Pregnancy cramps: what’s normal and when to worry

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Pregnancy cramps can be alarming. We speak to a midwife about when to worry and when to relax.

Medically reviewed by Dr Juliet McGrattan (MBChB) and words by Claire Chamberlain

If you experience mild cramps at any point during your pregnancy, you are not alone. Pregnancy cramps can be alarming when you first experience them, but for the most part they are perfectly normal and nothing to worry about.

Mild pain and cramps in early pregnancy is actually very common and will usually pass when you change position, rest or pass wind. However, occasionally, cramps during pregnancy may be a sign of something more serious that needs to be checked.

‘Uterine cramps and other sensations, such as stretching or pressure, are quite normal in pregnancy and are experienced by many women,’ explains Liz Halliday, Deputy Head of Midwifery at Private Midwives. ‘It’s not unusual for women to experience this in early pregnancy and some women will also report some discomfort during the second trimester.’

What causes early pregnancy cramps?

It may feel like period pains, but cramping during early pregnancy is actually your body preparing for your baby to grow. ‘Uterine cramps are often a result of the uterus growing and stretching during pregnancy,’ explains Halliday.

‘Other harmless reasons could be a full bladder or bowel, diarrhoea or constipation, ligaments stretching or even dehydration. Women might also experience sensations during or after exercise or sex,’ she adds.

What causes cramps later in pregnancy?

It’s also common to experience cramps during the later stages of pregnancy.

‘In the third trimester, many women feel a tightening of the uterus that can be quite regular and, for some women, quite intense,’ says Halliday.

For most women, cramping in pregnancy is a normal experience and is caused by the growing uterus.

‘However, the sensation is painless. These tightenings are called Braxton Hicks contractions and are harmless. They often occur in late pregnancy, as your body begins to practise for labour, but some women do experience them early in pregnancy – even as early as the second trimester.’

‘They can be intensified by dehydration, being on your feet all day or after sex,’ she adds. ‘If they become painful or uncomfortable, it’s advisable to call your healthcare provider.’

The following conditions may cause cramps during pregnancy and require urgent medical attention:

Ectopic pregnancy

An ectopic pregnancy occurs when the fertilised egg attaches itself outside the cavity of the uterus (womb), such as in the fallopian tubes.

An ectopic pregnancy is not usually capable of surviving and will spontaneously miscarry. The majority of women diagnosed will have to be operated on or treated with medication.

Pre-eclampsia

Pregnant women may notice mild pain just under the ribs during pregnancy from the growing baby pushing against the ribs and uterus. However, if the pain becomes severe, particularly on the upper right of the abdomen, it may be a sign of pre-eclampsia.

Pre-eclampsia can develop at any point during pregnancy, but typically occurs after 20 weeks. The main signs include hypertension (high blood pressure) and a high-level of protein in the urine.

However, other symptoms may include:

  • severe headaches
  • severe pain in the upper abdomen
  • blurred vision/floaters
  • swelling in the feet, legs and hands
  • vomiting
  • bruising more easily.

In rare cases, pre-eclampsia can progress to a condition known as eclampsia (convulsions), which can be very dangerous for both mum and baby. For this reason, women with pre-eclampsia should be closely monitored by a medical team throughout pregnancy and birth.

Miscarriage

Cramps and bleeding may be a sign of miscarriage. A miscarriage is the loss of a pregnancy before 24 weeks (after this, it is called a stillbirth). Unfortunately, miscarriage is very common, occurring in about one in five pregnancies.

Tips to relieve pregnancy cramps

You might find the following tips helpful for relieving early pregnancy cramps:

  • Go for a gentle walk
  • Take a warm, relaxing bath
  • Ask your partner or a friend to rub your lower back
  • Try some gentle stretches
  • Ensure you’re properly hydrated.

Pregnancy cramps warning signs

Occasionally, cramping in early pregnancy is a sign that something isn’t right. Halliday reveals the more serious causes of cramping:

  • If the cramping is associated with difficulty urinating, mid back pain or general ill health, it could be due to a urinary tractor kidney infection. Speak to your healthcare provider if you are concerned.
  • Occasionally, a yeast infectionor bacterial infection could cause cramping – again, your health care provider can investigate this and provide a prescription if required.
  • In early pregnancy, if the cramping is severe, one sided or accompanied by bleeding, it’s important to contact your healthcare provider immediately, as these can sometimes be symptoms of an ectopic pregnancy or miscarriage.
  • In the second or third trimester, cramping could be a sign of premature labour, so you should seek medical advice as soon as possible if you experience regular or painful cramping.

When to see your doctor for pregnancy cramps

If you experience acute pain or exceptionally severe cramps or you have any concerns, your GP or midwife will be happy to help you.

‘As a midwife, I always ask my clients to call me if they have any concerns,’ says Halliday.

‘If you experience cramps, pain, discomfort or bleeding, I would advise that you contact your healthcare provider immediately, who can then investigate the cause of your symptoms and act upon them appropriately.’

Net Doctor

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