Contractions

Overview

A contraction is a tightening and then relaxing of the muscles of the womb (the uterus — the organ where a baby grows during pregnancy). During pregnancy and birth, these squeezes can be mild and irregular, or strong and regular. Practice contractions, often called Braxton Hicks, are usually gentle and come and go. Labour contractions get stronger, longer and closer together over time, and they help open the cervix (the neck of the womb) so the baby can be born.

Yes. Every labour involves contractions, and most pregnant people also notice practice contractions in the weeks before birth. Feeling unsure about what you are feeling is extremely common, especially in a first pregnancy.

Anyone who is pregnant can have contractions. They are more likely to start early (before 37 weeks) in people expecting twins or more, those who have had a premature birth before, and those with certain infections or health conditions.

Symptoms

Common symptoms

• A tightening or hardening of the bump that builds up, peaks and then fades
• Period-like cramping low in the tummy or in the back
• Lower backache that comes in waves
• Contractions that become more regular, stronger and longer as time passes
• A show — a small amount of thick, jelly-like discharge, sometimes pink or streaked with blood
• Your waters breaking (a gush or a slow trickle of fluid)
• A strong urge to open your bowels, or a feeling of pressure low down, when labour is well established

Symptoms in children

• Not applicable — this article is about contractions in pregnancy and labour. Children and teenagers can get muscle cramps (for example in the legs at night or after exercise), which are a different thing; a pharmacist or doctor can advise on those.

Symptoms in older adults

• Not applicable — this article is about contractions in pregnancy and labour. Older adults may notice muscle cramps or spasms, which have their own causes and are worth discussing with a doctor if they are frequent or painful.

Causes

Main causes

• Normal labour starting at the end of pregnancy — the body's own hormones trigger regular contractions
• Practice contractions (Braxton Hicks) — the womb 'warming up', often brought on by activity or dehydration
• Preterm labour — labour starting before 37 weeks, sometimes linked to infection
• Other causes of tummy pain in pregnancy, such as a urinary infection, constipation, wind or stretching ligaments, which can feel crampy but are not labour
• Induced labour — when the care team starts labour for medical reasons, contractions may come on more quickly and feel stronger

Risk factors

• A first pregnancy
• Expecting twins or more
• Having had a premature birth before
• Infections of the urine, vagina or gums
• Smoking, or using drugs during pregnancy
• A short gap between pregnancies
• Problems with the cervix (the neck of the womb) or the shape of the womb
• High blood pressure or other health conditions in pregnancy

When to see a doctor

See a doctor urgently if:

• Regular contractions before 37 weeks
• Your waters have broken
• Bleeding from the vagina that is more than a light streak
• Your baby is moving less than usual
• Severe headache, blurred vision, swelling or pain under the ribs
• A high temperature, or fluid that is green or smelly

Book a routine appointment if:

• You are not sure whether what you feel is labour
• Contractions are irregular and you want reassurance
• You are finding it hard to cope with pain or with lack of sleep
• You want to talk through your birth preferences or pain relief choices before labour starts

Diagnosis

There is no single test for labour. Your midwife or doctor will ask about your contractions — when they started, how long they last, how far apart they are and whether they are getting stronger — and will check you and your baby. They may gently feel your bump, listen to your baby's heartbeat, and sometimes do an internal examination to see how open the cervix is. If you are having contractions early, they may check your urine and do other tests to look for infection.

Tests that may be done

• Timing your contractions and noting any other symptoms
• Listening to the baby's heartbeat (with a hand-held monitor or a belt monitor)
• An internal examination to check how open and soft the cervix is
• A urine test to look for infection
• A blood pressure and temperature check
• Sometimes a scan, or a swab to check for infection if early labour is suspected

What to expect at your appointment

Appointments are usually calm and private. You can take your birth partner with you. You can ask questions at any point, and you can ask for a pause or an explanation if anything is unclear. Nothing is done without your agreement, and you can always ask for time to think.

Treatment

For most people, labour contractions are not 'treated' — they are supported. The aim is to keep you comfortable, safe and informed while your body does its work. Your care team will help you find pain relief that suits you, and will keep a close eye on you and your baby. If contractions are too strong, too long, or labour slows down, they may suggest other options.

