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Labour contractions are your body’s way of helping your baby come out when he or she is ready to be born; ideally sometime between the 37th and 40th week of pregnancy.

Here’s how this happens in a normal delivery: As the baby’s head comes lower down the expecting mom’s pelvis, it sends a signal to her brain to produce oxytocin (a hormone that is also associated with breastfeeding). The oxytocin causes the mom-to-be’s uterus muscles to contract or tighten. When the uterus contracts, it causes the cervix to open up (dilate) and become thinner (efface). As the contractions increase in frequency and intensity over time, the cervix opens more, allowing the baby to come down the birth canal and be delivered.

However, contractions are not limited to labour time. Uterine contractions can occur as early as the sixth week of your pregnancy. And they can be of different types, depending on when they occur and the results they produce. For example, while labour contractions end in the birth of a baby, Braxton-Hicks contractions are like a rehearsal for the real thing. Meaning that Braxton-Hicks contractions can be mistaken for labour pains but they tend to fade away or stop suddenly without resulting in birth.

Knowing about the various types of contractions can help you understand what you may be experiencing, and act accordingly. So, read on to know about the different types of contractions, as well as how to time your labour contractions and how to relax while you are having the different types of contraction during pregnancy.

  1. Types of contractions
  2. Back labour pain
  3. What do contractions feel like?
  4. Tips to relax during contractions
  5. How to time your contractions
Doctors for Contractions in pregnancy

Women can experience different types of contractions, depending on how far along they are in their pregnancy and their outcome. These are:

Labour contractions

These contractions are an important indicator of how far along you might be in your labour: in the earliest stage of labour, the contractions tend to be irregular and mild (they may feel like menstrual cramps or stomach gas). As labour progresses, they tend to become very regular and very strong. The time gap between the contractions also reduces.

Some key features to recognise labour contractions by are:

  • The contractions are rhythmic; meaning you can time them and see patterns in the intervals between contractions and the length of contractions.
  • The intensity and duration of contractions increase with time.
  • The pain usually starts in the back and radiates towards the front of the body.

Here’s a look at the three stages of labour, and how contractions feature in each one:

Stage 1

Oxytocin hormone and prostaglandins (made up of lipids) are the two main chemicals responsible for producing labour contractions. While they are produced naturally in the body, doctors may also use these chemicals to induce labour where necessary.

Here's how the chemicals are produced in the body naturally: When the baby comes lower down the mom-to-be’s pelvis, it causes the cervix to open up and become thinner. This, in turn, sends signals to the brain to release oxytocin, to trigger contractions.

At this time, the placenta releases prostaglandins which also help to produce contractions and thin out the cervix further.

The longest of the three stages, stage 1 can last from 12-20 hours. By the time stage 1 ends, the cervix dilates to about 10 centimetres (or about four times its normal size).

Some important signs of this stage include lower back pain and cramping. Just before this stage begins, the fetal membranes (a sort of sac that protects the baby during pregnancy) break and amniotic fluid comes out - this is colloquially known as water breaking. Whenever this happens, you may notice a brownish discharge before the amniotic fluid starts to flow. Rest assured, this is absolutely normal.

Intensity and frequency of contractions

  • In the latent phase of stage 1 of labour, the frequency of contractions can be anywhere between one in every 20 minutes to one every five minutes. Each contraction can be 30-90 seconds long.
  • The contractions come in faster and last longer as the labour progresses to the active phase of stage one. At this time, the contractions tend to be 45-60 seconds long, and they recur every three to five minutes.
  • In the final phase of stage 1, called the transition phase, the contractions are much closer together: they can be 60-90 seconds long and 30-120 seconds apart.

Stage 2

In this stage, the baby slides further down. Once the baby’s head pushes out into the birth canal, the mom-to-be can start pushing the baby out in time with the contractions (sometimes this is instinctive, at other times, a doctor or midwife needs to encourage expecting mothers to push and relax at the proper intervals). The duration of this stage can vary between a few minutes and three hours.

