Not much can make you worry more during pregnancy than seeing some blood in your underwear. Does spotting during pregnancy mean you’re having a miscarriage, bloody show, or something else? This guide to spotting and bleeding during pregnancy will help you know what’s going on, and what to do about it for peace of mind.

The Difference Between Spotting and Bleeding

Spotting is defined as colored vaginal discharge that’s enough to leave some marks on a pad or panty liner, but not enough to soak it through. Spotting can range from pink-tinged discharge, to brown or bright red. Bleeding on the other hand is when there’s enough fluid to soak through a panty liner or pad, and its often bright red, though not always.

Spotting During Early Pregnancy

The American Pregnancy Association estimates about a third of women experience what’s called implantation bleeding. This happens after conception, when the fertilized egg burrows into the uterine lining. Implantation bleeding occurs about 10 to 14 days after ovulation and is often mistaken for a missed period.

Implantation bleeding is typically light pink to brown and only lasts a few hours to a few days. It is much lighter than a usual period, which is heavier bleeding that continues for about a week.

Is Spotting Normal During Pregnancy?

An estimated 20% of women will report having spotting during the first trimester, according to the American Pregnancy Association, about the same amount that will also have implantation bleeding. Another statistic says that about 50% of mamas will have bleeding or spotting at some point in their pregnancy, so it’s not uncommon. Heavy bleeding however is always a cause for concern and should be checked out as soon as possible by your midwife or doctor.

Bright Red Spotting During Pregnancy

There are several different issues that can cause bright red spotting during pregnancy, some more benign than others. Some lesser reasons for bright red spotting include recent vaginal irritation from intercourse, from checking your cervix or a pap smear. When the discharge is bright red, it means that the blood is fresh. Here are some other possible reasons for bright red spotting:

Placenta Issues

Placenta previa is when the placenta partially or fully covers the cervix and can cause bleeding, usually bright red, later in the pregnancy. This condition is usually detected early by ultrasound, before bleeding occurs. Most cases of placenta previa will resolve themselves by delivery, as it only occurs in about 1 in every 200 deliveries. However, placentas that don’t migrate up where they belong can cause bleeding in the second or third trimester, necessitating further interventions.

Placental abruption is when the placenta separates from the uterus. It usually occurs during the last 12 weeks of pregnancy. This event is rare and occurs in about 1% of pregnancies according to the American Pregnancy Association. Placental abruption is accompanied by light to heavy bleeding, with or without clots.

Make sure to contact your midwife or doctor for any bleeding during the second half of your pregnancy.

Molar Pregnancy

A molar pregnancy is also known as gestational trophoblastic disease (GTD). In the case of molar pregnancies, a placenta is created, giving a positive pregnancy test result, but because of a lack or overabundance of chromosomes, there will either be a cluster of cells and no fetus present or an embryo which is severely malformed. Bleeding is dark brown to bright red and may be accompanied by nausea, vomiting and cramping. Molar pregnancies are rare, and only happen in 1 out of 1,000 pregnancies. If you suspect a molar pregnancy, see your health care professional immediately for treatment as it could lead to a rare form of cancer.

Is it a Miscarriage?

Bright red spotting or bleeding in the first trimester can indicate a miscarriage. It is estimated that half of all pregnancies end in miscarriage, though often it’s so early that it isn’t noticeable. If an ultrasound shows a normal heartbeat between seven and 11 weeks, then there’s more than a 90% chance of not miscarrying, according to a study in the U.S. National Library of Medicine.

Bleeding during pregnancy can be classified either as a threatened miscarriage or an inevitable miscarriage. A threatened miscarriage will present with spotting or bleeding and often abdominal pain, but the cervix is still closed upon examination. An inevitable miscarriage however means that the cervix is dilated, bleeding is heavy and a miscarriage is almost certain to occur. Someone who is may be miscarrying could experience some or all of the following symptoms during pregnancy.

Symptoms of Miscarriage

  • White/pink mucus discharge
  • Brown or bright red bleeding
  • Abdominal cramping and pain
  • Blood clots
  • Lower backache

How to Prevent a Miscarriage

While you can’t prevent a miscarriage if your body isn’t meant to carry the embryo, there are ways to prevent a full miscarriage if you suspect you may be having a threatened miscarriage. Note that if the cervix is already dilated and the bleeding is heavy, then it’s likely an imminent miscarriage and probably can’t be stopped. If you suspect a miscarriage, contact your midwife or doctor right away. Your health care provider will be able to examine you and let you know what’s going on.