Self-care at home

• Time your contractions on a phone or notepad so you can describe them
• Keep sipping water and eat light, easy-to-digest food if you feel like it
• Rest or sleep between contractions whenever you can — even short naps help
• Try a warm bath or shower, a warm pack on your back, or a massage from your birth partner
• Move around, rock, sway or use a birthing ball — staying upright and mobile often helps
• Use breathing and relaxation techniques you have practised, or music and a calm, dim room
• Ask your midwife about a TENS machine (a small hand-held device that gives gentle tingling pulses through pads on your back)

Medical treatments

Pain relief in labour ranges from simple methods you can manage yourself — warmth, movement, breathing, massage and water (a birth pool) — through to medicines and regional pain relief given by your care team. Your midwife or doctor can explain the benefits and downsides of each option so you can choose what feels right. If contractions are too strong or too frequent, or if labour is very slow, they may suggest ways to adjust the pace of labour, and they will discuss the reasons with you first. If you are having contractions early, they may offer medicines to try to settle them, along with treatment for any infection found.

When is surgery considered?

A caesarean birth (an operation to deliver the baby through a cut in the tummy) may be suggested if there is a concern about you or your baby, if labour is not progressing, or if the baby needs to be born quickly. Assisted birth (using forceps or a ventouse cup to help the baby out) is another option in some situations. These are always discussed with you beforehand — or, in an emergency, explained as clearly as possible at the time.

Living with this condition

In the last weeks of pregnancy, it can feel like your body is giving mixed messages — cramps that come and go, a sore back, restless nights. Try to keep life gentle and flexible. Have your hospital bag packed and your maternity unit's number saved in your phone from around 36 weeks. Ask your partner, family or friends for practical help so you can rest.

Lifestyle tips

• Keep a note of your maternity unit and out-of-hours numbers somewhere easy to find
• Pack a bag early so you are not rushing
• Plan how you will travel to the hospital or birth centre, day or night
• Keep up gentle daily movement if you feel well
• Rest when you can, and say yes to practical help
• Avoid alcohol and smoking — stopping smoking is one of the best ways to reduce the chance of early labour

Diet and exercise

Eat regular meals and keep hydrated — dehydration can trigger practice contractions. Gentle exercise such as walking, swimming or pregnancy yoga is good for you if you feel comfortable and your midwife has not advised against it. In late pregnancy, rest matters as much as movement, so do not feel guilty about slowing down.

Mental health and emotional wellbeing

Pregnancy and the thought of labour can bring up a lot of emotions — excitement, worry, fear of pain, or memories of a difficult past birth. All of these are valid. If anxiety is affecting your sleep, eating or day-to-day life, please tell your midwife or doctor; support is available and asking for it is a sign of strength. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot and would not want to prevent the contractions of normal labour — they are a natural and necessary part of birth. What you can do is reduce the chance of labour starting too early, and prepare so you feel more confident when it does.

Vaccines

Staying up to date with the vaccines recommended during pregnancy helps protect you and your baby from infections that can trigger early labour. Ask your midwife or GP which ones are suggested for you.

Screening programmes

Regular antenatal appointments are the main way to spot problems early. Your care team checks your blood pressure, urine and your baby's growth, and listens to your baby's heartbeat. If you have a history of early birth, they may offer extra checks such as scans of the cervix. Tell your midwife about any previous early birth or cervix treatment so they can plan the right care for you.

Complications

If left untreated

• Very long or very strong labour can leave you exhausted and make it harder to cope
• If labour is not progressing, the care team may need to step in with extra support or an assisted or caesarean birth
• Early labour (before 37 weeks) can mean your baby needs extra care after birth
• Rarely, serious problems such as heavy bleeding or the baby being distressed can develop — this is why your team watches closely
• Untreated infection can make contractions start early or make you feel very unwell

Long-term outlook

For most people, contractions do their job and a healthy baby is born. Labour can be unpredictable, and plans sometimes change — that is not a failure, it is simply the care adapting to what you and your baby need. Talk openly with your midwife or doctor about your wishes, ask all your questions, and remember that support is there throughout.

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