Many pregnant women experience abdominal cramping and wonder if this means their cervix is dilating and labor is starting. Cramping can occur for various reasons during pregnancy, and only sometimes is it associated with dilation. This article will explore the causes of cramping in pregnancy, how to differentiate between normal cramping and possible dilation, and when to contact a medical provider about cramping symptoms.
What causes abdominal cramping in pregnancy?
There are several common causes of benign cramping during pregnancy unrelated to cervical changes:
Round ligament pain
The round ligaments are bands of tissue that run from the sides of the uterus down into the groin. As the uterus grows rapidly during pregnancy, it can put tension on these ligaments leading to occasional cramping sensations on one or both sides of the abdomen. This type of cramping tends to be episodic and feel stabby or achey.
Gas and bloating
Intestinal gas and bloating are very common during pregnancy due to hormone changes slowing down digestion. The growing uterus also physically crowds the digestive tract. This can manifest as mild diffuse cramping or sharp localized pains when gas bubbles get temporarily stuck.
Braxton Hicks contractions
Braxton Hicks contractions are episodes of tightening and cramping of the uterine muscle. They are sometimes called “practice contractions” as they prepare the uterus for true labor. However, unlike true contractions, Braxton Hicks are sporadic and do notProgressively increase in strength or frequency.
Urinary tract infections
Pregnant women are at increased risk of urinary tract infections (UTIs) that can cause pelvic pain and cramping, especially with urination. UTIs require medical treatment with antibiotics.
Constipation
Constipation is another common pregnancy complaint. In addition to abdominal discomfort, some women experience cramping with bowel movements when straining to pass hard stools. Staying hydrated and eating enough fiber can help reduce constipation.
When might cramping indicate labor is starting?
While the above causes of cramping are benign, sometimes persistent cramping can signal preterm or term labor. Signs that cramping may be linked to early cervical changes and dilation include:
Timing and duration
Labor-associated cramping tends to come and go in a rhythmic pattern, lasts 30 seconds or more, and increases in frequency and intensity over hours to days as labor progresses. Benign cramping is more random, sporadic, and short-lived.
Additional symptoms
Cramping from labor is often accompanied by other signs like low back pain, pelvic pressure, bloody mucus discharge, diarrhea, and warm sensations in the pelvis or upper legs.
Change with position
Getting up and moving around tends to intensify real labor cramping, while improving benign cramping.
Preterm
Any persistent cramping before 37 weeks pregnancy should be evaluated quickly to rule out preterm labor.
How and when does the cervix dilate?
To understand how cramping relates to dilation, it helps to first review some key facts about the cervix and its changes leading up to delivery:
Location and structure
The cervix is the lower part of the uterus that protrudes into the top of the vagina. It is normally closed and rigid, with an opening about the size of a pinhole.
Effacement
In the weeks before labor, the cervix starts to thin out in a process called effacement. It goes from being 2-3 cm long early in pregnancy down to paper thin at full effacement. This prepares the cervix to dilate.
Dilation
Dilation refers to the opening of the cervix from 0-10 cm to allow the baby to pass through the birth canal. Early labor dilation is slower from 0 to 6 cm. Active labor progresses more rapidly from 6 to 10 cm right before delivery.
Timing
For first pregnancies, the cervix often does not start dilating until contractions are regular and intense. In subsequent pregnancies, it can begin dilating weeks ahead of full labor.
What degree of dilation is associated with cramping?
Here is an overview of how cervical dilation typically correlates with cramping sensations:
Early labor: up to 6 cm dilation
The cervix gradually opens from 0 to 6 cm in early labor. Contractions may initially be 20-30 minutes apart, becoming closer together and more intense over time. Cramping is typically mild and felt low in the abdomen or like menstrual cramps.
Active labor: 6 to 10 cm dilation
From 6 cm onward, contractions are strong, frequent, and rhythmic, coming every 3-5 minutes and lasting 60-90 seconds. Cramping significantly intensifies as the cervix dilates fully to 10 cm. Pain is often focused in the lower back and radiates around to the abdomen.
Transition: 8 to 10 cm dilation
The most intense cramping is typically felt in late active labor as the cervix dilates from 8 to fully 10 cm. Contractions last 90+ seconds and come as frequently as every 2 minutes. Many women report shaking, chills, nausea, and the urge to push at this point.
