• The Fit Midwife

Spot the difference….. All you wanted to know about spotting and bleeding in pregnancy.

There is no doubt that when you are pregnant and see any sign of bleeding in any way, shape or form your mind goes into panic mode. Of course it does!! Everything is scary when you are trying to grow a tiny human. Especially if you have suffered a loss of any kind before.

So this post is designed for you to arm yourself with the knowledge that allows you to recognise normal from abnormal. And when to seek help! This post was in answer to a question from a lovely lady asking if “brownish discharge was normal in early pregnancy”.

So let’s talk numbers first….. spotting (literally meaning light spots of brown, pink, red blood on wiping or on a pad/underwear) occurs in nearly one third of all pregnancies with absolutely no bad outcomes for mum or baby! So below are a few of the reasons you may be spotting in pregnancy….

  • Implantation bleeding: This is the most common and happens around 4-5 weeks into pregnancy. This happens when the fertilised egg implants and attaches to you uterus wall. It nestles in to the soft lining and as a result cells and tissue sheds slightly and this causes a small amount of pinkish/brownish spotting.

  • Sex: If you’ve recently done the deed, there can be pinkish spotting. Usually from the cervix. Remember blood flow to these areas now is increased!

  • Internal Exam: if you have had an examination/speculum from the doctor or midwife then this can cause the same irritation and spotting. Especially if you are later in pregnancy, vaginal examinations become more frequent.

  • Infection: If the spotting is accompanied by foul smelling or strange coloured discharge, or pelvic pain then consider being checked by the doctor for any infections.

  • EARLY LABOUR: This is a good sign, when you have had a low risk, trouble free pregnancy, it could be your show. This is often a couple of spots of pinkish blood, or very red but mucousy/jelly like discharge. Seek advice if you are before 37 completed weeks!

Some slightly more serious complications could be:

  • Chemical pregnancy: known as a missed miscarriage. This occurs when the egg never fully implants but hormonal changes show on a pregnancy test.

  • Miscarriage: Usually this bleeding is bright red, fresh blood, usually with clots and heavy like a period. This is accompanied by abdominal cramps and pain.

  • Ectopic Pregnancy: Occurs when the fertilised egg implants somewhere other than the uterus, usually in the fallopian tube causing a rupture. This requires immediate attention. Though bleeding is common it is often accompanied by feeling unwell, nausea, fever. And with intense shoulder or abdominal pain.

  • Placenta Praevia: when the placenta covers the cervix partially or completely

  • Placental abruption: When the placenta comes away from the wall of the uterus. This is a very serious condition that requires immediate attention. It usually causes severe vaginal bleeding. Don’t be so concerned with this one (it happens only in about 1% of all women).

So what is the actual difference with the lists above??? One describes spotting. The second list, the more severe list, describes bleeding! They are so very different. Now I am by no means saying don’t act on what you see. This guide is to help you NOT TO PANIC! I still advocate calling your OBGYN or midwife and just chatting it through with them just to confirm what you already know from reading above!

If you feel unwell, not yourself or are really concerned about any vaginal bleeding then please do go and see a Doctor or Midwife. If you are experiencing heavy bleeding from the vagina then GO TO THE EMERGENCY ROOM! Heavy blood loss is not normal.

So just to reiterate the differences between SPOTTING and BLEEDING I have found some visual aids…. Sorry, its not pretty, but it helps!!


LIGHT SPOTTING (After sex or a vaginal examination):


MUCOUS/BLOODY SHOW (Early labour):


Any HEAVY, FRESH RED bleeding is abonormal and needs immediate attention. The below pictures are all abnormal bleeding for pregnancy!



  • Soaking a maternity pad, soaking through clothes

  • Blood running on to floor

  • Soaking bedsheets


So now you can call your Doctor or Midwife and explain to her that you are “spotting” or “bleeding”. This changes the course of treatment and the advice we give you.


Spotting is normal and harmless in pregnancy following vaginal examinations and sex. Always advise your Doctor or Midwife but use the term spotting. Call them up, talk them through what is happening and they can give you the best advice. Me….. I advise to put a clean pad on, take it easy and monitor the spotting. If it gets worse, go to hospital. If it resolves then keep on maintaining your healthy pregnancy!

If you are bleeding please seek immediate attention, no matter how far along you are. Real vaginal bleeding in pregnancy is never normal and always needs to be investigated. If you are bleeding heavily then call an ambulance (like you would for any heavy bleeding).

So, even thought any sign pink, brown or red on your underwear or pad causes such fear, do not panic. Spotting is normal and common and does not mean miscarriage when it appears.

As always, message me with any questions :)

The Fit Midwife xx


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