Braxton Hicks vs True Labor Contractions

By Dr. Kenosha Gleaton, OBGYN

Braxton Hicks (BH) contractions are false labor pains that are typically felt during the second or third trimester of pregnancy. Braxton Hicks contractions help the body prepare for true labor but are not a sign that labor has started. True labor contractions will be slightly different, so it’s important to know the key differences between Braxton Hicks and real contractions. 

What to Know About Braxton Hicks

Braxton Hicks are a normal part of pregnancy and shouldn’t be cause for concern. [1] It can be hard for some people to distinguish between BH and true labor contractions, but the timing and sensation of true labor pains is usually a bit different. Here’s an overview of what you need to know about Braxton Hicks. 

When Do Braxton Hicks Start?

Most people won’t notice Braxton Hicks contractions until the second or third trimester, however researchers believe that they start as early as six weeks gestation. [1] It’s also believed that BH tend to increase in frequency and intensity as pregnancy progresses. 

What Causes Braxton Hicks Contractions?

The feeling of Braxton Hicks is caused by the muscle fibers in the uterus tightening and relaxing (aka contracting). We aren’t exactly sure why Braxton Hicks occur, but researchers do believe that they are the body’s way of preparing for true labor. [1] There are some circumstances that may trigger BH contractions, such as [1]:

• Increased physical activity
• Full bladder
• Sexual activity
• Dehydration (find out why hydration is so important during pregnancy)

A common link between these circumstances is the need for increased blood flow to the placenta and the potential for fetal stress. [1] 

What do Braxton Hicks Feel Like?

Many people compare the feeling of Braxton Hicks contractions to mild menstrual cramps. BH contractions should not be painful but may be uncomfortable. There is often a tightening or cramping in a specific area of the abdomen that will come and go. [1] BH contractions can vary in duration and intensity, but are usually irregular and will occur infrequently. Contractions are more likely to be random and unpredictable than true labor contractions. [1]  Learn more about cramping during pregnancy

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How to Stop Braxton Hicks

While BH contractions aren’t painful, they can be uncomfortable. There is no medical treatment for BH at this time, however there are some tips you can try to lessen the severity or duration [1]:

• Changing position: Switching from one side to the other, sitting up, or laying down may help ease the tension and cramping you’re experiencing.
• Change activity level: If you’ve been laying down for a long time, try getting up and going on a walk or doing some yoga. If you’ve been particularly active, you may want to get off your feet for a while and lay down.
• Relax: Treat your body the way you would if you were experiencing painful menstrual cramps. Try taking a warm bath, taking a nap, reading a book, or getting a massage to help unwind.
• Stay hydrated: Dehydration is thought to trigger BH contractions. Make sure you’re drinking plenty of water and maintaining a proper electrolyte balance. 
• Emptying the bladder often can also be helpful for decreasing the frequency of BH. 

What to Know About True Labor Contractions

For most, labor begins sometime between weeks 37 and 42 of pregnancy. [2] When the time comes for true labor, contractions are more likely to occur rhythmically and will typically increase in frequency, duration, and intensity. When in true labor, the cervix will begin to dilate and you may or may not experience your water breaking. [2] 

What Do Labor Contractions Feel Like?

Unlike Braxton Hicks contractions, true labor contractions are more likely to be painful or more intense than typical menstrual cramps. [1-2] When in labor, contractions will begin to occur more frequently, last longer, and may become increasingly intense. 

Braxton Hicks vs Real Contractions

So what are the key differences between Braxton Hicks and real labor contractions? Aside from the differences in frequency, intensity, and duration, true labor is often accompanied by other symptoms, such as [2-3]:

• Lightening: This is a term used to describe the feeling of the baby dropping or moving lower into the uterus. Lightening doesn’t always occur but can happen a few weeks to a few hours before labor begins. Those that do experience this describe a feeling of lightness or relief from the baby dropping. 
• Vaginal discharge: Many will notice an increase in vaginal discharge when nearing or during labor. This discharge is a result of the cervix beginning to dilate and is often clear, pink, or slightly bloody. 

Preterm Labor vs Braxton Hicks

If you are experiencing contractions prior to 37 weeks, you may be concerned about preterm labor. Keep in mind that Braxton Hicks contractions are normal and may be felt earlier on in pregnancy. Start by timing the duration and frequency of your contractions to determine if you are experiencing premature labor pains or not. [1-3] Premature labor contractions will feel similar to full-term labor contractions and may be accompanied by the lightening sensation or vaginal discharge mentioned previously. Some other symptoms of preterm labor include [2-3]:

• Regular, rhythmic, or increasing painful or frequent contractions
• Regular tightening or pain in the lower back
• Increased pressure in the pelvis or vagina

If you notice these symptoms are long-lasting and aren’t relieved from changing positions, you may want to speak to a healthcare provider. If you are experiencing premature labor, there are some medications that may be able to stop or delay labor from occurring. [3] 

When to Speak to a Medical Provider

It can be hard to distinguish true labor contractions from false labor contractions and decide when you should seek out medical care. If you ever have any concerns or questions, don’t be afraid to reach out to your healthcare provider. That being said, the general recommendation is that anyone experiencing regular contractions every five to ten minutes for an hour or longer should seek out medical care. [1-3] Other symptoms that should prompt someone to reach out to their provider include [1-3]:

• Vaginal bleeding
• Leaking of vaginal fluid
• Inability to walk through contractions
• Noticeable change in fetal movement or lac

If you are earlier than 37 weeks, your healthcare provider may talk to you about your options for delaying labor. 

Key Takeaways

• Braxton Hicks contractions are false labor pains that are the body’s way of preparing for true labor.
• Braxton Hicks contractions are thought to begin very early on in pregnancy but often aren’t felt until the second or third trimester.
• BH contractions often feel like menstrual cramps, aren’t rhythmic, and do not increase in intensity or frequency.
• True labor pains are often more intense and painful than BH, and will increase in severity, frequency, and duration.
• When in true labor or premature labor, there may also be an increase in vaginal fluid, discharge, bleeding, or a lightening sensation.

References:

1. Raines DA, Cooper DB. Braxton Hicks Contractions. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470546/
2. When does labor usually start? National Institutes of Health. Office of Communications. September 2017. URL. Accessed July 2023. 
3. Preterm Labor. Cleveland Clinic. November 2022. URL. Accessed July 2023.