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Recognising Contractions — Braxton Hicks, Lightening and Real Labour

“Is this a contraction?” Nearly every pregnant person asks this. Here is your calm, evidence-based guide: which type of contraction is which, how they feel, and when it is actually time to go.

Evidence-basedUpdated: April 2026
Table of Contents

The four types of contractions

Contractions are not all the same. The uterus tightens from early pregnancy — most contractions you don’t even feel. Four types matter in the third trimester and around birth.

Braxton Hicks — from week 20

  • Irregular, usually painless or mildly uncomfortable
  • Short, about 20–60 seconds
  • Belly tightens briefly, then softens
  • Do not get stronger or more frequent
  • Ease with rest, water, changing position
  • Train the muscle, do not open the cervix

Lightening contractions — last 2–4 weeks

  • Pulling in the lower belly, often downward and into the groin
  • More frequent than Braxton Hicks but still irregular
  • Belly visibly drops, breathing easier, more bathroom trips
  • Position the baby — not the start of labour
  • In later pregnancies often right before birth; in first-time mothers 2–4 weeks earlier

Pre-labour contractions — the last days

  • Period-like pulling in lower belly and back
  • More rhythmic than lightening, not yet regular
  • 30–60 seconds
  • Often at night, quieter by day
  • Ripen the cervix — softer and shorter
  • Typically fade with a warm bath or rest

Labour contractions — this is it

  • Regular and getting more frequent over time
  • Get longer and stronger — not weaker
  • 45–90 seconds, eventually every 3–5 minutes
  • Wave-like pain, often starting deep in the lower back and wrapping around
  • Do NOT ease with position change, rest, or a warm bath
  • Often with show (bloody mucus) or water breaking

Practice or real? How to tell them apart

The German DGGG, ACOG and WHO describe three simple distinguishing markers that help at home.

The 3-question check

  1. Timing: regular and getting more frequent? (yes = likely labour)
  2. Intensity: growing stronger, not weaker? (yes = likely labour)
  3. Reaction: do they ease with a warm bath, water, position change? (yes = practice/lightening/pre-labour)

The 5-1-1 rule

The 5-1-1 rule is the international standard (ACOG, NICE, DGGG) for first-time mothers with an uncomplicated pregnancy to go to the hospital:

  • 5 — contractions every 5 minutes
  • 1 — each lasts at least 1 minute
  • 1 — for at least 1 hour
  • For subsequent births go in earlier (often 7-1-1 — labour tends to be faster)
  • For risk pregnancies, long drive, or after caesarean — call earlier

Red flags — go now

Whether contractions or not: with the following signs the 5-1-1 rule no longer applies — go to the hospital or call emergency services immediately.

Hospital now — or 911

  • Fresh bright-red vaginal bleeding — more than just show
  • Water breaking with green, brown or foul-smelling fluid
  • Clearly reduced or absent fetal movement in the past 2–4 hours
  • Constant abdominal pain that does not wave (possible placental abruption)
  • Severe headache, vision changes, nausea, upper abdominal pain (possible pre-eclampsia)
  • Fever over 38 °C in pregnancy
  • Regular contractions before 37+0 weeks — possible preterm labour

Coping with contractions — pain management

The WHO, NICE and DGGG vaginal birth guidelines treat pain relief as a human right — the best option depends on stage, preferences and clinical status. A good mix often wins.

Non-medical strategies

  • Breathing (deep exhale, 4-7-8)
  • Movement: walking, bouncing on a birth ball
  • Warm water: shower, tub, water birth
  • Counterpressure on the sacrum by partner / doula
  • TENS unit — evidence-based in early phase
  • Massage, labour-safe aromatherapy
  • Hypnobirthing, visualisation
  • Music, dim light, familiar environment

Medical options

  • Nitrous oxide (N2O) — fast, short-acting, minimal baby impact
  • Opioids (e.g. piritramide, meptazinol) — strong pain relief, avoided close to pushing
  • Epidural — most common regional method, very effective
  • Spinal — mainly for caesarean
  • Combined spinal-epidural (CSE) — benefits of both

Before you set off to hospital

Calm check

  • Quiet trip to the bathroom
  • Water, a small snack
  • Call the hospital and describe timing
  • Grab birth plan and records
  • If possible: 30 minutes of breathing and movement first
  • If stable: head in — don’t drive yourself

And most importantly: trust your gut. You can always call and say “I’m not sure, I’d rather come in.” No midwife and no hospital will lecture you. Better one unnecessary trip than one too late.

Frequently Asked Questions

What do real contractions really feel like?
Like a wave starting deep in the lower back and wrapping around to the front. The belly becomes board-hard. Between waves it softens and you can breathe. They get longer, stronger, more regular.
When are Braxton Hicks normal?
From week 20. Before week 37 they should be rare, irregular, painless and easily stopped by rest. More than 4 contractions per hour before week 37 — call the hospital.
How do I tell lightening from real labour?
Lightening is irregular, pulls downward, eases with rest, doesn’t intensify. Real labour is regular, stronger, persists with rest.
What is the mucus show?
A dislodged mucus plug with light bloody streaks — a sign the cervix is changing. Labour may still be hours or days away.
Water breaking — what now?
Note colour and smell. Clear = usually fine, record time and call the hospital. Green, brown or foul = go now. If baby’s head isn’t engaged: lie down and call emergency services (cord prolapse risk).
How long does a first labour last?
Median is about 8–12 hours of active labour in first-time mothers; 6–24 hours is considered normal. Later births often just 5–8 hours.
Can contractions be only in the back?
Yes — “back labour”, often when baby faces posterior. Usually constant lower back pain even between contractions. Position changes (hands and knees, side lying) help a lot.
When should second-time mothers go in?
Earlier — at 7-1-1 or when contractions are regular and unmistakable. Subsequent births are usually much faster.
What helps with contractions naturally?
Breathing, movement (birth ball, walking), warm water, sacral counterpressure, TENS in early labour, warm compresses — evidence-based per WHO and Cochrane.
When is it preterm labour?
Regular contractions or waters breaking before week 37+0. Always go in now — modern care can often delay birth and support lung maturity.
Can sex trigger labour?
Theoretically yes (prostaglandins, oxytocin), practically only when the cervix is already ripe — near due date. With an uncomplicated pregnancy sex is fine; with preterm labour or cervical issues, not.
I’m past my due date. When is induction?
Most hospitals start extra monitoring at 41+0 and suggest induction between 41+3 and 42+0. ACOG and DGGG recommend induction by 42+0 at the latest to lower infant risk.

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Unsure whether to go in?

Our AI answers your question instantly — or connect with other mothers. For medical decisions always call your midwife or the hospital.

This guide does not replace medical care. For bleeding, green amniotic fluid, clearly reduced fetal movement, persistent headache or vision changes, severe abdominal pain unrelated to contractions, or anything that feels wrong — call the hospital or emergency services immediately. Trust your gut.