Pain, bleeding or spotting

Pain in pregnancy doesn’t always mean that there is a problem.

Some women feel discomfort as ligaments stretch with the growing baby. Many women experience backache, especially as the pregnancy progresses. And abdominal pain may be due to a stomach upset or constipation.

But if you are worried, and especially if you have severe abdominal or one-sided pain or pain in your shoulders, it might be wise to contact your GP and explain what is happening. That’s even more important if you have previously had an ectopic pregnancy.

Similarly, if you have pain when you try to move your bowels (pass a motion), you might also want to ask if you might be referred for an ultrasound scan to rule out the possibility of ectopic pregnancy.

Bleeding in pregnancy may be light or heavy, dark or bright red.  You may pass clots or “stringy bits”.  You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks.  It can be very hard to know what’s happening.

Am I miscarrying?

Bleeding or spotting in pregnancy (especially during the first 12 weeks) doesn’t necessarily mean that you are miscarrying or that you will miscarry.

One study [1] of women attending an Early Pregnancy Unit because of bleeding in pregnancy showed that about half of them had continuing pregnancies.  So if you have bleeding or spotting, you may still go on to have a healthy pregnancy.

You might be more at risk of miscarrying if you have heavy and bright red bleeding and are passing clots.  But some women with these symptoms do go on to have a healthy pregnancy.

How can I know what’s happening?

If you have vaginal bleeding (or spotting) at any time during your pregnancy, it is worth talking first to your GP. S/he may refer you to hospital for an ultrasound scan to try to see whether the pregnancy is developing as it should.

Many hospitals now have a specialist Early Pregnancy Unit, sometimes called EPU, EPAU or EPAC.  They usually require a GP referral. You can find information about your nearest Early Pregnancy Unit here or you could just contact the nearest hospital that has maternity facilities.

My GP won’t refer me for a scan…

Some doctors are reluctant to refer women for scans in the early weeks of pregnancy.  That might be because it is too early to be able to see even a healthy pregnancy on scan.  In that case, it might make sense to wait until you are at least seven weeks pregnant (see our section on scanning).

Some doctors take a “wait and see” approach.  Your doctor may advise you to stay home and put your feet up or stay in bed, or just to go about your normal routine.

You might find this very frustrating and even frightening, especially if you are feeling very anxious as many women (and their partners) do:

  • If it’s your first pregnancy, you may worry because you don’t know what is normal and what isn’t.
  • If you have had a previous healthy pregnancy, you may worry because this pregnancy is not progressing in the same way.
  • And if you have previously lost a baby, you are likely to be particularly anxious because of what happened last time.

It is important to be referred for an early or emergency scan if:

  • you have previously had an ectopic pregnancy
  • If you have sharp one-sided pain and/or pain in your shoulders

But I really want a scan…

If you want a scan because of bleeding or spotting, and you can’t get an appointment at an Early Pregnancy Unit or Emergency Gynaecology Clinic, you could go to your nearest Accident & Emergency Department.  Bear in mind that you might have a long wait and that they may not be able to scan you there and then.

If you want a scan for reassurance, you might decide to go for a private scan (try putting “early pregnancy scan”  and the name of the nearest town into your search engine).

What should I do?

Whatever you do – have a scan, stay in bed or continue your usual routine – it’s very unlikely to make a difference to the outcome of your pregnancy.  Sadly, if the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to stop this. (The only exception might be if the bleeding occurs in the last few months of the pregnancy).

Resting in bed might slow down any bleeding, but when you get up, perhaps to go to the toilet, it’s likely to start again.  That’s not your fault – it’s just because of gravity. (Again, the only exception might be in the later months of pregnancy.)

Some people prefer to rest, others to continue their usual routine. It makes sense to do what feels right for you.

You can read more about ultrasound scans below.

[1] Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s, Unpublished dissertation