Intensity and frequency of contractions

  • The contractions tend to be regular, longer and stronger now, to ease the baby’s passage through the birth canal.
  • In this stage, while a portion of the uterus actively helps to push the baby out, the lower half of the uterus remains relaxed and stretches to let the baby come out through the birth canal.

Stage 3

Over the next few minutes to a half-hour, mild contractions push the placenta out of the new mom's body after delivery.

As the contractions become stronger, the important thing to remember is to breathe through them, call your doctor and make arrangements to get to a hospital where you can deliver your baby safely. Remember also that you’ve prepared for this is over several months

Braxton-Hicks contractions

Getting contractions before the 37th week of pregnancy can be scary. However, mild and irregular contractions can be perfectly innocent and nothing to worry about.

In fact, pregnant women can experience mild uterine contractions as early as six weeks into the gestation period. These contractions, known as Braxton-Hicks contractions, are more commonly felt in the second and third trimester of pregnancy, though.

While doctors don’t know the exact cause for these contractions, some factors that can trigger them are dehydration and having sex during pregnancy. Braxton-Hicks are also considered to be the body’s way of getting ready for labour.

Some key features to recognise Braxton-Hicks contractions by are:

  • They are non-rhythmic, sporadic, unpredictable contractions that do not become regular with time.
  • They are usually triggered when the mom-to-be has been very active or is dehydrated.
  • Braxton-Hicks contractions can last up to 2 minutes, whereas real labour contractions are typically under 90 seconds.
  • Braxton-Hicks contractions become weaker with time, whereas real labour contractions get stronger.
  • Braxton-Hicks contractions often affect the abdomen or one particular area rather than radiating from the back to the front of the body.

Also known as false labour, Braxton-Hicks contractions tend to be irregular and do not increase in intensity over time. Shifting positions and doing breathing and relaxation exercises can help some women overcome these. That said, you should visit your doctor if the pain does not go away even after shifting positions, drinking water and doing breathing exercises.

Preterm labour contractions

Going into labour anytime between the 20th week of pregnancy and the 37th week of pregnancy is known as premature labour. Contractions between week 20 and week 37 of pregnancy that are regular in frequency, and which result in the opening of the cervix for birth are known as preterm labour contractions. (These are different from Braxton-Hicks contractions, as Braxton-Hicks do not result in birth.)

There are many risk factors for going into premature labour, including carrying twins, smoking and a previous premature delivery. Talk to your doctor about preventive steps and care measures, if you are at risk of going into labour prematurely.

If you get contractions before the 37th week of pregnancy, time them and monitor them for intensity. Head to the hospital if your contractions are getting stronger or if have more than six contractions in one hour: there’s no need to panic but if the contractions do cause your cervix to open, it would be a good idea to be in the hospital in case they send you into premature labour.

Technically, this is a type of labour pain rather than contraction. It occurs when the baby's head pushes against the mom-to-be's spine and tailbone during birth. This pain may occur during contractions as well as in-between them.

It is a good idea to ask your doctor about the benefits and side effects of epidural to relieve pain before your due date.

Contractions can feel different, depending on their types as well. Here's what you can expect:

Labour contractions

  • Labour contractions are triggered when the baby’s head comes lower down the pelvis. As a result, most moms can feel pressure on the pelvic region.
  • Contractions typically start as a dull ache in the back that spreads towards the belly. (Some expecting moms find that coming on all fours or leaning on a birthing ball takes some of the pressure off their back.)
  • The pain can feel like stomach gas or really bad menstrual cramps in the beginning. As the labour progresses, the contractions become stronger and regular.
  • Many women say their belly becomes hard and unyielding. There’s also added pressure on their rectum.
  • Labour contractions are not a continuous pain; rather they begin, hit a peak and recede for a few minutes. The duration in-between contractions becomes shorter and shorter as the time for delivery comes closer.

Braxton-Hicks contractions

  • Braxton-Hicks contractions are uncomfortable but not as painful as labour contractions.
  • They are irregular and tend to go away with time.
  • They tend to start in the belly or in one specific area rather than radiating from the back.
  • Changing positions, drinking water and doing relaxation and breathing exercises can help to stop these contractions.

