Braxton Hicks Contractions

Article Author:
Deborah Raines
Article Editor:
Danielle Cooper
Updated:
5/2/2019 3:27:33 PM
PubMed Link:
Braxton Hicks Contractions

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.

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.


References

[1] Hanghøj S, When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy. Women and birth : journal of the Australian College of Midwives. 2013 Sep;     [PubMed PMID: 23711581]
[2] MacKinnon K,McIntyre M, From Braxton Hicks to preterm labour: the constitution of risk in pregnancy. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres. 2006 Jun;     [PubMed PMID: 16871850]
[3] Dunn PM, John Braxton Hicks (1823-97) and painless uterine contractions. Archives of disease in childhood. Fetal and neonatal edition. 1999 Sep;     [PubMed PMID: 10448189]
[4] Lockwood CJ, The diagnosis of preterm labor and the prediction of preterm delivery. Clinical obstetrics and gynecology. 1995 Dec;     [PubMed PMID: 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. Gynecologic and obstetric investigation. 1994;     [PubMed PMID: 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. American journal of obstetrics and gynecology. 1993 Jan;     [PubMed PMID: 8420324]
[7] Lockwood CJ,Dudenhausen JW, New approaches to the prediction of preterm delivery. Journal of perinatal medicine. 1993;     [PubMed PMID: 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. American journal of obstetrics and gynecology. 1991 Jul;     [PubMed PMID: 1677235]
[9] Oosterhof H,Dijkstra K,Aarnoudse JG, Fetal Doppler velocimetry in the internal carotid and umbilical artery during Braxton Hicks' contractions. Early human development. 1992 Aug;     [PubMed PMID: 1396288]
[10] Oosterhof H,Dijkstra K,Aarnoudse JG, Uteroplacental Doppler velocimetry during Braxton Hicks' contractions. Gynecologic and obstetric investigation. 1992;     [PubMed PMID: 1427416]
[11] Bower S,Campbell S,Vyas S,McGirr C, Braxton-Hicks contractions can alter uteroplacental perfusion. Ultrasound in obstetrics     [PubMed PMID: 12797102]
[12] Hill WC,Lambertz EL, Let's get rid of the term     [PubMed PMID: 2314790]