds at a time. Changing positions may provide relief. Round ligament pain is often felt during the second trimester when the uterus is expanding most rapidly, but it can occur any time in pregnancy.
Braxton Hicks Contractions
Commonly called “practice contractions,” Braxton Hicks contractions are sporadic tightening sensations of the uterus that can start as early as the second trimester. They are usually relatively mild, irregular, and infrequent. Dehydration can trigger more intense Braxton Hicks, so staying hydrated is important. Walking, changing positions, and resting may help alleviate discomfort. These contractions do not cause the cervix to dilate or efface.
Normal Abdominal Cramping
Some achiness and cramping in the lower abdomen is common as the ligaments stretch and the uterus grows. This may feel similar to premenstrual cramping. Unless it becomes severe, such transient, mild cramping is usually nothing to worry about.
Pressure and Heavy Sensations
As the baby’s head descends lower in the pelvis in preparation for birth, a woman may feel more pressure, fullness, and heavy sensations in the vagina and rectum. This can radiate toward the lower back and upper thighs as well. Changing positions may temporarily relieve the pressure.
Distinguishing True Labor from False Labor
So how can a woman tell if she is truly in labor rather than just experiencing normal pregnancy aches and pains? There are some key ways that true labor cramps and contractions differ from the more ambiguous cramping of false labor:
Increasing Frequency and Intensity
One of the hallmarks of true labor is that the contractions continue to strengthen and come at increasingly shorter intervals. They do not go away for long periods or stop when changing positions. Rather, they become longer, stronger, and closer together over time.
Regular Timing
Braxton Hicks and other false labor cramps are often irregular. True labor contractions will fall into a fairly regular pattern with consistent time between each one. It is a good idea to begin timing them with a watch or contraction tracking app when they seem strong and close together.
Progression
In real labor, the contractions stimulate progressive changes in the cervix including thinning, dilation, and effacement. False labor cramps do not lead to these measurable changes that indicate the body’s preparation for birth.
Lower Abdominal Location
While false labor may produce generalized achiness all over the uterus, real labor contractions usually begin in the lower back and radiate toward the front of the abdomen. The pain tends to be centered low, close to the pubic bone.
Intense Cramping Sensation
The abdominal cramping of real labor is usually much more intense than typical pregnancy aches and pains. It feels like a strong squeezing and tightening that peaks at the height and then tapers off. Breathing techniques may be needed to manage the discomfort.
Bloody Show
As the cervix dilates, there may be a discharge of blood-tinged mucus known as the “bloody show.” While not all women experience this, it is a sign that labor is progressing and the cervix is effacing.
Common Patterns of Labor Cramping
Labor contractions can begin in subtle ways before intensifying into active labor. It is helpful to be aware of the common progression:
Early, Irregular Contractions
In the days or weeks before full-blown labor begins, some women experience light, irregular contractions that are longer and milder. This pre-labor cramping may come and go without clear pattern. Effacement and dilation are beginning.
Prodromal Labor
This term refers to early labor that progresses for hours or days and then stalls before active labor begins. Contractions may become quite strong and close but then taper off. The cervix dilates slowly. Prodromal labor is frustrating, but it is usually a good sign that the body is preparing for active labor soon.
Active Labor
Progressively strong contractions 3-5 minutes apart signify active labor. This is associated with faster dilation typically from 4-7cm. Contractions increase in intensity and last 45-90 seconds. Most women head to the hospital in active labor.
Transition Stage
This intense stage is when contractions are 2-3 minutes apart and 60-90 seconds long as the cervix dilates fully from 7-10cm. Thought of as the most challenging part of labor, it is thankfully the shortest for most women.
Pushing Stage
In the second stage of labor, contractions may space slightly farther apart but maintain intensity as the mother begins pushing. Cramping provides the force she needs to birth the baby through the vaginal canal.
When to Call Your Healthcare Provider
If you believe you are in labor, it is important to contact your doctor, midwife, or birth center for guidance. You should call right away if you have any of these more concerning symptoms:
Water Breaks
A rupture of membranes is a sure sign you are in labor. Fluid leaking from the vagina indicates the amniotic sac has opened. Labor usually follows within hours.
Bleeding
While a small amount of bloody show is normal, significant red bleeding could indicate a problem like placental abruption. Heavier bleeding always warrants an immediate call to a provider.
Decreased Fetal Movement
If you notice a major slow-down or stop in baby’s normal in-utero activity, contact your healthcare provider right away to check on the baby.
