If you're pregnant, you're probably hearing—and thinking—a lot about contractions. Get the inside scoop on what they really are.

By Lisa Milbrand, Mehmet Oz, M.D. and Michael Roizen, M.D.

No matter where you are in your pregnancy, you're probably thinking an awful lot about the end of it—labor, delivery, and that beautiful baby. And what's going to get you there? Contractions.

Because contractions generally signal that labor is starting, they can be viewed as a warning sign, a green light or a cue to ask, "Honey, the crib is set up, right?" But having contractions before you're due doesn't necessarily mean that Baby has requested an early checkout from Hotel Utero. Here's what you need to know about uterine contractions—whenever they occur.

What is a Contraction?

You may start to feel a tightening and hardening of your stomach throughout your pregnancy, as your body starts prepping for the work to come. "The uterus is exercising for the grand finale," says Paul du Treil, M.D., director of maternal and child health at Touro Infirmary in New Orleans. These first, disorganized twinges are a precursor of the real deal.

Consider contractions your body's way of helping nudge your baby out into the world. "The uterus surrounds the baby, and when the uterine muscles contract, that helps labor progress," says Bart Putterman, M.D., an ob-gyn at Texas Children's Pavilion for Women in Houston. The uterine contractions are what get your baby into position for birth, and help him progress through the birth canal.

True labor contractions, which might start out as an occasional, uncomfortable tightening and hardening of your stomach, will slowly build to something more—like really bad menstrual cramps or gas pains. As labor progresses, these contractions will help get your baby into position and will become stronger, more intense, and closer together.

Different Types of Contractions and What They Mean

Early contractions

You can experience contractions even in the first trimester as your body adjusts to the pregnancy. The stretching of the ligaments around the uterus can cause contractions, and so can dehydration, constipation and gas pains. If they're accompanied by spotting, bleeding and/or abdominal pain, you need to see a doc to rule out an ectopic pregnancy or a potential miscarriage.

The easiest way to know if you're having true labor contractions is by doing a simple self-test. Lie down and place a hand on your uterus. If your entire uterus is hard during the cramping, it's probably a contraction. If it's hard in one place and soft in others, those are likely not contractions—it may just be the baby moving around.

Preterm contractions

Many contractions that occur after week 34 are random and irregular; these are known as Braxton-Hicks contractions. If contractions come regularly (every 10 minutes or less) rather than intermittently, you may be in preterm labor. Report any contractions to your doctor or midwife so she can determine what's happening.

If you're not having regular contractions signaling preterm labor, try calming the cramps by drinking plenty of water, taking a warm bath, emptying your bladder, and breathing rhythmically.

Sex contractions

If you have a normal, uncomplicated pregnancy, orgasms—with or without intercourse—don't increase the risk of premature labor. Likewise, sex during pregnancy isn't likely to trigger labor even as your due date approaches, but you may experience Braxton-Hicks contractions or even light spotting afterward. These should subside in a couple of hours. If they are accompanied by any troubling symptoms (like bleeding, pain, vaginal discharge, or a decrease in fetal movements), contact your doctor or midwife.

Back contractions

True labor contractions can cause back pain, ranging from a dull aching or cramping that radiates towards your uterus to more severe discomfort in the lower back. If the pain is intense and remains mostly in your back, you are likely experiencing back labor.

Back labor is typically a result of the baby's position as it moves into the birth canal. Babies that present with their heads facing up (called occiput posterior) often place more pressure on the nerves in the mother's back, causing a heightened sensation of pain. But some laboring women simply feel the pain or pressure of contractions more acutely in their backs, which may or may not subside as the labor progresses. Talk to your birthing staff about pain relief options—there are medicated and drug-free ways to reduce the pain of back labor.

Preparing For Labor and Delivery

Once you've confirmed that the contractions you're experiencing are true labor contractions, it's time to prepare yourself for your baby's debut.

While there's no need to time yourself like Olympian Usain Bolt in a 100-meter dash, you or your partner should start noting how long the contractions last and the length of the time between them (measured from the beginning of one contraction to the beginning of the next). Are these contractions coming in regular intervals, spaced closely and so painful that it's hard to talk during them (as opposed to little twinges)? You're considered to be in active labor if you have contractions that last for about a minute and come regularly more often than every five minutes.

If you're very uncomfortable during the contractions or if you live far from the hospital or birthing center, your doctor or midwife may recommend that you come in. You'll be assessed every two hours to determine whether or not you're in active labor.

Otherwise, unless your labor is progressing rapidly, this might mean staying home and resting as much as possible: It's a lot of work to push an eight-pound baby through a very small opening, so you may find that labor contractions sap a lot of your energy.

"You may be able to go about your life when labor starts, but there's a time where the energy shifts, and you can't do anything other than labor," says Siobhan Kubesh, a certified midwife with OBGYN North in Austin. That's usually when it's time to hit the hospital or birthing center.

If this is your first pregnancy, it might take a while for your body to get into the groove. Your entire labor will likely last for several hours—or even more than a day. Subsequent pregnancies may involve much shorter labor. "Second and third babies typically come a lot quicker," Dr. du Triel says. "The mother's body has done this before and remembers the process, so they can quickly progress to active labor."

Will contractions hurt? 

That depends on a lot of factors: how your baby is positioned within your body, your position as you labor, and your own perception of pain. "Some people have Braxton Hicks contractions that make them double over in pain, while others don't even realize they're in labor—they just feel a little cramping or backache," Dr. Putterman says. You decrease the discomfort by trying different positions (on all fours, straddling a birthing ball, on your side), sitting in a warm bath or shower, or utilizing pain medications via epidural.

But whether your contractions are simply uncomfortable or downright painful, you'll know that something amazing comes out of them. And that makes your labor worth it!


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