“How will I know…?” The experts weigh in on contractions, labor, and birth.

We all face a looming, life-changing event at end of pregnancy – a new baby. Yay!

But before we get to the beautiful moment of meeting our child, we first must face the big unknowns of the third trimester:

Was that a contraction? What will a labor contraction feel like? What will a Braxton Hicks contraction feel like? How are Braxton Hicks contractions and labor contractions even different? How will I know when I am in labor?

Yikes!


Contractions, labor, birth – entering the mysterious world of your third trimester

When I was pregnant with my first child, I soaked up everything I could possibly learn about contractions and labor. I took the classes, I read the books, I talked to friends.

After I had my own birth story, my own labor story, my own contraction story, I realized something: the third trimester remains mysterious because everyone is different, every birth story is different, every labor is different, everyone’s contractions are different.

Yes, I know that isn’t helpful for you, dear pregnant friend – after all, you don’t know your birth story, your labor story, or your contraction story – so I gathered up our friends from the birth community to answer a few questions and help guide you through the mysterious third trimester.

We chat with Felicia (our favorite birth doula), Jessica (a kickass midwife), Kirti (a rockstar Ob/GYN), and Tracy (a birth educator, doula, midwife, do-it-all!)


How do you answer “what does a contraction feel like?” for moms-to-be?

“Usually a contraction is described as an uncomfortable tightening sensation that may begin in the back and wrap around to the front of the abdomen or just in the uterus/front of the abdomen that gradually intensifies and then climaxes and peaks with a pressure felt down in the lower pelvis/vaginal area at which point it lessens and goes away. It can be described as a menstrual cramp only a lot stronger.”  – Jessica Haag, Certified Nurse Midwife

“Contractions feel like very strong, very painful menstrual cramps. You’ll notice your belly (the uterus) gets very firm and rounded like a basketball.” – Kirti Patel, OB/GYN

“A contraction is not an isolated sensation. It is a fuller experience than just cramping. It’s a combination of pressure and squeezing and back pain. Leg cramps that a lot of women experience are way worse than any contraction she will ever have. There is a violence to those leg cramps that is not existent in labor contractions. Labor contractions are gentle building and gentle receding with an intense peak. I know without a shadow of a doubt that women can handle the pain of labor, as it is not designed to be more than we can bear. What is in question is for how long can she bear it.” Felicia Roche, birth doula


How do you describe the difference between a Braxton Hicks contraction versus a labor contraction?

Braxton Hicks contractions are usually irregular and don’t settle into any kind of pattern. They can be set off by doing too much, being dehydrated or they may simply be your clever body’s way of helping to shift your baby into a better position before labor. Some moms experience regular Braxton hicks in the third trimester when the bump turns to a basketball (rock hard) and is accompanied by a tightening feeling. The real deal will generally become more regular and settle into a pattern. They may increase in intensity and require more focus (Braxton Hicks can feel quite strong too)” – Tracy Donegan, Birth Educator, Founder of GentleBirth

“A Braxton Hicks is usually painless tightening that is irregular and infrequent.  They are more of an annoyance and may or may not be noticeable. A labor contraction effects change to the cervix and therefore is more intense. I usually say, ‘you will know because it will be a totally new sensation and if it is truly labor those waves will not go away totally but will increase in frequency and intensity.’ Also important to note that fetal movement can be misinterpreted as a contraction.” – Jessica Haag, CNM

“Braxton Hicks contractions are painless tightenings of your uterus, while labor contractions are painful tightenings. It’s hard to know what’s “painful” because it’s relative, but if it catches your breath or you can’t comfortably speak through them, it’s probably the real deal.” – Kirti Patel, OB/GYN


How do you know when a mom is in labor?

“Doctors typically regard active labor as “regular contractions accompanied by cervical change”. So, if on an hourly or near-hourly basis your cervix is changing, we consider you in active labor.” – Kirti Patel, OB/GYN

(Note: leave this one to the experts, girls, only your health care provider can check your cervix)

It’s not unusual for a first time mom to experience warm-up-like sensations for more than 24 hours as labor gets underway but if you’re unsure try the following:

• Have something to drink – warm ups can be caused by dehydration.

• Empty your bladder – a full bladder can sometimes bring on warm ups.

• Change position or take a walk – true labor will continue through position changes.

