We investigate motion mode (M-mode) ultrasound scan as a potential non-invasive uterine monitoring technique and compare its contraction characteristics with external tocodynamometry (TOCO). This prospective diagnostic accuracy study included 39 term pregnant woman in active spontaneous labor. M-mode and TOCO were simultaneously performed and uterine contraction characteristics and consistency were compared quantitatively and visually. The results identified a 71.5% ± 35.3% uterine wall thickening during uterine contractions on M-mode. Uterine monitoring with M-mode had a consistency rate of 88.7% ± 6.9% with conventional TOCO method. During 20-min monitoring, the number of detected contractions was significantly higher (p < 0.001) in M-mode (8.2 ± 1.2) than TOCO (7.4 ± 1.5). As for the mean value of the duration of a contraction (seconds), it was significantly shorter (p < 0.001) in M-mode (38.5 ± 3.5) than TOCO (49.2 ± 4.1). For M-mode, the number of detected contractions had a negative but insignificant correlation with the body mass index (BMI) (r = - 0.25 - 0.52, 0.07, p = 0.127) and the subcutaneous tissue thickness (STT) (r = - 0.21 - 0.49, 0.11, p = 0.200). As for TOCO, the contractions had a negative and significant correlation with BMI (r = - 0.41 - 0.64, - 0.11, p = 0.009) and negative and insignificant correlation with STT (r = - 0.26 - 0.54, 0.06, p = 0.104). The evidence suggests that contraction detection with M-mode is a promising non-invasive technique for uterine monitoring. The preliminary analysis finds that contraction detection is not affected by BMI or STT. With future sensitivity studies, and improvements in image-processing and software technologies, the proposed technique promises to be a viable alternative to existing techniques, especially for obese patients.