There are many aches, pains, and other sensations you may experience during your pregnancy, including stomach tightening.

Stomach tightening may start early in your first trimester as your uterus grows. As your pregnancy progresses, it may be a sign of a possible miscarriage in the early weeks, premature labor if you aren’t due yet, or impending labor. It can also be normal contractions that don’t progress to labor.

Here’s the lowdown on why you might experience stomach tightening at different stages of your pregnancy.

Your stomach may feel tight in your first trimester as your uterus stretches and grows to accommodate your growing fetus. Other sensations you may experience include sharp, shooting pains on the sides of your abdomen as your muscles stretch and lengthen.

Is it a miscarriage?

Painful stomach tightening may be a sign of miscarriage. A miscarriage is a loss of pregnancy before week 20, though it’s most common before week 12.

You may have no symptoms with a miscarriage, or you may experience some or all of the following symptoms:

  • tightness or cramping in your abdomen
  • pain or cramping in your lower back
  • spotting or bleeding
  • seeing fluid or tissue pass from the vagina

Causes of miscarriage aren’t always clear. Some may be due to a blighted ovum, which means no embryo forms. Others may be due to:

  • genetic issues with the fetus
  • diabetes
  • certain infections
  • thyroid disease
  • cervix issues

If you have painful stomach tightening along with other signs of miscarriage, call your doctor or midwife.

As your body continues to adapt to pregnancy, you may experience stomach tightening and even sharp pains called round ligament pain. This type of discomfort is most common during the second trimester, and the pain may extend from your abdomen or hip area to your groin. Round ligament pain is considered totally normal.

It’s also possible to experience Braxton-Hicks contractions as early as the fourth month of pregnancy. During these “practice contractions,” your stomach may feel very tight and uncomfortable. Some women get more of these contractions than others. Braxton-Hicks contractions aren’t as painful as regular labor contractions. They often occur with activity, like exercise or sex.

These contractions don’t generally affect the dilation of the cervix. They are irregularly, with no set pattern that you can time.

In some cases, you may develop what is called an irritable uterus. Contractions or stomach tightening with an irritable uterus feel similar to what you would expect to experience with Braxton-Hicks. With irritable uterus, though, you may actually get regular and frequent stomach tightening that doesn’t respond to rest or hydration. While this pattern may be alarming and a sign of preterm labor, women with irritable uterus don’t necessarily see a change in dilation.

If you aren’t yet due, being dehydrated can also lead to increased contractions. If you’re feeling cramps that come and go, be sure to drink plenty of fluids. They often will diminish when you’re rehydrated. If the cramps and contractions are getting longer, stronger, or closer together, see your healthcare provider to prevent premature delivery.

If you’re having frequent contractions in your second trimester, it’s always best to contact your healthcare provider to rule out preterm labor or miscarriage. They can perform tests, like an ultrasound, to measure your cervix and evaluate other signs to see if you’re in labor.

Stomach tightening in your third trimester may be a sign of labor. Labor contractions may start out mild and get stronger over time.

You can usually time these contractions by starting a stopwatch as one ends and stopping the watch as another one starts. The time between them will generally be steady. At first, they will be spaced further apart, maybe every eight minutes or so. As labor progresses, they will get closer together.

True labor contractions become more and more intense over time.

Braxton-Hicks contractions are more common in the third trimester of pregnancy. You may notice them in the final weeks of pregnancy. It’s also possible to notice them earlier in your third trimester.

Braxton-Hicks contractions are also referred to as “false labor” because many women mistake them for labor. If you’re getting lots of irregular contractions or stomach tightening, call your healthcare provider. If it’s after hours, you can also place a call to your local hospital and speak to a triage nurse. They can advise you on whether you should see a healthcare provider.

The rule of thumb is to call if you’ve had more than four to six contractions in an hour, no matter their pattern.

Braxton-Hicks vs. labor

Still confused about the difference between Braxton Hicks contractions and the real thing? Changing position, drinking a glass of water, or taking a gentle walk may make false labor contractions go away.

Other signs of labor include:

  • lower back pain or cramping that doesn’t go away
  • gushes or a trickle of clear liquid from the vagina, which is a sign of your water breaking
  • red-tinged vaginal discharge, also known as “bloody show

If a change in activity doesn’t relieve the stomach tightening, or the pain and frequency in your contractions gets worse, it may be time to visit the hospital.

When should I go to the hospital if I’m in labor?

You are probably in labor if your contractions are getting longer, stronger, and closer together. If this is your first baby, head to the hospital or call your midwife when your contractions come every three to five minutes, and last 45 to 60 seconds over an hour-long period of time. If you’re not a first-time mom, consider getting there when your contractions come every five to seven minutes, and last 45 to 60 seconds over an hour-long period. Head immediately in for care if your water breaks, regardless of whether you’re having contractions.

If your stomach tightening is irregular and mild:

  • drink a tall glass of water and stay hydrated
  • move your body to see if a change in positions helps relax your stomach
  • avoid getting up too quickly from bed or other positions
  • consider getting a pregnancy massage to relax tired muscles
  • use a warm water bottle or heat pad, or take a warm bath or shower

If these home measures don’t relieve your stomach tightness or you have other concerns, contact your doctor or midwife.

Go to the hospital immediately if you’re less than 36 weeks pregnant and have other signs of preterm labor, like:

  • bleeding
  • fluid leakage
  • pressure in your pelvis or vagina

You should also contact your healthcare provider if you have more than four to six contractions in an hour, regardless of their timing. Hospitals often get calls from women who don’t know the different sensations of pregnancy, and it’s better to be safe than sorry if you suspect something might be happening with your pregnancy.

If you’re ever concerned about stomach tightening or contractions during your pregnancy, or any other symptoms, call your doctor. Your healthcare provider won’t mind if it’s a false alarm. It’s always better to be on the safe side.

While many cases of stomach tightening can be attributed to Braxton-Hicks contractions or growing pains, there’s always a slight chance it may be the real deal. Your healthcare provider can set your mind at ease if it’s a false alarm. If you’re in labor, they can help safely deliver your baby.