If you’ve been overdoing it lie down and rest – true labor will continue when resting.” – Tracy Donegan, Birth Educator

“For every woman it is different in timing and sensation and for each pregnancy as well. Really talking to the woman, sometimes at several points in time during the process of early labor vs active labor is necessary to truly know when to go to the hospital and then when or if to admit the patient.  There is somewhat an art to it and sometimes we aren’t always right. However, if the woman is experiencing regular, consistent waves that have gotten more intense and closer together for at least a couple of hours, it is worthy of an evaluation. Cervical exams are not always very telling but can be helpful.” – Jessica Haag, CNM

“The only true sign that a mom is in labor are contractions that are progressing. She can have contractions every 10 minutes for weeks/months. It’s when they are on the move from 10 minutes to 9 minutes to 8 minutes that are also causing cervical dilation. Unfortunately some women become prodromal and this can be very frustrating and defeating. Real contractions that progress in intensity and frequency but cause no dilation. So it’s a combination of frequency, intensity and dilation.” – Felicia Roche, birth doula


Are there other signs of labor that you often look for?

“Yes there are. Things like bloody show or loss of mucous plug can indicate cervical change and therefore labor coming on or happening. Water breaking is not a sign of labor but can indicate labor may be starting within 24 hours or if the woman already has started with contractions may mean labor is more active or will be. The woman being nauseous or throwing up or shaky or turning inwards/personality changes can be signs of transition and active labor/proximity to delivery. These are valuable because they are all part of the bigger picture and the woman’s experience as a whole of labor and delivery. It is not merely contractions but the body doing all of these things intricately and together to ultimately help the baby be born.” – Jessica Haag, CNM

“Yes. Other things that doctors look for are a “bloody show” (which indicates the cervix is softening and starting to dilate), breaking your water, and descent of the baby’s head in the birth canal. Sometimes patients don’t meet the “regular contractions and cervical change” criteria exactly and these other factors help us decide if it’s the real deal and not just false labor.” – Kirti Patel, OB/GYN

“Yes, there are a potential of four bodily fluids and I like to see three of them to confirm that labor is ‘active’ – And when they ask what those are, my answer is ‘You’re not going to like them’: 1. Amniotic fluid   2. Blood (bloody show)   3. Vomit   4. Tears   (Profound shaking can take the place of one of the bodily fluids.)” – Felicia Roche, birth doula


Did you follow this advice/pattern when you were in labor?

“I knew nothing about labor when I was in labor. I just knew that I would rely on those around me to help me. I instinctively knew I could not do it alone. My labor was very unusual from the standard/normal labor but in a very good way. But it did prepare me to know that labors can take on many patterns and still be normal and ANYTHING can happen and labor changes on a dime.” – Felicia Roche, birth doula

“With my first child, I was induced due to low amniotic fluid and received pitocin for an entire day and didn’t progress beyond 2 cm despite hours of contractions every 2 minutes. I was in a lot of pain but didn’t think of asking for an epidural because I didn’t fit the usual criteria for “active labor”, so I tried to silently suffer it out. Finally, my OB at the time ended up recommending an epidural anyway, at 2 cm, late in the afternoon after an entire day of pitocin.

Strangely enough, the epidural helped to relax me so much that I was fully dilated and had my daughter an hour and half later! I learned from that experience to sometimes give epidurals early in patients I’m inducing, especially if they are having regular, strong contractions and it seems like nothing is happening even after many hours.  I now tend to think labor goes best if you can be both mentally and physically relaxed during it.

For my second child, I went into labor on my own, waited it out at home a little bit, and went in once I knew they were painful and regular.  It happened pretty quickly.  I was about 4-5 cm when I went in, got my epidural, and had my son a few hours later.  It was a much easier experience than the first time, partly because I knew exactly what it felt like. Both of these experiences has really helped me understand what my patients are going through, anticipate their concerns, and be a better doctor.”  – Kirti Patel, OB/GYN

“There is the whole “5-1-1” rule or variations of it stating contractions every 5 minutes lasting one minute each for at least an hour to then call the provider or be seen. This is a very vague piece of advice and does not really apply to everyone in labor or most in labor. When I was in labor, I had had two nights of prodromal labor so I was doubtful I was actually progressing but it was the intensity of the contractions and ultimately the regular pattern and increase in pressure that made me take pause and start to really pay attention to what was happening in my body. I think that is the most important message for women is to really listen to their bodies and what is going on as a whole with the cramping/wave sensations being contractions that are creating pressure and baby moving down and cervical change and discharge and the whole physical and mental and emotional work that it all is.” – Jessica Haag, CNM

“I had regular warm ups in the lead up to Cooper’s birth – although uncomfortable it gave me a great opportunity to practice my breathing techniques and GentleBirth training. On my son’s birth day it was obvious that the tightenings I was experiencing were growing more intense as the hours passed and required more focus and I began to experience more reliable signs of labor (birth show).” – Tracy Donegan, Birth Education

About the Author

Molly leads Content and Community at Bloomlife and edits the Bloomlife newsletter. She likes to puts her PhD in Physiology to good use by digging into the scientific literature to share fun facts about pregnancy and parenting along with a few busted myths backed by solid research studies. Yay science!

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