Bleeding and Spotting in Pregnancy: When to Call Your Midwife

How common is bleeding in pregnancy?

Bleeding during pregnancy is more common than many people realise. Around 15-25% of pregnant people experience some form of bleeding in the first trimester, and in many cases the pregnancy continues perfectly normally. However, any bleeding during pregnancy should be mentioned to your midwife, even if it turns out to be nothing to worry about.

The amount, colour, and timing of bleeding can give important clues about what is happening. Light pink or brown spotting is often less concerning than bright red, heavy bleeding. But the only way to know for sure is to have it checked.

Common causes in the first trimester

Implantation bleeding. When the fertilised egg attaches to the lining of your uterus (around 6-12 days after conception), it can cause light spotting. This is usually pink or brown, lasts a few hours to a couple of days, and happens around the time you might expect your period. It affects roughly 15-25% of pregnancies and is completely normal.

Cervical changes. During pregnancy, blood flow to your cervix increases significantly. This means the cervix can bleed more easily after sex, a cervical smear, or even a vaginal examination. This type of bleeding is usually light, brief, and harmless.

Hormonal bleeding. Some people experience light bleeding around the time their period would have been due (every 4 weeks or so) during the first trimester. This is caused by hormonal patterns that have not yet fully adjusted.

Subchorionic haematoma. A small collection of blood between the pregnancy sac and the uterine wall. These are relatively common, are usually picked up on ultrasound, and most resolve on their own without affecting the pregnancy.

Causes in the second and third trimester

Bleeding after the first trimester is less common but should always be assessed promptly.

Cervical ectropion. Hormonal changes can cause the cells from the inside of the cervix to appear on the outside, making it more prone to bleeding, particularly after intercourse. This is harmless and very common in pregnancy.

Placenta praevia. When the placenta is lying low in the uterus, partially or completely covering the cervix. This can cause painless bleeding, typically in the second or third trimester. It is identified on your anomaly scan and monitored with follow-up scans. Many low-lying placentas move upward as the uterus grows.

Placental abruption. When the placenta partially or fully separates from the uterine wall before birth. This typically causes painful bleeding and is a medical emergency. It is rare (affecting about 1% of pregnancies) but requires immediate attention.

Bloody show. In the final weeks of pregnancy, losing the mucus plug can cause a small amount of blood-tinged discharge. This is a normal sign that your body is preparing for labour and usually happens from around 37 weeks onwards.

When to contact your midwife

As a general rule, always report any bleeding to your midwife or maternity unit. Even if it turns out to be harmless, having it assessed gives you peace of mind and ensures nothing is missed.

Contact your maternity unit urgently if you experience: heavy bleeding (soaking a pad in an hour or less), bleeding accompanied by severe abdominal or pelvic pain, bleeding accompanied by dizziness, faintness, or feeling very unwell, passing clots or tissue, or any bleeding after 12 weeks.

In early pregnancy (before 12 weeks), your GP, midwife, or local Early Pregnancy Assessment Unit (EPAU) can assess you. Many hospitals have an EPAU that accepts self-referrals, so you may not need to go through your GP. Check your local NHS trust website for details.

What happens when you get checked

If you report bleeding in early pregnancy, your care team may arrange an ultrasound scan to check on the pregnancy. Depending on how far along you are, this might be a transvaginal scan (a small probe inserted into the vagina, which gives a clearer picture in early pregnancy) or an abdominal scan.

They may also check your blood group and rhesus status. If you are rhesus negative and experience bleeding, you may be offered an anti-D injection to prevent your body producing antibodies against the baby's blood cells.

In later pregnancy, monitoring may include checking the baby's heartbeat, measuring your blood pressure, and assessing the placenta's position with an ultrasound.

Spotting vs bleeding: what is the difference?

Spotting is very light bleeding. You might notice a few drops of blood in your underwear or when you wipe. It is usually pink or brown (brown blood is older and has taken longer to leave the body). Spotting does not fill a pad and is often brief.

Bleeding is heavier, more like a period or more. The blood is usually bright red. It may be continuous and may be enough to fill a pad. Heavy bleeding, particularly with clots, always needs urgent assessment.

The distinction matters, but both should be reported. Even light spotting gives your midwife useful information about your pregnancy.

What you can do while waiting to be seen

If you are experiencing light spotting and waiting for an appointment, rest at home, avoid sexual intercourse until you have been assessed, wear a pad (not a tampon) so you can monitor the amount of blood, and note the colour, amount, and whether there is any pain. This information helps your care team when they assess you.

Try not to catastrophise while you wait. Spotting in early pregnancy is common and, in many cases, everything is fine. But getting it checked is always the right thing to do. You are not wasting anyone's time.