How to manage Braxton Hicks contractions?

Management of Braxton Hicks Contractions

Braxton Hicks contractions should be managed primarily with non-pharmacological interventions including hydration, rest, and position changes to reduce discomfort and frequency of contractions.

Understanding Braxton Hicks Contractions

• Braxton Hicks contractions are normal physiological uterine contractions that typically begin in the third trimester of pregnancy 1
• They represent a process of increasing coordination of uterine activity as pregnancy progresses toward delivery 2
• These contractions may impact fetal wellbeing, with studies showing changes in fetal heart rate parameters during contractions 1, 3

Effects on Maternal-Fetal Circulation

• During Braxton Hicks contractions, there is a considerable increase in resistance to blood flow in the uteroplacental circulation 4
• Research shows increased pulsatility index in uterine arteries during contractions (from 0.71 to 1.14) 4
• Studies have demonstrated slight but significant decreases in fetal brain and liver T2* measurements during contractions, suggesting temporary changes in fetal oxygenation 5
• Maternal perception of Braxton Hicks is associated with higher fetal heart rate, lower long-term variability, and reduced number of accelerations on computerized cardiotocography 1

Non-Pharmacological Management

• Hydration: Increase fluid intake, as dehydration can trigger or worsen Braxton Hicks contractions 6
• Position changes: Change positions when experiencing contractions; moving from standing to sitting or lying down may help relieve discomfort 6
• Rest: Take breaks and rest when experiencing frequent contractions 6
• Warm water therapy: A warm (not hot) bath or shower may help relax the uterine muscles and provide pain relief 6
• Physical counterpressure maneuvers: For contractions associated with presyncope symptoms, lower-body maneuvers such as leg crossing with muscle tensing may be beneficial 6

When to Seek Medical Attention

• Seek immediate medical attention if:
  • Contractions become regular, painful, and increase in frequency and intensity 7
  • Contractions are accompanied by vaginal bleeding 7
  • There is leaking of amniotic fluid 7
  • Persistent dizziness or faintness occurs 7
  • Severe pain develops that is not relieved by position changes or rest 7

Pharmacological Management

• Pharmacological interventions are generally not recommended for Braxton Hicks contractions 7
• If medication is deemed necessary for severe discomfort, consult with obstetric specialists to weigh risks and benefits 7
• Muscle relaxants should be avoided during pregnancy, especially in the third trimester 7
• If muscle relaxation is absolutely necessary, certain beta-blockers with selective β1 properties may be safer options, with metoprolol preferred over atenolol 7

Preventive Measures

• Maintain adequate hydration throughout the day 6
• Avoid physical overexertion and take regular rest periods 7
• Practice proper body mechanics and ergonomic adjustments to reduce musculoskeletal strain 7
• Consider appropriate exercise programs such as swimming or aquafit, which are associated with less risk of falling 7