Is It a Miscarriage?

If I were to write a movie script about my experience with pregnancy, I would be tempted to title it There Will Be Blood. But that’s already taken. So maybe I’ll go with What I Never, Ever Expected While Expecting.

The one constant in each of my pregnancies has been heavy bleeding. There’s nothing like the sight of blood when you’re pregnant to send you into a full-on panic, but it’s comforting to know you’re not alone — about 30 percent of women experience some form of bleeding in the first trimester, and about half of them go on to have normal pregnancies, while the other half suffer miscarriages. I’ve been on both sides of the statistics: my first two pregnancies ended in miscarriage, while the third is healthy and due to arrive any day now.

Throughout my pregnancies, I sought out as much information as I could about what causes bleeding during pregnancy. I had countless conversations with three different obstetricians and one reproductive endocrinologist — and did perhaps way too much Internet research in my hunt for reassuring information. Here’s the bottom line: If you see blood, call your doctor as soon as possible. Try not to panic. Wear a pad so that you can monitor how much you’re bleeding, and lie down while you wait to see your doctor. If you end up bleeding through a maxi pad every hour, head straight to the emergency room.

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There are many reasons bleeding can occur in pregnancy. While it’s always best to consult with your doctor if you suspect something is wrong, here are some possible scenarios:

1. Implantation Bleeding. If it’s very early in your pregnancy, you could be experiencing implantation bleeding (anywhere from 6-14 days after conception). Implantation bleeding happens when the fertilized egg burrows into the lining of the uterus. The bleeding is typically lighter than your period, and about one-third of pregnant women experience this type of bleeding. Some will lightly spot for a few hours while others may bleed for a few days.

2. Sensitive cervix. If you’ve recently had sex, a pelvic exam, or a transvaginal ultrasound, your cervix might be irritated, causing light bleeding, with dark-red or brownish-colored blood. If you experience this type of bleeding, consult with your doctor and discontinue intercourse until your doctor has seen you in order to prevent further discomfort.

3. Miscarriage. One out of every four known pregnancies ends in miscarriage, and the reason it happens is most often out of the pregnant woman’s control. (Often it happens so early that a woman may not even realize she was pregnant.) The majority of miscarriages occur during the first 12 weeks of pregnancy, and the signs include bright-red bleeding and pain similar to menstrual cramps. Personally, my first miscarriage happened at 10 weeks and the second at 8 weeks. In both cases, the bleeding started with a dark-brownish blood for a few days and continued with bright-red blood. Before you assume you’re having a miscarriage, visit your doctor so he or she can check for the fetal heartbeat.

If you do suffer a miscarriage, do not blame yourself. Miscarriages occur for a variety of reasons, including hormonal imbalances or an infection that takes place early in development. More than half of all miscarriages are caused by chromosomal abnormalities in the fetus. After my second miscarriage, I was so devastated that I sought out a local support group through Resolve: The National Infertility Association. The group gave me invaluable support and helped me realize that I didn’t have to grieve through my miscarriages alone.

4. Subchorionic hemorrhage. At the beginning of my third pregnancy, I was more paranoid than ever. I took as many naps as possible, ate only the healthiest food, and tried to remain calm. I saw my doctor every week, and he confirmed the heartbeat each time. Despite my precautions, at 8 weeks I found myself bleeding bright-red blood and immediately assumed I was having another miscarriage. When I visited my obstetrician, he confirmed that the fetal heartbeat was there and said the baby was fine. My doctor ended up diagnosing me with a subchorionic hemorrhage, or a blood clot that forms between the uterine wall and the chorion that surrounds the baby.

These hematomas, or clots, form in as many as 20 percent of pregnancies and can cause a host of problems — or none at all. In the first trimester, the hematoma can separate the placenta from the uterine wall, causing a miscarriage, or it can heal naturally on its own. If the hematoma doesn’t heal by the third trimester, it can cause placental abruption or preterm labor. If you are diagnosed with a subchorionic hemorrhage, your doctor will likely monitor it with ultrasounds. In my case, the hematoma was small, and I bled for about two weeks as it healed. My doctor advised a lot of rest and continued to monitor me with weekly ultrasounds. The hematoma healed completely by 10 weeks, and I’m now 39 weeks along with the same pregnancy: a soon-to-be baby boy.

5. Placenta previa. In most pregnancies, the placenta attaches to the top or sides of the uterus, but in 1 in every 200 pregnancies the placenta will attach low in the uterus, partially or completely covering the cervix. This condition is known as placenta previa. It can cause bleeding that generally occurs after movement and isn’t typically accompanied by abdominal pain. Your doctor will diagnose placenta previa via ultrasound and might prescribe bed rest and limitations on physical movement and sex. If necessary, a C-section may be scheduled in order to deliver the baby safely.

Pregnancy is a time that involves so much joy and fear, and bleeding can be one of the most anxiety-inducing symptoms. If you’re bleeding at all, just call your doctor to be on the safe side. Throughout my three pregnancies, I’ve learned that much of the process of gestating another human is out of my control. While I still worry at times, my experience and knowledge help me through the uncertain moments — and I’ve never been more grateful for a healthy pregnancy.

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