Cramps during pregnancy – what’s normal and what’s not

Although cramps during pregnancy often result from normal changes that take place with your body and growing baby, it’s important to know the difference between what’s normal and what’s not throughout the nine months.

What causes normal cramping?

According to experts, your womb expands 1000 times during pregnancy, from the size of a plum to the size of a watermelon. It’s liquid capacity changes from holding 10ml fluid to more than five litres in the third trimester. It’s no wonder you might experience strange sensations in your abdominal area.

First trimester What’s normal: Implantation bleeding and your expanding uterus

Before you’re even aware that you’re pregnant, your body is going through immense physical changes to accommodate your rapidly growing baby and this can include pain and cramps in your stomach. Suddenly you may feel bloated, queasy, and unusually tired, or experience strange sensations in your stomach. In fact, studies show that about 20% of women will experience some cramps – resembling period-type pain and implantation bleeding, as soon as the fertilised egg implants in the womb. The foetus undergoes dramatic changes in the first weeks – growing from a tiny bundle of cells to a little human by the 10th week. This means that your uterus will expand from the size of a walnut to a large orange in the first few weeks, and will continue to expand throughout each trimester to make space for your baby. Plus, hormonal changes often result in gas, constipation, and bloating – all of which can cause minor pain or cramping sensations.

What’s not: Sharp, sudden cramps accompanied by bleeding

While cramps alone aren’t a sign of miscarriage, if you feel sharp, persistent pain in your lower abdomen, heavy bleeding with clots, and pain, immediately see your doctor.  

Second trimester What’s normal: Growing pains and round ligament pain

The second trimester is normally a blissful stage when you’ll feel most comfortable with your body and your bump. There’ll be a sense of energy and excitement as you look forward to welcoming your little one into the world. However, some women do still experience mild pain and cramping, from weeks 15 to 26. This is most likely due to round ligament pain, according to the American Pregnancy Association. The round ligament is a muscle that supports the uterus, and when it stretches, you may feel a sharp, stabbing pain, or a dull ache in your lower abdomen. Although it might feel alarming, this type of pain is short and sharp and doesn’t last longer than two minutes. The best way to handle it is to take a few deep breaths, lie on your left side, and wait for it to subside. Growing pains tend to occur on either side of the abdomen as the uterus continues to stretch. They can feel dull and achy, which is normal.

What’s not: Consistent pain or heavy bleeding

If you experience severe lower abdominal pain that won’t go away, cramping along with pain in your shoulder or neck, dizziness, or gastrointestinal symptoms, the American Pregnancy Association recommends you call your doctor right away. Heavy bouts of bleeding accompanied by pain should also be taken seriously as this could be a sign of placental abruption – where the placenta tears and separates from the uterine lining. The good news is, only about 1% of all pregnant women will experience this as it’s very rare.

Third trimester What’s normal: Braxton Hicks

This is normally the time when those famous Braxton Hicks or false labour pains start to occur. These feel similar to labour contractions and pain, but the difference is, Braxton Hicks tend to be erratic, only last for around 20 seconds at a time, and never advance into labour. They can also be brought on by strenuous exercise, sexual intercourse, or lifting heavy objects.  At this stage of pregnancy, it’s always a good idea to contact your doctor if you feel any abnormal sensations or pain in the abdominal area.

What’s not: Timed contractions and early labour or spontaneous bleeding

The closer you get to D-day, the more aware you’ll need to be of any type of pain or cramping, as it could be a sign of preterm labour. If you start to experience pain that doesn’t subside or you start to feel contractions a few minutes apart, call your doctor immediately. Preeclampsia (also known as high blood pressure in pregnancy) can flare up in the third trimester and is linked to intense pain or cramping in the upper abdomen as well as high levels of protein in the urine. However, your doctor should be checking your blood pressure and urine at every scan and will be aware of any risk factors that could harm you or your baby.