In a threatened miscarriage, the cervix is still closed, so there’s still a chance that the baby will stay put for a while. Your midwife or doctor will be able to give you guidance, but the following tips can be helpful at preventing a threatened miscarriage from becoming an imminent miscarriage. The most important thing is to relax and reduce stress.

  • Put your feet up and relax
  • Don’t lift anything over 10 pounds
  • Bed rest
  • Stay calm
  • Try forest bathing
  • Repeat positive affirmations. The brain is a powerful tool!
  • Take magnesium to relax, or use a topical magnesium oil or lotion
  • Recline in the bathtub with some soothing Epsom salts (which are magnesium)
  • Get help if needed. Have family or friends help out with household tasks or taking care of the kids.

Brown Spotting During Pregnancy

A brown discharge during pregnancy is from blood that’s older and not as recent as red blood. Miscarriage, molar pregnancy and bloody show can all be a reason for brown spotting. The most common reason for brown spotting during pregnancy though is from vaginal irritation.

Vaginal Irritation

During pregnancy, the number of blood vessels in the cervix increase. Sex or vaginal exams can cause irritation in this delicate area, and the increased blood flow may cause spotting. The spotting can be brown, pink or red. If the discharge continues and isn’t occasional, then it could be a cause for concern and should be reported to your health care professional.

Other Reasons for Spotting During Pregnancy

There are many other reasons other than miscarriage for spotting during pregnancy that could cause red or brown spotting. Some possible causes are:

Subchorionic Hemorrhage

This condition is when blood accumulates in the folds of the outer fetal membrane next to the placenta or between the uterus and placenta. Usually these resolve themselves, but sometimes it can increase the risk for preterm labor or other complications. A subchorionic hemorrhage causes light to heavy spotting and can be brown, dark blood possibly accompanied by blood clots. The blood clots are either absorbed by the body or expelled from the vagina. Even though this issue may not be serious, it still requires prompt medical attention.

STDs and Infections

Most providers will routinely test for the sexually transmitted diseases chlamydia and gonorrhea during pregnancy, as these can cause health issues for the baby. Group B Strep bacteria is also routinely screened for, as it can cause bladder or uterine infections or complications in newborns. Both STDs and infections can irritate the cervix and cause spotting.

The blood is sometimes accompanied by mucosal discharge. If you have a fever, painful urination, nausea or vomiting along with spotting, be sure to contact your health provider right away. This could indicate a urinary tract infection or other illness, and needs addressed promptly.

Cervical Polyp or Fibroid

Fibroids are growths that can occur in the uterine lining. If the placenta embeds itself in a uterine fibroid, it can cause some bleeding. Bleeding can also occur if there is a polyp on the cervix. A polyp is an abnormal growth that often occurs as a result of elevated estrogen levels during pregnancy. Combined with an increased number of blood vessels in the cervix, the cervix is more likely to bleed if there is polyp present. Note that polyps are usually benign are not cause for concern. But any continual spotting or bleeding should be brought up to your health care provider just to be safe.

Ectopic Pregnancy

An ectopic pregnancy is when the embryo is lodged outside of the uterus, typically in a fallopian tube. This is sometimes called a tubal pregnancy, which can rupture the fallopian tube as the embryo grows. According to the American Pregnancy Association, ectopic pregnancy occurs in about 1 of 50 pregnancies and almost always results in the loss of the pregnancy. The blood can range from spotting to bleeding, and is usually brown or red.

Ectopic pregnancy is a serious complication and should be addressed immediately as it can also result in severe health complications for the mother. Be sure to tell your health care provider right away if you experience any of the following symptoms along with the spotting or bleeding:

  • Pain in the shoulders
  • Pain in the pelvis or abdominal muscles
  • Severe sharp pain on one side of the lower abdomen
  • Rectal pressure
  • Lightheadedness or fainting

Spotting or Bleeding During the Third Trimester

Once you are in your third trimester, spotting or bleeding could indicate the beginnings of labor, so it’s important to pay attention to your body and contact your health care provider immediately if you experience any pre-labor symptoms or unknown bleeding. Some possible causes for bleeding the the third trimester include the loss of your mucus plus and what’s known as the “bloody show,” which isn’t nearly as messy as it sounds.

