The early stages of labor can be filled with a range of emotions for expecting mothers including pain and uncertainty. Preparing yourself for the unexpected — to the best of your ability — and practicing pain management techniques can help your labor and delivery play out as smoothly as possible, particularly during the early stages.
“Birth is unpredictable,” says Denise G Castellanos, the lead midwife at MemorialCare Saddleback Medical Center’s Women’s Health Pavilion in Laguna Hills, California. “Education gives you tools, ideas and strength to acknowledge that labor is a unique experience — and being flexible can allow peace.”
How to Identify Labor Contractions
Your body shifts and expands during pregnancy. It cramps up and contracts too. Contractions are common during the final stages of pregnancy, as your body prepares to go into labor. Typically, contractions that are painful and regular signify that you are entering the early stage of labor — or that you’re already in it. But not all contractions are painful and regular. People can also experience irregular, mildly painful or painless contractions in their later weeks of pregnancy. These are known as Braxton Hicks contractions, and do not signify that you are entering labor.
[SEE: What to Pack in Your Hospital Bag When You’re Expecting.]
True Labor vs. Braxton Hicks Contractions
Differentiating Braxton Hicks contractions from true uterine contractions can help you know when to head to the hospital for your delivery, versus when to wait a few more days (or weeks). Educating yourself on the various sensations that accompany contractions can help you mentally prepare for pain management during active labor.
What are Braxton Hicks contractions?
Sometimes thought of as a “false alarm” for labor, Braxton Hicks contractions are largely painless contractions that occur as the uterus prepares for labor, but before true labor has begun. Braxton Hicks contractions tend to be felt in the second or third trimesters of pregnancy, but researchers believe they begin to occur, undetected, much earlier — around six weeks after gestation.
What do Braxton Hicks contractions feel like?
Braxton Hicks contractions may feel like a tightening or spasming of the uterine muscle and are often localized to one area, such as the front of the abdomen. They are rarely painful, will not increase in intensity over time and may grow weaker. They are not regularly occurring, either, and your cervix will not dilate during a Braxton Hicks contraction.
“When you experience a Braxton Hicks contraction, you will see your uterus tighten and become hard like a rock — but it is not associated with pain,” says Dr. Sherry Ross, a board certified OBGYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, California. “Braxton Hicks contractions are so subtle, most pregnant women do not realize they are having them.”
True labor contractions: pain, regularity and timing
A true uterine contraction, meaning the type of contraction that signifies you are in or entering into labor, can feel painful. In fact, Dr. G. Thomas Ruiz, a board-certified OB-GYN and lead OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California, says that some patients describe uterine contractions as the most painful experience they go through.
In contrast to a Braxton Hicks contraction, real uterine contractions are painful and regularly occurring, and increase in length and intensity over time.
“Real uterine contractions start as a menstrual cramp and continue getting more intense and painful, unlike Braxton Hicks contractions,” Ross says.
[READ Protein During Pregnancy: How Much?]
Comparing Braxton Hicks Contractions to True Labor Contractions
| Characteristic | Braxton Hicks (False Labor) | True Uterine Contractions (Active Labor) |
| Pain/Intensity | Mild, painless, or tightening. Intensity does not increase. | Painful; increase in length and intensity over time. |
| Regularity | Irregular; inconsistent timing. | Regular and predictable; interval between them decreases. |
| Location | Localized to one area (often the front of the abdomen). | Felt broadly; wrap around the back and abdomen. |
| Duration | Last for varying times. | Consistent in length; last a full minute (60 seconds). |
| Cervix | No change in dilation. | Causes the cervix to dilate. |
When to Go to the Hospital: the “5-1-1 Rule” and Multiparous Patients
Uterine contraction pain can also be felt more broadly, wrapping around your back, abdomen and midline of your body. Further, your cervix will dilate during uterine contractions, preparing your body for active labor. As uterine contractions increase in length and intensity, the interval between them will decrease. For first-time mothers, Ruiz says it’s time to go to the hospital once uterine contractions have lasted a full minute, at five-minute intervals for an hour. To more easily remember this queue, he encourages patients to think of the acronym “511.”
Some providers may suggest slightly different ranges for first-time mothers, such as heading to the hospital when uterine contractions have been occuring every 3 to 5 minutes for two hours. For peace of mind about your birthing experience, talk to your doctor about their recommendations for you.
