Spotting during pregnancy – What to do, What it means and Why worrying is normal


Andrea and Judith emailed with similar questions about spotting, discharge and cramping.  Spotting and cramping are among the top three questions I receive. While the symptoms are always similar (pink discharge, very light bleeding, achy belly and lots of worry), the reasons why those little spots of blood show up can be very different.  Here are Andrea’s and Judith’s emails:

Andrea wrote:


I went to the bathroom and had 2 small red blood 
Clot on the tissue then pink peach discharge there 
Has been nothing since should I be worried ? 

Judith wrote:

I woke up dis morning feeling a severe pain in my tummy only for me to notice some creamy blood coming out my body bt is nt much wat do I do. 

Judith didn’t mention how far along she is in her pregnancy, but Andrea said she’s 17 weeks.  Both of them want to know, “What do I do?” and “Should I be worried?”  Here are the short answers:  What should you do?  Call your provider and make an appointment.  Should I be worried? No, you shouldn’t worry, but I bet you will anyway. Let’s break down the reasons why pregnant women have spotting and maybe that will help alleviate a few fears.

First Trimester Spotting

About 20-30% of all pregnant women have a little bit of bleeding or spotting during the first trimester and most of them are not having miscarriages. Instead, they might be experiencing:

  • Implantation bleeding – when the fertilized egg finishes its journey through the fallopian tube and burrows into the uterine lining.
  • Cervical bleeding caused by fragile, super-filled teeny-tiny blood vessels that break with any kind of contact (AKA, sex) and sometimes with no contact at all.
  • Vaginal infection that makes vaginal tissues inflamed and irritated
  • Hormonal changes

If you’re not miscarrying, the spotting should stop on its own within a few hours (sometimes days) and chances are good it won’t start again.  If you are miscarrying, the bleeding will most likely increase. I’m sorry, honey, but there’s nothing your doctor or midwife can do at this stage of your pregnancy to stop it though they can provide medical care to make sure you’re physically OK throughout this sad experience.  About 20% of all pregnancies end in miscarriage (most before a woman knows she’s pregnant) and most happen in the first trimester.  My guess is that neither Judith nor Andrea are miscarrying, but I’m a bit more concerned about Andrea.

Second Trimester Spotting

At 17 weeks, Andrea’s in her second trimester when spotting is a little less common.  The reasons why spotting occur are most likely due to hormonal changes, a sensitive cervix or vaginal irritation, but it could also be caused by her placenta being too close to her cervix.  Andrea, it doesn’t sound to me like this is what’s going on because you describe such a scant amount of bleeding, but this is something you need to get checked out right away.  Your midwife or doctor will most likely want to do an ultrasound to evaluate your placenta.

Normally, the placenta is located on the uterine wall nowhere near the cervix. If your placenta is in a weird position and is encroaching your cervix, that means that some of the highly vascular tissue could be letting blood leak through your cervix.  While it’s probably not going to harm you or your baby, your midwife or doctor is going to want to keep a close eye on things, just in case the placenta has problems adhering to the uterine wall.  I know that sounds scary, but very often, as the uterus grows, the cervix repositions itself and the placenta no longer covers it.

If the placenta still partially or completely covers the cervix during the last weeks of pregnancy; that’s a rock solid reason for having a C-section.  You can’t deliver a baby vaginally if the placenta covers the cervix. Nope – Never.

Third Trimester Spotting

If spotting occurs late in your pregnancy, near your due date – congratulations, that might be bloody show and labor might be just around the corner.  It shouldn’t be heavy bleeding – nothing that soaks a pad.  It’s very often mixed with discharge and sometimes with gunky, chunky mucousy stuff that indicates the mucous plug is dissolving.  It’s gross and it’s messy, but it’s also kind of exciting.  Something’s going on down there.

Any spotting, whether it’s in the first, second or third trimester should be reported to your midwife or doctor.  Even if there’s not a lot they can do about it (when it happens very early in pregnancy) they can provide support, information and reassurance.   You’re going to need that.  Chances are very, very good that you and your baby are 100% fine, but it’s 100% normal to feel afraid and vulnerable.  Get the support you need from your healthcare providers, your partner, your family and friends.

Thanks for emailing.  Send your questions to and they might be answered here at The Labor Nurse – Since You Asked.


DISCLAIMER: Any information provided in this blog “The Labor Nurse – Since You Asked” is for educational purposes only.  It is not intended to be medical advice, nor does it replace care given by your health care provider. Please consult your health care provider when seeking medical advice.



The Labor Nurse – Since You Asked

I used to answer reader’s questions every week over on my column:  Fit Pregnancy’s Ask The Labor Nurse, but we’re changing things up over there. While I’m still writing Ask The Labor Nurse (eight years and counting), I’ll now answer reader emails right here on my own website

I’ve been talking and blogging women and men through the confusing, befuddling, disturbing, exhilarating and super funny parts of their pregnancies, births and parenting from pre-conception through the toddler years forever.  I’ve worked in women’s health, maternal health, newborn care and more for more than 30 years, 25 of those as a registered nurse.  I’ve been a mom to many for decades too, which adds to my arsenal of experience to draw from.

I’ve been writing about these topics and others for more than a dozen years for magazines, blogs, websites, newspapers and of course, in my book, The Complete Illustrated Birthing Companion. 

I know how complicated pregnancy can seem so I’ve written up My Simple Seven Tips For Having Your Best Pregnancy and Birth and made them available for free on my website.  Each week, I’ll tackle another question or two right here at  The Labor Nurse – Since You Asked and we’ll get through all of this together.  Feel free to email your questions to


Jeanne Faulkner