Braxton Hicks contractions are named after the English doctor John Braxton Hicks who first described them in 1872. He reported many women felt contractions without being near confinement. He said this process was usually painless, but caused women confusion as to whether they were going into actual labour.

Braxton Hicks contractions are usually due to part but not all the uterus contracting. The contractions are not sufficiently strong or co-ordinated to cause cervical change. The onset of labour is defined as when there are regular co-ordinated contractions that cause the cervix to change (dilate and become thinner).

The occurrence of Braxton Hicks contractions should not be surprising as the uterus is a muscle and muscles contract. The uterus muscle has a skin on the outside called the serosa and a skin on the inside called the endometrium or decidua in pregnancy. When a woman is not pregnant contractions of the uterus muscle facilitate the release of menstrual blood and contribute to menstrual pain.

What do Braxton Hicks contractions feel like?

  • The pregnant woman is aware of usually one part and not the whole uterus contracting or going hard. She may be aware of the whole uterus going hard especially when they occur closer to her due date.
  • There are usually, but not always, painless. While they can be considered painful on occasions, the awareness is often described as uncomfortable. The pain of Braxton Hicks contractions is less than labour contractions.
  • While there can be a ‘run of contractions’ over a period, they do settle.
  • They tend to be episodic and infrequent, though they will recur in the pregnancy and become more apparent the closer the woman is to term gestation.
  • Their onset is usually in the third trimester of pregnancy, though some women are aware of them even from 20 weeks gestation.
  • Braxton Hicks contractions are often associated with considerable anxiety as the pregnant woman is worried she is going into preterm labour.

How can you tell the difference?

  • In contrast to labour pains, Braxton Hicks contractions do not get stronger, do not get more coordinated, do not get more frequent and settle with time. Braxton Hicks contractions are usually infrequent, irregular, and involve only mild cramping.
  • It is usual for their awareness to be in part but not all the uterus contracting with Braxton Hicks contractions, especially before term gestation. With labour, the whole uterus goes hard.
  • Braxton Hicks contractions are not associated with a ‘show’. A show is due to cervical changes and so if there is a show with contraction it is likely the contractions are early labour pains.
  • Braxton Hicks contractions are usually felt only in the front of your abdomen. True labour contractions are more intense and often start in your lower back and move to the front of your abdomen. But they may start in your abdomen and move to your back.

How often do Braxton-Hicks contractions happen?

  • The occurrence varies. Some pregnant women have them a lot and others do not get any.
  • Sometimes they can be isolated events occurring once in pregnancy and sometimes they can happen often in the pregnancy. There can be run of contractions that can last an hour and sometimes just one contraction.
  • They are more common the closer a woman gets closer to her due date.

What can be done?

  • If you are concerned that the contractions are not Braxton Hicks but due to early onset of labour, then give the Birth Unit a call. The midwife can give you advice and if concerned will ask you to attend for monitoring and, if necessary, further checking.
  • If you notice a ‘show’ in association with the contractions, then give the Birth Unit a call and tell the midwife. The midwife can give you advice and if concerned will ask you to attend for monitoring.
  • Braxton Hicks contractions are more common when you are active. Minimise activities that trigger Braxton Hicks contractions.
  • You can take a mild painkiller if needed to help you rest.
  • Sometimes an obstetrician will prescribe an antitocolytic (to stop contractions) medication.

False labour pains

These are contractions that occur in the lead up to true labour. False labour pains do not result in cervical change and can easily be distinguished for the onset of true labour by the obstetrician or midwife doing an internal examination to check for cervical change.

False labour pains in contrast to true labour pains do not become more frequent and stronger and usually settle, though they can recur.

They can result in a woman becoming anxious as she is not sure about the onset of labour. They can be tiring and result in loss of sleep and can be painful (though less painful than true labour).

Usually, when a woman says she had a labour that lasted for days she is also counting false labour pains as true labour. I had that experience with a new gynaecology patient recently who wanted to talk through her first childbirth experience as a public patient. She said her labour was for four days duration. The hospital discharge summary she showed me reported her true labour was only six hours.

A note of caution

On occasions, a woman will arrive at hospital minutes before she delivers or will deliver in the car on the way to the hospital or at home. On quizzing these patients, they did have contractions, but they were coping. They did not want to come to the hospital too soon and they were waiting for their contractions to become more painful. Often, they just thought it was false labour pains they were experiencing.

Just because you are coping with contractions at home do not assume they are false labour pains. If the whole of the uterus is contracting, the contractions are becoming stronger and more frequent (especially if they are every two to three minutes) then give the Birth Unit a call and make your way to the hospital.

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