Multiparous patients — or those who have already given birth — however, will want to head to the hospital even sooner, such as when contractions are anywhere between five to ten minutes apart.
“They should be painful, lasting a full minute, but the interval should not be as close as five minutes apart,” Ruiz says. “The difference is because second deliveries move a lot faster. So if you wait until painful contractions get five minutes apart for an hour, you could be having that baby on the way to the hospital.”
Despite changes in the speed of labor and delivery, however, Ruiz says that multiparous patients won’t necessarily experience a lower level of pain during their subsequent births. Still, some patients may develop an increased tolerance for pain and may feel better suited to manage labor pains in later pregnancies.
[READ: Delivery and Labor: What to Expect at the Hospital]
How to Prepare for Pain Management During Labor
Because uterine contractions are painful, it can help to physically and emotionally prepare for how to manage pain during labor. Personal pain management techniques can be invaluable throughout all stage of labor, but particularly during the early stages — before you are admitted into the hospital.
Ruiz explains that patients are not admitted to the hospital until they are in active labor, which occurs when the cervix has dilated to about six centimeters for first-time mothers, and between four and six centimeters for people who have already had babies.
Once you’re admitted to the hospital, you may choose to utilize anesthesia or other medicinal pain remedies. But “until then, you’re kind of relying on breathing and focus,” Ruiz says.
[READ: Checklist for Choosing a Maternity Hospital.]
Birthing classes for pain management
To prepare yourself to manage pain on your own — for those early stages or throughout the labor process, should you prefer to have an unmedicated birth — you can sign up for birthing classes or practice mind-body relaxation exercises.
Ruiz recommends patients start birthing classes as soon as they enter their third trimester of pregnancy, or about 26 weeks. How often you attend class may depend on your lifestyle and availability — but Ruiz says to prioritize fitting in what you can. “The pain of labor can be intense — and that’s why I encourage people to do birthing classes,” Ruiz adds. “It’s not enough to watch a YouTube video.”
According to Ruiz, patients who take birthing classes can feel more equipped to handle labor pains, or even go on to have successful unmedicated births. Breathing exercises are often key to this success, he adds.
Ross agrees that breathing exercises can be essential for labor preparation. She recommends patients practice “transition breathing” by thinking about forming the tone “hee-hee-who” with their breaths, to calm the body during contractions. “Focusing on each breath is a helpful distraction to uterine contractions,” Ross says.
Some patients may even benefit from taking things a step further and combining breathing exercises with mind-body relaxation techniques to promote a calm state of mind, Castellanos says.
“Being calm between contractions to rest and regroup is essential,” Castellanos adds. “Laboring with your mind, body and heart can give you the peace needed to move forward.”
Sttill, because getting to a state of calmness can be easier said than done — especially during great pain — it is important to practice techniques beforehand.
Some practices that Castellanos recommends include:
— Practicing low, deep breathing exercises
— Listening to calming, personal music
— Visualizing positive imagery
— Thinking about, or keeping with you, memorable items
— Thinking about inspirational mantras
In addition to your individual prep work, Castellanos suggests establishing a support team to uplift you during your birthing experience. A support team can consist of family, friends, loved ones or professionals who can offer you encouragement, a quiet presence and respect on your day, she says.
[READ: Natural Ways to Induce Labor: What Experts Recommend]
Birth plans for labor preparation
Another way to prepare for the emotional and physical toll of labor is to create a birth plan. Also referred to as “birth preferences” or “birth day wishes,” a birth plan can be a simple one-page document that describes your ideal birth experience.
This can include things like:
— If you do or do not want an epidural
— If you do or do not want IV medication
— If you do or do not want other medications or pain remedies
— If you do or do not want a certain person in the room with you
— Other requests related to the room you are in, such as dimmed lights or blankets
— Other requests related to the birthing experience
Ideally — and so long as it is readily accessible and easy to read — your provider will follow your birthing plan to the best of their ability. However, sometimes day-of circumstances may require them to stray from the plan for the safety of you and your baby. You are also free to change your mind about your plan during labor, should you feel differently in the moment.
Ross encourages patients to keep an open mind to the unexpected. “Staying relaxed, calm and not following a preconceived labor ‘agenda’ supports the laboring process and minimizes stress and disappointment,” she says.
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Early Labor Signs and Symptoms originally appeared on usnews.com