Back labour

  • This back pain is more intense than normal contractions. It occurs when the baby's head pushes against the expecting mom's spine and tailbone (coccyx) during birth.
  • This type of pain may not reduce in-between contractions.

Afterpains

  • Some women can experience contractions for two or three days after giving birth. Known as afterpains, these contractions can happen as the uterus starts to shrink back to its original size.
  • Researchers say these contractions also help to minimise blood loss after a C-section delivery, as they cause the blood vessel in the uterus to contract.

Though different things work for different women, there are some techniques you can try to help you relax during contractions.

For labour contractions

  • Progressive relaxation: Similar to the Savasana in yoga, this exercise involves tightening and then relaxing each muscle in your body one by one. 
  • Mental visualisation: Try to picture something that makes you happy and calm. You could also focus your attention on a physical object that is calming and helps to take your mind off the pain.
  • Hydrotherapy: This involves sitting in a tub of warm water during labour to ease the pain and try to relax.
  • Walk: It may sound counterintuitive, but some women can get relief from labour contraction pains by walking around - make sure someone is around to assist you while you try this.

For Braxton-Hicks contractions

  • Try to drink some water.
  • Change your position to a more comfortable one.
  • Try doing simple breathing exercises, to get enough oxygen into your body and calm your nerves.
  • You can also try taking a warm bath to relax.
  • Try taking a walk; or if you were very active just before the contractions started, try resting for a few minutes.

For back labour

  • Try to get someone to gently massage your lower back.
  • Try the double hip squeeze: Lean over something soft yet firm like a birthing ball or a pile of pillows while a therapist massages both buttcheeks gently. Do give them your feedback on what feels best.
  • Consider epidural and spinal anaesthesia.

Pregnant women can time their contractions with a simple wristwatch. If need be, doctors can use a cardiotocography to monitor them also.

Contractions are timed from the beginning of one contraction to the beginning of the next one. It is a good idea to put these timings down on a piece of paper, to help you notice any patterns.

Timing the contractions in the latter half of stage 1 (the active phase) can be useful, to determine when to go to the hospital. Gynaecologists recommend the 4-1-2 rule to know when to go to the hospital:

  • 4: You have a contraction every four minutes.
  • 1: Each contraction lasts between 30 and 70 seconds, but usually around the minute-mark.
  • 2: And this goes on for about two hours

Most women are able to relax and talk in-between contractions. However, if your contractions are too painful or you can’t relax in-between contractions, you should go to see your gynaecologist right away. You should also head to the hospital if you feel your baby isn't moving or is moving much less than usual.

Dr. Sonam Yadav

Dr. Sonam Yadav

Obstetrics & Gynaecology
7 Years of Experience

Dr. Priyanka Gupta

Dr. Priyanka Gupta

Obstetrics & Gynaecology
10 Years of Experience

Dr. Vrinda Khemani

Dr. Vrinda Khemani

Obstetrics & Gynaecology
6 Years of Experience

Dr Megha Apsingekar

Dr Megha Apsingekar

Obstetrics & Gynaecology
4 Years of Experience

References

  1. Chatterjee J., Gullam J., Vatish M. and Thornton S. The management of preterm labour . Archives of Disease in Childhood. Fetal and Neonatal Edition, March 2007; 92(2): F88–F93.
  2. Deborah A. Raines; Danielle B. Cooper. Braxton Hicks Contractions. StatPearls, Florida, US. Updated November 2019.
  3. Husslein P. The importance of oxytocin and prostaglandins to the mechanism of labor in humans. Wien Klin Wochenschr Suppl. 1984;155:1-32.
  4. Sutter Health, California, US [Internet]. Labor Contractions.
  5. Uvnäs-Moberg, K., Ekström-Bergström, A., Berg, M. et al. Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin. BMC Pregnancy and Childbirth, 2019; 19, Article number: 285
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