Labour Contractions – Types, Causes & Pain Relief
Labour contractions are rhythmic tightenings of the uterus that initiate and drive the birth process. They are a natural part of childbirth.
Things worth knowing about "Labour contractions"
Labour contractions are rhythmic tightenings of the uterus that initiate and drive the birth process. They are a natural part of childbirth.
What Are Labour Contractions?
Labour contractions are rhythmic, involuntary tightenings of the uterine muscle. They play a central role in the birthing process by helping to open the cervix and push the baby through the birth canal. Contractions can take various forms – from harmless practice contractions during pregnancy to the intense contractions experienced during active labour.
Types of Contractions
Braxton-Hicks Contractions (Practice Contractions)
These so-called practice contractions can occur from mid-pregnancy onwards. They are generally irregular, relatively painless, and help prepare the uterus for labour. They do not cause the cervix to dilate.
Lightening Contractions
Lightening contractions occur shortly before labour begins and cause the baby to drop lower into the mother's pelvis. This can relieve pressure on the diaphragm but increase pressure on the bladder.
Cervical Dilation Contractions
Dilation contractions mark the beginning of the active phase of labour. They become increasingly regular, stronger, and more frequent over time. Their goal is to fully dilate the cervix to approximately 10 centimetres.
Pushing Contractions (Expulsive Contractions)
Pushing contractions occur during the expulsive phase of labour, once the cervix is fully dilated. They are particularly intense and encourage the mother to push actively in order to deliver the baby.
Afterbirth Contractions (Afterpains)
After the birth of the baby, afterbirth contractions help expel the placenta and close the blood vessels of the uterus to prevent excessive bleeding.
Causes and Triggering Factors
The exact mechanism that triggers labour is complex and not yet fully understood. The following factors play an important role:
- Hormonal changes: An increase in oxytocin and prostaglandins promotes uterine contractions.
- Stretching of the uterus: As the baby grows, the uterine muscle stretches, increasing its sensitivity to contraction-stimulating hormones.
- Signals from the baby: Hormonal signals from the baby itself contribute to the onset of labour.
- Cervical ripening: The softening and ripening of the cervix is an important precursor to the onset of labour.
Symptoms and Recognising True Labour
True labour contractions can be distinguished from Braxton-Hicks contractions by the following characteristics:
- Regularity: The intervals between contractions become progressively shorter.
- Increasing intensity: Contractions become stronger and last longer.
- Location: Pain often begins in the lower back and radiates to the abdomen.
- No relief with movement or change of position.
- Associated signs such as the loss of the mucus plug or rupture of membranes may occur.
Diagnosis and Monitoring
During labour, contractions are monitored using a cardiotocograph (CTG). This device simultaneously records the baby's heart rate and the mother's uterine activity to ensure the safety of both mother and child. In addition, the progress of labour can be assessed through vaginal examinations.
Treatment and Pain Relief
There are various options for managing labour pain:
Non-pharmacological Methods
- Breathing techniques and relaxation exercises
- Heat application (e.g. warm baths, heat packs)
- Movement and specific body positions
- Massage and acupuncture
- Water birth
Pharmacological Methods
- Epidural anaesthesia: A commonly used form of regional anaesthesia that effectively relieves pain without affecting consciousness.
- Opioids: Pain-relieving medications such as pethidine may be used under medical supervision.
- Nitrous oxide (laughing gas): Available in some hospitals as an inhaled pain relief option.
Labour Induction and Tocolysis
In certain medical situations, it may be necessary to artificially induce labour (e.g. in cases of post-term pregnancy or premature rupture of membranes). This is commonly done using oxytocin or prostaglandins. Conversely, in cases of preterm labour, tocolytic medications may be used to delay premature birth.
References
- World Health Organization (WHO): WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva: WHO, 2018. Available at: https://www.who.int/publications/i/item/9789241550215
- Cunningham, F.G. et al.: Williams Obstetrics. 25th Edition. McGraw-Hill Education, New York 2018.
- National Institute for Health and Care Excellence (NICE): Intrapartum Care for Healthy Women and Babies. Clinical Guideline CG190. London: NICE, 2014 (updated 2017). Available at: https://www.nice.org.uk/guidance/cg190
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