Second stage labor: 10 cm dilation
After the cervix is fully open to 10 cm, cramping may decrease in between contractions. Pushing urges become very strong with immense rectal pressure. Cramping flares again while bearing down with each contraction.
How can you tell if cramping is causing dilation?
It can be challenging to determine if cramping sensations are actually connected to progressive cervical changes, especially in early labor. Here are some ways to assess if persistent cramping likely indicates dilation is occurring:
Monitor contraction pattern
Time how often cramping episodes occur and how long they last. If a predictable pattern emerges that intensifies over time, it likely represents productive contractions.
Note baby’s movements
Decreased fetal movement may indicate a tightening uterus with dilation.
Check any discharge
Pink or bloody mucus discharge can mean the cervix is dilating and effacing.
Feel your cervix
Your provider can check if the cervix is softening, thinning, and beginning to open.
Monitor for other labor signs
Cervical change often coincides with ruptured membranes, pelvic pressure, and increased vaginal discharge.
Get checked for preterm labor
If cramping emerges before 37 weeks, get evaluated for possible preterm dilation.
When to call your provider about cramping and possible dilation
Contact your healthcare provider right away if you experience any of the following:
- Persistent or worsening cramping before 37 weeks gestation
- Regular contractions every 5-10 minutes that don’t subside with hydration and rest
- Unusual vaginal discharge or unexplained bleeding
- Cramping accompanied by pelvic pressure, low back pain, or change in vaginal discharge
- Sudden intense or unbearable abdominal pain
- Difficulty walking or changing positions due to pain
- No fetal movement felt after cramping episodes
- Sudden gush or continuous leaking of fluid from the vagina (possible rupture of membranes)
- Fever, chills, vomiting, or other concerning symptoms along with cramping
Prompt evaluation for possible labor or other complications is recommended in these scenarios.
How healthcare providers check for dilation
If you go to your provider’s office or the labor and delivery triage unit with cramping, they will perform an exam to evaluate whether your cervix is dilating. Methods may include:
Visual inspection
Your provider looks at the cervix with a speculum to see if the opening appears to be enlarging.
Cervical exam
Using gloves, your provider inserts 1-2 fingers through the vaginal canal and gently palpates the cervix to feel if it is softening, thinning, or beginning to open.
Measuring dilation
Dilation may be quantified by noting how many finger tips can fit through the cervical os – 1 cm of dilation approximately equals the width of one fingertip.
Monitoring contractions
Your provider may hook you up to an external fetal monitor or internal contraction monitor to see if cramping correlates with measurable uterine tightenings.
Ultrasound
Transvaginal ultrasound can visualize cervical length and funneling of the membranes into a dilating os.
Ways to cope with cramping in early labor
If cramping is determined to be early labor but not yet time to go to the hospital, here are some ways to manage the discomfort until active labor begins:
- Take a warm bath or shower
- Use heat packs on the lower abdomen or back
- Practice slow controlled breathing and relaxation techniques
- Distract yourself by walking, swaying, or bouncing on an exercise ball
- Stay well hydrated by sipping water or electrolyte drinks
- Eat small light snacks to keep up your energy
- Listen to music, meditate, or practice your focal point for labor
- Use a birthing ball for pelvic rocking or circling motions
- Take acetaminophen if approved by your provider to take the edge off
- Rest and nap between contractions to conserve energy
Having a support person provide comforting touch, encouragement, and distraction can also be very helpful.
When to go to the hospital or birth center for cramping
You should plan to go in for professional evaluation if you have any of the following:
- Contractions 5 minutes apart or less that do not subside with positioning changes
- Persistent strong contractions for 1-2 hours that take concentration to breathe through
- Sudden blood-tinged vaginal discharge (“bloody show”)
- Rupture of membranes confirmed by obvious leakage of fluid from the vagina
- Need to vocalize through contractions or inability to talk during them
- Shaking, chills, and nausea between contractions
- Strong and irresistible urge to push or bear down with contractions
These are signs that active labor is likely underway and you should be evaluated for cervical change. Call ahead so your birth team is ready when you arrive.
Conclusion
In summary, abdominal cramping during pregnancy has many causes – some benign and others indicating possible cervical change. Persistent rhythmic contraction-like cramping that grows stronger and more frequent over hours to days, especially along with other labor signs, warrants evaluation for possible dilation. Stay in touch with your healthcare provider about any concerning cramping symptoms in pregnancy so progression to active labor can be appropriately monitored and managed.