Your pregnant body

• Your body goes through major changes during pregnancy.
• Weight gain, breast changes and aches and pains are common.
• There are ways to deal with common discomforts and changes.

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Some short-term achiness in the belly is normal during pregnancy. But, severe cramping or pain never is. Call your health care provider when you show signs of severe pain.

Causes of normal abdominal pain during pregnancy
There are different causes for mild achiness or pain in the abdomen during the different stages of pregnancy.

Implantation

• Many women have low, period-like pain or cramps for a day or so early in pregnancy.
• This usually happens around the time the embryo is embedding itself in the lining of the uterus.

Stretching of ligaments

• In the second trimester, the muscles and ligaments (tough bands of tissue) that support your uterus stretch.
• This can cause a dull ache across the belly or a sharp pain on one side. Many women feel this pain most severely when getting up from a bed, chair or bathtub or when coughing.

False labor

• In the second and third trimesters, you may feel contractions or an irregular tightening of your uterus muscles, often called Braxton-Hicks contractions or false labor.
• False labor is usually painless, but some women feel pain.
• False labor tends to increase in the weeks right before your due date and can be confused with early labor.
• You are probably having false labor if the contractions stop when you walk, are irregular and don't get stronger or closer together over time.

Cramping

• In the last weeks of pregnancy, cramping may be a sign that labor is almost ready to begin.
• At the start of labor, you may have strong cramps that come regularly every 5-10 minutes and feel like a bad backache or menstrual cramps.
• Normal abdominal pain may also be caused by gas pains and bloating caused by hormones that slow your digestion, the pressure of your growing uterus, constipation and heartburn. 

What you can do
When you feel abdominal achiness, sit down, put your feet up and relax. Resting comfortably should quickly relieve your symptoms. Other tips include: 

• Avoid quick changes in position, especially turning sharply at the waist.
• When you do feel a pain, bend toward the pain to relieve it.
• Walking, doing light housework or changing position may help relieve gas pains.
  Put a hot water bottle wrapped in a towel or a heating pad on the lowest setting on your belly. 
• Take a warm bath or shower.
• Make sure you are getting enough fluids.

When to talk to your health care provider

Severe pain
While some pain or achiness is normal, severe abdominal pain or cramps could be a sign of a serious problem. Many conditions can cause this type of pain, whether you're pregnant or not. Severe pain may be a sign of stomach virus, food poisoning, appendicitis, urinary tract infection, kidney infection, kidney stones, gallbladder disease or complications of pregnancy (such as preeclampsia).

Contact your provider if you have severe and continuous pain, or if you also have:

• Cramps
• Bleeding or discharge from your vagina
• Fever
• Chills
• Lightheadedness or faintness

Ectopic pregnancy
During the first 3 months of pregnancy, abdominal pain can be a sign of ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg is implanted outside of the uterus. This serious condition requires immediate medical attention. Call your health care provider right away if you notice slight, irregular vaginal bleeding a week or more after you miss your period. The bleeding is often followed by pain in the lower abdomen, usually on one side. Without treatment, the pain will get worse and may be accompanied by shoulder pain, faintness or dizziness, nausea or vomiting.

Preterm labor
Before the 37th week of pregnancy, abdominal cramping can be a sign of preterm labor. Call your health care provider or go to the hospital right away if you have any of the following:

• Contractions (your abdomen tightens like a fist) every 10 minutes or more often
• Change in vaginal discharge (leaking fluid or bleeding from your vagina)
• Pelvic pressure—the feeling that your baby is pushing down
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

Labor
You'll know you're in labor when you feel frequent and regular contractions—the only true sign that labor has begun. Call your health care provider when:

• Your contractions are between 5 and 10 minutes apart.
• Your water breaks, especially if the fluid is stained dark, greenish brown.
• You have bleeding from your vagina.
• You can no longer walk or talk during contractions.
• You are concerned about your health or the health and well-being of the baby.

June 2009