Bleeding In Pregnancy Is Serious, But It's Not Always Catastrophic

Over the last month, as the whole world watched via social media, Chrissy Teigen bravely shared her journey with excessive bleeding in mid-pregnancy. She bravely let us into her experience from bedrest to hospital stays and transfusions. Last week, millions of people mourned with Chrissy as she endured the tragic loss of her third child with husband John Legend.

Chrissy Teigen’s brave decision to share her complicated pregnancy and heartbreaking loss with the world has opened up an opportunity for an important conversation surrounding grief. Many people criticized her for sharing her experience publicly, but just as many reached out to thank her for bringing the grief of pregnancy loss into the light.

Her experience has also raised a lot of questions about second trimester bleeding. What can cause it? When should you call the doctor? Can everything end up okay?

No amount of education could have changed Chrissy Teigen’s situation. Her doctors did everything they could possibly do, and she did everything they asked. As heartbreaking as it is, some tragedies can’t be avoided. Life is so terribly unfair.

But even in the face of a tragedy, knowledge is power. That’s why education is important. The more of us that know the basics about bleeding in pregnancy, the more likely we can use that knowledge to encourage a pregnant person to seek care that could spare their baby’s life. I spoke to Natasha Spencer, MD, and OB-GYN with Orlando Health Physician Associates to get some answers to our most pressing questions.

When is bleeding in pregnancy normal?

This answer is tricky. Many times, bleeding is not a sign of catastrophe, but all blood should be investigated by your doctor.

“Bleeding during pregnancy can be a common event and it’s typically a maternal source, rather than fetal. However, it is a less common event in the second half of pregnancy,” reports Dr. Spencer.

According to the American College of Obstetricians and Gynecologists, some light spotting during pregnancy can be normal. Early on, it can be caused when the embryo implants into the uterine lining. As the pregnancy progresses, you might see a little light pink or brown spotting when the cervix is irritated by sex or a pelvic exam.

You might also have a condition called a subchorionic hematoma, which causes bleeding but is often not a danger to the baby.

During the first trimester, if the bleeding is very light, not accompanied by cramps and goes away quickly, it can often be benign. Of course, it can also be a sign of a miscarriage or molar pregnancy.

Which leads me to my next point…

When should I call my doctor?

The short answer? Any time you see blood. That’s the most important thing to know about bleeding during pregnancy: If you see any blood at all, your doctor needs to know.

“All bleeding should be addressed during pregnancy, but not all are concerning,” says Dr. Spencer. “Women should feel comfortable contacting their primary OB-GYN and staff to inform them about any vaginal bleeding that is occurring or has occurred. The significance and urgency of the incident will be determined by the staff and physician. They will manage accordingly depending on the circumstances and history of the pregnancy.”

If the bleeding is light or has stopped, and you’re not in any pain, you probably don’t need to skip straight to the ER. But waiting for a call back can be incredibly nerve-wracking—so here’s some information you can use to feel more confident.

According to the Mayo Clinic, during the first trimester, call your doctor within 24 hours of any bleeding that lasts longer than a day.

During the second trimester, “contact your health care provider the same day if you have light vaginal bleeding that goes away within a few hours,” or “contact your health care provider immediately if you have any amount of vaginal bleeding that lasts longer than a few hours or is accompanied by abdominal pain, cramping, fever, chills or contractions.”

During the third trimester, any bleeding, with or without pain, warrants an immediate call to your care provider.

When should I skip calling the doctor and head to the ER?

I’m answering this one from personal experience: When you feel strongly that something isn’t right, it’s better to be safe than sorry. It’s fine to seek immediate medical care if you feel “off.” You’d rather get care you don’t need than need care you don’t get, right?

As far as actual symptoms are concerned, if you are bleeding heavily or in any pain, don’t wait for a call back from your OB. You should never be the one to try to determine how much blood is cause for concern. A doctor should do that. Head to the ER to be safe, and call your regular doctor on the way.

What could be causing my bleeding in pregnancy?

Spotting and light bleeding can have a lot of benign causes. Second and third trimester bleeding can also be signs of early labor. Heavy bleeding could indicate a problem with the placenta.

Placenta previa is the term for a placenta that blocks the cervix. Placental abruption sounds catastrophic, but sometimes it means only a very small piece of the placenta has separated from the uterine lining. Bedrest and time might be all these two conditions need to resolve themselves.

“Placental insufficiency” occurs when the placenta doesn’t develop properly. Placenta accreta is the name for a placenta that implants too deeply in the uterine lining. These conditions can lead to some bleeding, too, usually in the third trimester. The “cure” for these conditions is often delivery.

As scary as all of these placenta issues sound, they are not always disastrous. Your doctor can help you determine how concerned you should be.

Science has given us a lot of options. Many times, even when you see blood, you have every reason to continue to hope.

According to Dr. Spencer, “Management depends on several factors such as the gestational age and fetal status, cause, and severity of bleeding as well. Bedrest, blood transfusions and hospitalization are the mainstay for treatment.”

When should I panic?

Never.

But take it from me and my anxiety disorder: I know this is almost impossible. If you are going to panic anyway, try to do it while you focus on taking some deep breaths and getting medical attention.

Mid-pregnancy bleeding is not always a sign of a catastrophe. You might be just fine. It’s important to keep that in mind while you’re waiting for answers.

“Not all bleeding results in terrible endings,” assures Dr. Spencer. “The risk depends on the amount of bleeding as well as the cause. The heavier the bleeding, the more likely the adverse outcome.”

Since second trimester bleeding can have some serious causes, such as a problem with the cervix, premature labor or an issue with the placenta, it’s important to take it seriously. Don’t allow anyone to downplay your symptoms. You have the right to adequate medical care, and if you feel something isn’t right, don’t stop asking for answers until you have them.

Any time you see blood while you’re carrying a baby you desperately want, it’s normal to be alarmed. While bleeding can be a sign of a serious complication, it can also be a signal that your body or your baby just need some attention. Your OB can help you figure out the source of the bleeding and your best course of action. If you see red blood, don’t lose hope for a healthy pregnancy and baby. Just call your doctor and ask how you should proceed.

Dr. Spencer reminds us, “Patients should keep their providers abreast of any bleeding and severity of bleeding. Try not to panic, as most causes are not disastrous.”

Even if you see blood, there’s a pretty good chance you and your baby are both just fine.