How Can I Tell the Difference Between Braxton Hicks Contractions and True Labor?

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Braxton Hicks contractions are the unpredictable, sporadic and usually non-rhythmical contractions that occur during pregnancy. These contractions were named after John Braxton Hicks because in 1872 he first called attention to this phenomenon. Their intensity varies between approximately 5-25 mm Hg (a measure of pressure). They are sometimes called “false labor.” For comparison, during true labor the intensity of a contraction is between 40-60 mm Hg in the beginning of the active phase. We call it false labor but sometimes only after we know it is not “true labor,” which are contractions that cause cervical change.

For the majority of pregnancies, the Braxton Hicks contractions are tolerable and not disruptive of day-to-day activities. But for some pregnancies, they are very disruptive because of the pain, discomfort and lack of sleep, even causing trips to Labor & Delivery to rule out labor. It can sometimes be extremely difficult to tell whether these contractions are going to cause labor and even pregnant obstetricians come to Labor & Delivery for evaluation! Fortunately, these types of Braxton Hicks contractions are near the end of pregnancy and therefore are short-lived.

Many things have been tried to alleviate Braxton Hicks contractions including hydration, walking, warm baths and yoga. There is no “tried and true” method that works for everyone. They are of most concern to pregnant women and their obstetricians when the woman has previously had a preterm delivery. The drugs we have available to stop premature labor (tocolytics) do not work very well and very seldom work for more than 48 hours. We try not to use these medications for false labor but if the patient is at the end of her rope and the medicine works, it is usually reasonable to use for a short time. Sometimes a mild pain medicine will get that person through until the end. Sometimes what she needs is a good night’s sleep and a mild sleeping pill will do the trick. These medications should only be used for a very short time.

“How will I know if it is true labor?”

I usually suggest women determine if the contractions are regular in frequency, intensity and duration. Not contractions every 10 minutes then 20 minutes…Not contractions that you can laugh and talk through then the next one brings you to tears…Not one contraction that lasts two minutes and another that lasts 20 seconds.

Once contractions are regular in frequency, each occurring less than four minutes apart, regular in duration, each lasting 40 seconds or more, and once they are regular in intensity and getting stronger by the minute (like watching the waves on a beach as a hurricane approaches), then it is time to call Labor & Delivery for further instructions and come in for evaluation.

Remember, Braxton Hicks contractions are a normal physiologic event during pregnancy. Most of the time, they are tolerable and once you begin to experience them you are usually near the end of your pregnancy. Always consult your physician if you are concerned.

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