No Relief Between Contractions
If strong cramps are coming back-to-back with no resting period in between, it could mean danger for the baby. Seek medical advice promptly.
Contractions Lasting Over 90 Seconds
Extremely long contractions place a lot of stress on the uterus. If they do not shorten when changing positions, it is important to be evaluated by your care provider.
Contractions 5 Minutes Apart or Closer
When contractions reach the point of coming every 5 minutes or faster, you are likely in active labor and will want guidance on when to head to the hospital or birth center.
Coping Techniques for Labor Cramping
While some pain medication options do exist, many women prepare natural techniques to help manage the intensity of labor contractions:
Focused Breathing
Patterned breathing directs attention and provides rhythm. Try breathing slowly and deeply during each contraction. Some women find blowing short puffs works better.
Relaxation Between Contractions
Make a point to release all tension and completely relax the body in the brief rests between contractions. This saves energy for the next surge.
Hydration
Drinking water prevents dehydration which can make contractions more painful. Electrolyte drinks like coconut water or sports drinks also help.
Moving Positions
Switching positions, walking, rocking hips, and leaning forward can provide some relief from intense sensations during contractions.
Massage
Having a partner apply counterpressure to the lower back can help offset labor cramping. Massaging the hips and thighs may also provide comfort.
Hydrotherapy
Being immersed in warm water often reduces the severity of labor contractions. Showers, tubs, and birthing pools can be used.
TENS Unit
This device transmits small electrical impulses through pads on the back to block pain signals. Some women find it helps distract from labor cramps.
Birth Ball
Sitting on a large birth ball and gently rocking the hips often takes pressure off laboring muscles. Leaning forward on the ball may feel good.
Visualization
Envisioning pleasant scenes, memories, or affirmations during contractions directs mental focus away from the discomfort.
When to Go to the Hospital
Deciding when to head to the hospital or birth center is an important judgment call. Here are some general guidelines on when to make the trip:
Contractions 5 Minutes Apart
When contractions have been coming steadily every 5 minutes for an hour or longer, most practitioners recommend going in. Exceptions may include women who live close by or have very fast labors.
Water Breaks
Once the amniotic sac ruptures, medical guidance on next steps is needed. You will likely be instructed to come in right away if labor doesn’t start spontaneously within a few hours.
Bloody Show with Contractions
Losing the mucus plug signals changes are happening. Pairing this sign with regular contractions indicates active labor has begun.
Can No Longer Talk Through Contractions
When it becomes very difficult to talk or concentrate during the peak of contractions, labor has typically progressed to an active phase. Begin heading to your planned birth place.
Emergency Signs
Rapid bleeding, decreased fetal movement, continuous contractions, or other concerning symptoms require prompt evaluation and should not wait. Call your provider right away or go straight to the hospital.
Other FAQs About Labor Cramping:
Are cramps a sure sign of labor approaching?
Cramps alone do not guarantee labor is imminent. Only when they become more intense, regular, and frequent is true labor likely beginning. Cramping and contractions are very common throughout pregnancy.
How long does cramping last in early labor?
For most women, the early labor stage with light, inconsistent contractions lasts several hours to a day or longer. There may be cramping on and off for days or weeks before active labor begins.
What do real labor cramps feel like?
The cramping sensation of real labor is intense tightening and squeezing of the uterus that peaks and then subsides. It is typically concentrated low in the pelvis and may radiate to the back and hips.
Should I time cramps to see if labor is close?
Timing cramps is helpful to discern if they are increasing in frequency and intensity like true labor contractions. Contractions 5 minutes apart or less that last 45-90 seconds likely indicate active labor.
How can I tell if cramps are Braxton Hicks or real contractions?
Braxton Hicks are sporadic, irregular cramps that don’t get closer together or stronger. Real labor brings progressive intensification and increasing frequency of contractions.
Is it normal to have menstrual-like cramps before labor?
Mild cramping similar to menstrual cramps is common throughout pregnancy as the uterus grows and ligaments stretch. More intense cramping that progresses may indicate true labor.
Should I call my doctor if I have cramps?
Light cramping is usually not concerning, but do contact your provider if cramps become frequent, prolonged, or severe. Also call for any bleeding, fever, reduced fetal movement, or other issues.
What can I do to ease labor cramping at home?
Changing positions, walking, massage, hydration, hydrotherapy, birth ball exercises, breathing exercises, and relaxation techniques are some natural ways to cope with labor cramps at home.