First and foremost, it’s important to know that bleeding early on happens in a quarter of all pregnancies. Understandably most women who see bleeding are really upset and fear the worst – a miscarriage. I’m quick to reassure my patients, though, because in 80 per cent of cases the bleeding settles down and a healthy baby is delivered seven or eight months later. But that doesn’t mean you should ignore bleeding. The bottom line is that if you’re bleeding at any stage in your pregnancy you need to call your GP, midwife or obstetrician and let her know.

There are many different reasons you might see blood during your pregnancy. These include…

This type of bleeding is very light, with no pain. It happens as your embryo attaches to the lining of your uterus, usually between 10 and 14 days after fertilisation or, in other words, around the time your period is due. In fact a lot of women assume it’s just a very light period and are shocked to find they’re a whole month more pregnant than they’d first thought!

With all the extra oestrogen in your body, the cells of your cervix become more sensitive, making it more likely to see spotting after sex or an internal exam. Again, there will be light bleeding or spotting and no pain involved.

This is one of the most common causes of bleeding in early pregnancy and involves a collection of blood forming between the wall of the uterus and the placenta. The bleeding can be very light or pretty heavy, depending on the size of the haematoma, but is painless. It’s diagnosed by ultrasound and for small haematomas (which are the majority), the prognosis is fantastic. They usually just go away. However if you’re an older mum and the haematoma is large, you’re more likely to experience a miscarriage. You’re also at higher risk for placental abruption, premature labour and stillbirth. This all sounds terrible, but I’m usually very reassured that my patients and their unborn bubs will be fine.

What becomes concerning is when your bleeding turns painful. This is, I’m afraid, often – but not always – a sign that you are going to lose the pregnancy. The bleeding can become heavy and you might see some firmer tissues coming out as well. Most miscarriages happen in the first eight weeks of pregnancy. If you’re bleeding heavily and are having cramps, call your GP straight away.

Researchers have found some factors that make miscarriage more likely. These include being an older mum, smoking, drinking alcohol and possibly even coffee. This last one is controversial, but some studies have linked having two or more cups a day with miscarriage (though others haven’t). If you’re concerned about this, discuss it with your care provider. Other factors linked to miscarriage include low levels of human chorionic gonadotropin (hCG), medical problems such as poorly controlled diabetes, small foetal length on ultrasound and having a large amount of bleeding.

This is a rare condition where you have tissues that aren’t forming an embryo growing in your uterus. The bleeding is often dark and there is often severe nausea and vomiting, and you can also get crampy pain. Molar pregnancy is diagnosed with an ultrasound.

• Put on a pad and monitor how heavy the flow is and how often you’re changing the pad.
• Call your healthcare provider – she may order an ultrasound or tell you to come in, depending on how severe the bleeding is.
• Avoid intercourse until the bleeding has settled down and you’re given the all-clear by your midwife or doctor.
• If the pregnancy continues, studies suggest you’re at higher risk for other problems such as early labour, pre-eclampsia and having a small baby, so you’ll need closer monitoring during pregnancy.
• Some doctors I refer to still tell mums, especially mums at higher risk, to take some time off work and take it easy for a month or two. Some research suggests this mightn’t make much difference, but discuss

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