Crazy Cramps

What Do They Mean?


Let's talk about cramps. You thought you'd leave those suckers behind for nine months once you got pregnant. You figured you'd have a bunch of big whoppers when you went into labor but other than that, you'd be cramp-free. Along with no period, isn't that supposed to be one of the perks of pregnancy? But then you notice some twinges. A little aching that comes and goes. Maybe you're just a few weeks along and worried there's a miscarriage coming. Maybe you're in your second trimester and worried it's preterm labor. And then there are those you'll get in your last month that will drive you crazy because you'll wonder, "Is this labor?" Darn cramps—they're such a pain in the...ehem, uterus.

But what do they mean? Oh so many things, ladies. Britte wrote this week and says she's about six weeks along, has had a previous miscarriage and is having cramps off and on during the day and a little worse at night. These episodes last about five minutes. Of course, Britte's worried this may signal another miscarriage. She's not spotting or bleeding, didn't mention any other health concerns and has an appointment with her doctor soon. Her doctor may order a blood test to confirm she has a high HCG level (the hormone that indicates pregnancy). At six weeks, it's a little too early to see much on an ultrasound. Assuming she's not miscarrying (and I know, Britte, that's hard to do considering your past experience), the cramps she's feeling are probably due to the growth of a healthy pregnancy. Her uterus is busy growing a placenta and amniotic sac and filling it with fluid. It's getting that baby all settled in to its endometrial lining and starting to stretch and grow as a muscle. Though most women don't feel uncomfortable during this stage, others have extremely sensitive uteruses and feel a lot.

Women in their second trimester often feel mild cramps or aching as the uterus grows and the muscle fibers stretch. Mild contractions (that most don't feel but some do), sometimes called Braxton Hicks, are the uterus' way of flexing its muscles, getting strong and ready for its big job: labor. Most of us feel more cramps, contractions, aches and pains at night when we've settled down for the night. That might be because babies tend to exercise more at night when the uterus isn't bouncing around with mom's activities. They figure it's their playtime. We're also more likely to notice our uterus' business because we're just lying there doing nothing.

Lots of women have mild contractions after having sex. Most of the time that's nothing to worry about. Orgasms cause uterine contractions whether we're pregnant or not. Even if you don't reach orgasm, your uterus might act up a little after being poked and prodded.

Those late pregnancy cramps are a lot of trouble but are doing important work. Women who've never been through labor before wonder if "this is it." They've been told to expect contractions at a regular duration that are more painful than menstrual cramps and get stronger over time. So, they have cramps for a few hours and decide, "Yep, this must be labor." Then they take a bath or go for a walk and they go away. Or worse, they hop in the car (dragging their anxious partner and all their gear with them), drive to the hospital, get hooked up to a bunch of monitors only to find out it's "nothing."

It's not really "nothing." It's exercise and pre-labor work. We call it prodromal labor. Your uterus has a lot to do to prepare for labor. It has to squeeze that baby's head down into the birth canal. It has to start thinning out that cervix so it can eventually dilate. The cervix is one tough little sphincter and since it's job has been to squeeze tight for all these months to make sure that baby stays in, some are a little resistant to the idea of letting that baby out. It takes a lot of contractions for it to get the right idea that, "Oh, OK, we're done here. Time to open up for business and produce this kiddo."

When I was pregnant with my first and she was two weeks late, my husband and I spent hours timing contractions and writing them down. They were uncomfortable, tight and exhausting. They had to be labor, right? Wrong. Night after night they'd hit a rhythm and go nowhere. In hindsight, I don't know why we felt so compelled to document all these contractions. It's not like we were going to miss it when labor really kicked in. It was just something we'd learned in Lamaze class, probably to keep us busy until things got moving. Our time would have been better spent getting whatever shut-eye we could manage, considering how uncomfortable I was. Once labor is really happening, you won't be calling them cramps anymore. Oh no; no doubt about it, they're way more than cramps. Hypnobirthers call them surges. Consider these dictionary definitions of "surge:" The motion of, or produced by, a great wave. A period of intense effort. A sudden, transient increase or oscillation in electric current or voltage. Yeah, that's about right. These suckers are strong. Strong enough to squeeze a big ol' baby out. They leave no room for doubt. When they tell you, "you'll know," it's true: You'll know a labor contraction when you feel one.

Britte, I hope, hope, hope for you that these cramps are the good kind indicating your pregnancy is healthy and strong. For those of you wondering what the heck is going on, follow these guidelines: Though most cramps are just part of the deal, some do indicate trouble. Let your practitioner know about them. If there's a lot of pain, they don't go away or there's any leakage of blood, fluid or mucous, tell your practitioner. If your baby's not moving normally, make that call. Most likely, you'll be reassured that "it's nothing." Yeah, right...nothing.

Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.