Braxton Hicks Contactions

Deborah A. Raines1; Richard Whitten.

1
Univ at Buffalo

Last Update: February 19, 2018.

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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.
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.
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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.
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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.
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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.
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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.
 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.
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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.
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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.
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.
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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.