Cramping During Pregnancy
I've been feeling cramps in my abdomen. Is this normal?
Pregnancy puts a major strain on your body, and nowhere is this more evident than in your expanding belly. As your baby grows, the added pressure on muscles, joints, ligaments, and surrounding organs can lead to cramping and discomfort. Knowing when and why cramps are likely to occur can help you recognize which ones are a normal part of pregnancy, and which ones may need your doctor's attention.
What causes cramps?
Throughout your pregnancy, the most common source of cramps are the ligaments that surround and support your uterus. As your baby grows, these ligaments stretch. When you change positions, you'll sometimes feel these ligaments cramp up on one or both sides of your abdomen or toward your back.
Ligament cramps can occur any time during your pregnancy, but they'll be more noticeable between 14 and 20 weeks. During this time your uterus is growing and putting pressure on the ligaments, but it hasn't grown so large that your pelvic bones help support it. If you have what feels like a ligament cramp, try lying down on your side until it goes away. A hot water bottle may also help, but usually these cramps disappear pretty quickly if you just rest.
Some women experience cramps during sex, both during and after orgasm. This occurs because when you're pregnant, blood flow to your pelvic area increases; this, combined with the normal increase of blood flow to your genitals that occurs during sex, can result in cramping and a low backache.
If you're worried that having sex might hurt your baby, you might be tensing up during lovemaking -- this can also cause cramping. Talk with your doctor about your fears, and try to relax. If you have a low-risk pregnancy, sex and orgasms won't hurt your baby. Cramps during sex usually go away pretty quickly. If they don't, ask your partner to give you a low back rub to help you relax and ease the cramping.
As early as your fourth month, but usually in your sixth or seventh month, you'll experience what may feel like mild menstrual cramps. This is your uterus tightening in what are called Braxton-Hicks contractions (named after the doctor who identified them). These "practice" contractions are getting your uterus ready for the hard work of pushing your baby out when you're ready to give birth. They can last anywhere from 30 seconds to two minutes, and will become stronger and more frequent as your due date approaches. If you're uncomfortable, try lying down, shifting position, or getting up and walking around. Sometimes a change of position is all that it takes to ease the contractions.
As you get closer to your due date and the contractions become stronger, it may be hard to tell whether you're still having Braxton-Hicks contractions or are heading into labor. If you're not sure -- and especially if you're at risk for premature labor -- call your doctor. You should also call your doctor if you experience any of the following symptoms:
- more than 4 contractions an hour
- pain in your back, abdomen, or pelvis
- unusual vaginal discharge
When to call the doctor
Generally, if your cramps are caused by a serious problem, you'll know it. They will be acutely painful, and will likely be accompanied by other symptoms such as bleeding or abdominal pain and tenderness.
In early pregnancy, cramps usually accompanied by bleeding may signal a miscarriage. Miscarriage is most likely in the first 13 weeks and is usually caused by the fetus not developing properly. If you have severe pain or bleeding that soaks through several sanitary pads in an hour, or if you pass blood clots or grayish material, go to the emergency room immediately. Otherwise, call your doctor right away if you have any of the following symptoms:
- bleeding with pain or cramps in the lower abdomen
- continuous, severe pain for more than a day, even if it is not accompanied by bleeding
- bleeding that is similar to a heavy menstrual period, or light bleeding that lasts for more than three days
Rarely, early cramping and lower abdominal pain can signal an ectopic (or tubal) pregnancy. This means the fertilized egg has been implanted in the Fallopian tubes or elsewhere outside the uterus. Most ectopic pregnancies are diagnosed before you even suspect you're pregnant -- symptoms usually show up within a week of the egg being fertilized -- but it's still a good idea to know what to watch for. Seek immediate medical attention if you have any of the following symptoms of ectopic pregnancy:
- pain in the lower abdomen that becomes more severe and localized, usually to the side that the ectopic pregnancy is on (similar to appendicitis pain)
- sudden, severe, stabbing pain in the lower abdomen, which may indicate a rupture of the Fallopian tube
- bleeding that precedes or accompanies pain
- nausea, vomiting, dizziness, or faintness with increased pain and bleeding
- mild to severe tenderness over the area of your Fallopian tube
Though miscarriages typically occur during the first trimester, it is possible to have a miscarriage between the 12th and 20th weeks of pregnancy -- called a "late miscarriage." (Delivery after the 20th week is usually considered a premature birth.)
Late miscarriages are usually due to problems with the placenta, health problems of the mother, a cervix that opens prematurely, or other problems. If you have a pink or brown discharge, call your doctor to have it checked out. It could be an early sign of a miscarriage or it could be a minor problem. However, if you begin to bleed heavily, seek immediate medical attention at your doctor's office or the emergency room. While you wait to be seen, sit or lie down with your feet up, and relax as much as possible.
Cramps late in pregnancy may signal preterm labor. This means labor contractions -- at least every 10 or 15 minutes -- that begin between the 20th and 38th week. If you suspect you may be in preterm labor, call your doctor. She may want to examine you or have you go to the hospital, where you may be given medication that can stop the contractions. Call if you experience any of the following symptoms:
- bleeding or a change in vaginal discharge
- feeling your baby push down on your pelvis
- a low, dull backache that may travel around to your abdomen
- what feels like menstrual cramps
- abdominal cramping with or without diarrhea
William Sears, MD and Martha Sears, RN. The Pregnancy Book. Little, Brown and Company.
Arlene Eisenberg, et al. What to Expect When You're Expecting. New York. Workman Publishing.
March of Dimes. What you need to know. Pregnancy and Newborn Health Education Center. January 2010 http://www.marchofdimes.com/pnhec/159_513.asp
National Women's Health Information Center. Pregnancy Complications: Symptoms, Diagnosis, and Treatment. http://www.4woman.gov/Pregnancy/complications.cfm
American College of Obstetricians and Gynecologists. Early Pregnancy Loss: Miscarriage and Molar Pregnancy. http://www.acog.org/publications/patient_education/bp090.cfm