Why Bleeding During Pregnancy Doesn't Always Mean Miscarriage

Once you know you're pregnant, having period-like bleeding can be scary. In fact, if one morning you wake up to discover some blood in your underwear, your first thought is likely to wonder if you're having a miscarriage. Thankfully, you don't always need to assume the worst. We spoke with experts to learn more.

What to Know About Period-Like Bleeding During Early Pregnancy

If you're experiencing bleeding during early pregnancy, don't panic. Yes, sometimes bleeding or spotting while pregnant can indicate pregnancy loss. However, it doesn't always mean that a miscarriage is imminent.

"Bleeding can occur in a completely healthy pregnancy," explains Zev Williams, MD, PhD, OB-GYN and Chief of the Division of Reproductive Endocrinology and Infertility at Columbia University Irving Medical Center in New York City. In fact, many people experience some form of vaginal bleeding, especially in the early weeks of their pregnancies.

According to an article published in the American Academy of Family Physicians, almost 1 in 4 pregnant people will experience bleeding during their first trimesters, but only about half of those cases will result in a miscarriage.

Causes of Bleeding During Pregnancy

As many pregnant people discover after visiting their pregnancy care providers, vaginal bleeding during pregnancy can be normal and is not always an immediate cause for concern. Some types of bleeding can be caused by implantation of the embryo into the uterine wall (most commonly around the day your period is due), an infection of some sort in the body, or irritation (like from vaginal intercourse).

Elizabeth Nowacki, DO, an OB-GYN at St. Vincent Fishers Hospital in Fishers, Indiana, explains that one of the most common causes of bleeding is "lag time" before the placenta is fully formed. Before the placenta starts forming around 12 weeks, the ovary that released the egg provides the main source of hormonal support to the pregnancy.

Bleeding that occurs later in pregnancy—specifically in the second or third trimester—can also have different causes that won't result in a miscarriage or stillbirth, such as cervical irritation or even cervical changes (such as a growth or polyp on the cervix, for example).

"Sometimes, the outside of the cervix, which connects the uterus to the vagina, can bleed or an area of bleeding can occur in the space between the placenta and the uterus, which will usually resolve on its own," says Dr. Williams. However, slight bleeding, especially if it's tinged with a mucus-like discharge, could also be a sign of early labor.

Ultimately, some bleeding during pregnancy is simply unexplained.

Implantation Bleeding vs. Miscarriage

Bleeding from an impending miscarriage or chemical pregnancy (a nonviable pregnancy) may begin as spotting and then turn into a heavier flow with visible clots and a dark red color, similar to a heavy menstrual period. In contrast, implantation bleeding may appear as a brown or lighter-colored discharge without clots. It is a lighter flow that lasts only a few hours to a few days.

Additional signs that you may be experiencing a miscarriage rather than implantation bleeding include cramping and passing tissue through the vagina.

What You Should Do About Bleeding During Pregnancy

Although vaginal bleeding during pregnancy does not always indicate a problem, bleeding at any point during pregnancy should always be evaluated by a health care provider. If you're experiencing spotting or bleeding, take the following steps:

• Call your health care provider. Call your OB-GYN or midwife to discuss your symptoms and/or make an appointment.
• Note the time and duration. Note when the bleeding started and any activities that may have contributed to the bleeding (for instance, did you have vaginal intercourse in the last 24 hours or have a vaginal exam performed recently?).
• Note the amount. Place a pad or panty-liner (never a tampon) for absorption and as a means to gauge the amount of bleeding; your health care provider may ask you how quickly you're filling up a typical overnight pad as a way to determine how much bleeding you're experiencing.
• Note the color. Note the color of the blood; your doctor may want to know if it's bright red, pink, brown, or somewhere in between.
• Rest. While waiting to hear from your doctor, try to sit down, put your feet up, and drink a large glass of water.
• Note any other symptoms. Ask yourself if you're experiencing any other symptoms, such as contractions, back pain, nausea, vision changes, or decreased activity of the baby.

Your medical provider will assess if you are experiencing pregnancy loss, another complication, or harmless bleeding and will provide a treatment plan if needed.

The Bottom Line

Any bleeding during pregnancy can be scary, and it's normal to worry that you're having a miscarriage. Luckily, that's not always what's happening, particularly if the bleeding is light and intermittent. However, sometimes, bleeding is due to pregnancy loss. If that's the case, look for support and give yourself grace as you heal physically and emotionally.