What Causes False Pains During Pregnancy
"False pains" during pregnancy—commonly called Braxton Hicks contractions—are caused by irregular, non-progressive uterine contractions that do not lead to cervical dilation, distinguishing them from true labor contractions. 1
Primary Mechanisms of False Labor Pains
Uterine muscle activity without cervical change is the hallmark of false labor. These contractions result from:
- Hormonal fluctuations throughout pregnancy that trigger uterine muscle activity without the coordinated pattern needed for true labor 1
- Physical stretching of the uterine muscle as the fetus grows, particularly in the second and third trimesters 1
- Uterine irritability from dehydration, full bladder, or increased physical activity 1
The key distinction from true labor is that false pains lack the progressive pattern of increasing frequency, duration, and intensity that causes cervical dilation 2.
Distinguishing Features
False labor contractions have specific characteristics that differentiate them from true labor:
- Irregular timing and intensity: Contractions do not follow a predictable pattern and may stop with rest or position changes 1
- Location: Pain is typically felt in the lower abdomen and groin rather than starting in the back and radiating forward 2
- No cervical change: Unlike true labor, these contractions do not cause progressive cervical effacement or dilation 2
Other Common Causes of Non-Labor Pain During Pregnancy
Musculoskeletal pain is extremely common, occurring in up to two-thirds of pregnancies, with prevalence peaking in months 6 and 7 of gestation 3. This results from:
- Joint laxity from pregnancy hormones causing reduced ligament rigidity and weakening joint stability 3
- Biomechanical changes from increased abdominal mass and shifts in the center of gravity 3
- Postural adaptations that place stress on the spine and supporting structures 3
Round ligament pain occurs from stretching of the ligaments supporting the uterus, causing sharp, brief pains in the lower abdomen or groin 1.
Critical Warning Signs Requiring Immediate Evaluation
Certain pain patterns indicate serious pathology and must not be dismissed as false labor:
- Severe pain exacerbated by fetal movement can be an early sign of uterine rupture and requires emergency evaluation 4
- Persistent, severe abdominal pain with vaginal bleeding, fever, or hemodynamic instability suggests placental abruption, ectopic pregnancy, or other emergencies 5
- Pain accompanied by regular contractions before 37 weeks may indicate preterm labor requiring immediate assessment 2
Common Pitfalls to Avoid
Do not assume all non-progressive contractions are benign. While most false pains are harmless, failing to evaluate persistent or severe symptoms can delay diagnosis of serious conditions 5.
Underreporting is common: Women often don't report these symptoms to prenatal providers, leading to insufficient clinical attention when evaluation is actually needed 3.
Dehydration and bladder distension are frequently overlooked triggers that can be easily addressed with increased fluid intake and regular voiding 1.