Losing the Mucus Plug

As your body prepares for your baby’s arrival, it will usually include the loss of your mucus plug. The mucus plug can vary in color from clear to white, or even be green, pink or brown. However, it is often clear with streaks of pink or brown. You will usually lose your mucus plug sometime during or after your 37th week of pregnancy, as it is usually a sign that your cervix is softening and/or dilating in preparation for labor. This may be accompanied by the bloody show.

Bloody Show

This event occurs at the tail end of pregnancy and is the result of tiny capillaries bursting in the cervix as it prepares for labor. First time moms usually have bloody show a few days before labor begins, while others usually don’t experience it until the cervix is dilating for active labor. The bloody show is a minimal amount of discharge that can range from brown, to pink, to the most common, bright red. It’s a sign that baby is on the way soon and there nothing to worry about. Bloody show may be accompanied by the loss of the mucus plug before active labor, or maybe not.

Premature Labor

Premature labor could also be a reason for spotting or bleeding in your third trimester. Premature labor is defined by the CDC as labor that starts before 37 weeks. But it’s important to understand the differences in contractions and symptoms to know whether your body is ready to have a baby.

Braxton Hicks contractions can often be mistaken for premature labor. However, Braxton Hicks contractions are small, practice contractions your body makes as it prepares for actual labor and they usually don’t involve any other symptoms.

Prodromal labor on the other hand feels like real contractions that even increase in frequency and intensity, but it also doesn’t result in baby’s appearance. Read more about Braxton Hicks contractions and prodromal labor symptoms.

Unlike Braxton Hicks contractions or prodromal labor, premature labor does result in the birth of the baby. Let your midwife or doctor know right away if you’re having the following symptoms, as premature labor requires prompt care for you and baby:

  • Vaginal discharge
  • Cervical dilation (you may or may not be able to feel that this has happened)
  • Pelvic pressure as baby descends or pushes down
  • Abdominal and/or uterine cramps
  • Lower back pain that’s dull
  • Loss of mucus plug or bloody show

When to Call Your Midwife or Doctor

Anytime you experience heavy bleeding in pregnancy, or the discharge is bright red, be sure to contact your provider promptly. It’s usually recommended to wait and report light spotting during office hours, as it’s usually not an emergency. While the information here can help point you toward what may be going on in your body, self-diagnosis has its limits. If you’re unsure or just feel uneasy about any vaginal discharge, it’s better to be safe than sorry and let your provider know right away.

How to Talk to Your Provider

Certain types of spotting during pregnancy aren’t really a cause for concern, while others are emergency situations. It can be hard to gauge what is what, so anytime you’re unsure, it’s best to err on the side of caution. If you notice spotting or bleeding, it helps to wear a panty liner or pad to better gauge of the color, the amount of discharge and if it’s accompanied by mucus. You don’t need to bring the pad in with you to an appointment, but take note of what it looks like and any other symptoms so you can pass the information along.

What Will Your Provider Do if There’s Spotting or Bleeding?

If the spotting is minimal and your symptoms point to an issue that isn’t serious, your midwife or doctor may choose to wait it out. Frequent spotting however can be due to a hormonal imbalance, and in this case your provider may check your HcG and progesterone hormone levels. It really depends on the specific discharge and symptoms you’re experiencing, but your provider may also do one or more of the following:

  • Perform a vaginal exam to check the cervix and vagina
  • Perform an ultrasound to monitor the baby
  • Use a doppler or fetoscope to check the baby’s heartbeat
  • Recommend abstaining from sex
  • Check for a UTI or other infection

The Most Important Thing to Remember

Stress makes any situation worse, so remember to relax! Spotting or bleeding during pregnancy is fairly common, and often has an easy solution. Let your doctor or midwife know what’s going on, and take some deep breaths, mama.

What About You?

Did you experience spotting or bleeding during pregnancy? How did you and your health care provider handle the situation?