Although vaginal bleeding not uncommon early in pregnancy, particularly around the time of implantation, it is not really ‘normal’ as such. Implantation bleeding is usually very light (spotting at most), around the time of your expected period, or just before. If you get any bleeding after this, it is always important to get it checked out. If your blood group is Rhesus negative then you will need an injection to prevent problems in future pregnancies.
Bleeding later on in pregnancy comes from one of three places, and should always prompt you to contact your midwife or the hospital directly. Sometimes the placenta (afterbirth) is lying low, perhaps over the neck of the womb (os). After 28 weeks this is called a placenta praevia and bleeding can happen as Braxton Hicks contractions open the cervix slightly. Some hospitals will tell you at the 20 weeks scan if the placenta is low lying or not – others don’t routinely report on this.
Another cause of bleeding is if the placenta starts to come away from the uterus. This is called an abruption. Typically placental abruption is associated with pain over the uterus and very often there are contractions, too. It is a serious, but thankfully a relatively rare condition. Sometimes bleeding comes from the cervix itself, due to a small polyp or an ectropion (often called an erosion). These are quite benign but need to be confirmed to rule out other more serious problems. When no cause is found, the most likely site of the bleeding is from the edge of the placenta – a marginal bleed. As long as the bleeding settles and the rest of the placenta carries on working OK, it usually isn’t a major problem. Sometimes a brownish loss continues a few days after a marginal bleed.
2. Waters gone?
Its not always straightforward to say that they have gone. Some women have a great gush and it is unmistakable, but for others a general ‘wetness’ is felt with, perhaps, a little trickle. Other common things mistaken for the waters having gone include accidental loss of urine from the pressure of the baby’s head on your bladder, and a vaginal infection leading to a watery discharge.
Your midwife or doctor will probably suggest a speculum examination (like when you have a smear test done) if there is any doubt. This usually confirms or rules it out. At the end of pregnancy it is not too much of a problem, as labour usually starts in about 80% of cases, within 24 hours. Earlier in pregnancy, there is more of a risk of infection as well as premature delivery. You will need to be seen at the hospital and they will advise on a course of action, but most often it is best to try and delay delivery, as long as no infection is already present.
Many women experience pain over the womb during pregnancy, and it is a very difficult symptom about which to give general advice. The most common cause of pain is called ‘musculoskeletal’. As the word suggests, this arises from the muscles or bones and is so frequent because of the effects of the hormones of pregnancy on these tissues. Progesterone and relaxin are two hormones that make all the tissues much more stretchy and able to ‘give’. Whilst this prepares the pelvis for delivery, it also means that you can pull things more easily.
As mentioned above, placental abruption can lead to a constant pain over the uterus, often associated with contractions. Other causes of pain include: urinary infections and appendicitis. If a pain is so severe that it isn’t relieved by paracetamol and keeps you awake at night, then you should see your midwife or a doctor.
4. Vaginal discharge
Vaginal infections are quite common – the most frequent one is candida, or thrush. This has a whitish discharge and is often associated with itching & soreness. Other infections that can be detected by the swabs which your midwife or doctor can take include: bacterial vaginosis, chlamydia, gonorrhoea and trichomonas. Remember that an increased discharge is quite normal in pregnancy and does not always signify an infection. All of the above STI symptoms can be safely treated during pregnancy.
If you have a significant fall or are involved in a traffic accident, no matter how small, it is important to get a check-over by your midwife. Most falls where you don’t actually land on your bump are of little consequence apart from shaking you up at the time. If you land on your bump or hit it against something, or if you get pain in the womb or bleeding after a fall, you should be reviewed at the hospital sooner rather than later. Moderate or severe trauma can lead to an abruption. The hospital will check both you and the baby over – its very reassuring to hear the strong heartbeat after something like this.
If you get one-sided back pain or stinging or burning when you pass water, these are common symptoms of a urinary tract infection (UTI). Simple UTI’s in pregnancy are much more likely to progress to kidney infections during pregnancy and a midstream urine given to your midwife or doctor’s surgery can rule this out. A quick dipstick test might suggest a high likelihood of infection and antibiotics can be prescribed right away. Untreated UTI’s can cause premature labour. One common symptom of UTI’s outside of pregnancy is frequently needing to go to the toilet. Unfortunately this is very common in normal pregnancy anyway, so is a less reliable indication of infection at this time.
Pre-eclampsia is a blood-pressure related disease, unique to pregnancy. It is most common in first pregnancies or in women who have had it before. It is more common toward the end of pregnancy and this is the main reason that first-time mums have weekly checks at this time. Associated symptoms include: severe headaches, pain at the top or right side of the abdomen, visual disturbance such as flashing lights or stripes in front of the eyes, a muzziness in the head and generally not feeling right. Symptoms like these should be reported to your midwife right away.
8. Baby not moving
Most women get an idea of what is right for their babies. Some babies are more active during the day, some in the evenings and some a little bit all of the time. There is no need for a low risk mother to do a formal daily count of the movements, but if you notice a significant reduction in movements or don’t feel any for a day, it is advisable to contact your midwife or a midwife at the hospital. They will most likely advise a quick checkup and tracing of the baby’s heartbeat.
9. Regular check up
You don’t have to have a reason to see your midwife! She will plan a series of checks appropriate to your pregnancy that will ensure everything is progressing normally. Typically for a first-time mother this begins with monthly checks until about 32 weeks, fortnightly until 36 and weekly thereafter. Your midwife will be checking for your general well-being, blood pressure problems, growth and position of the baby. She will check your urine for signs of infection or the development of diabetes. As pregnancy progresses you can obtain advice on issues such as maternity leave, benefit entitlements, as well as the choices available for pain relief in labour. For most women the midwife will be your main caregiver during pregnancy.
This kind of goes without saying, but if you have any signs that might suggest labour before you are due then this should be ruled out. Braxton Hicks contractions are very normal, but they are irregular, mild and short-lived contractions. They may stop you in your tracks for a few seconds, but they shouldn’t last very long. If you find that you are getting pains that are increasing in intensity, coming more & more often or that are associated with any vaginal loss, then you should be seen at the hospital sooner rather than later!