Spotting. Leaking. Cramps. These and other symptoms can be normal—or signs of trouble. Here’s how to tell the difference.
Six weeks into her second pregnancy, Kim Schuler Heinrichs thought all was lost. After learning she was pregnant, Schuler, now a mother of three in Allentown, Pa., started bleeding and cramping. "My husband and I were sure we were losing the baby," she says, "but soon the doctor found a heartbeat." A trouble-free seven months later, Schuler gave birth to a healthy girl.
Few women pass through pregnancy without an anxious moment (or more) like this along the way. Fortunately, most go on to have normal pregnancies and healthy babies. While women with special health conditions or a history of premature labor, or those who are carrying multiples, need to pay special heed when anything unusual occurs, most women can relax and let nature take its course.
We're here to help you do just that. The following are the most common concerns among pregnant women, with information about why you probably don't need to worry—and when you should. Keep in mind that these are only guidelines; call your doctor if you have questions or concerns specific to your pregnancy.
Why It Happens: Bleeding during pregnancy, especially in the first trimester, is fairly common. In fact, approximately 25 percent of women experience some spotting or heavier bleeding in the first 13 or so weeks; of those, more than half go on to have perfectly healthy babies.
Although bleeding—especially when accompanied by cramping—can be one sign of miscarriage, it often has other causes. The most common has to do with implantation of the egg in the lining of the uterus, says Daniel Landers, M.D., a maternal-fetal medicine specialist at the University of Minnesota, Twin Cities. Benign cervical polyps, which are fairly common whether you're pregnant or not, may also be to blame. Another potential cause is cervical bleeding, which can occur after intercourse in pregnant women with tender tissues. Finally, bleeding can occur when the mucus plug that seals the cervix is lost in early labor.
When To Call The Doctor: If you experience any bleeding, no matter when it happens.
Why It Happens: Many pregnant women experience random contractions, often called Braxton-Hicks contractions, after 24 weeks. These are normal as long as they are irregular and sporadic (as opposed to real labor contractions, which occur at regular intervals and increase in frequency and intensity). "Although no one knows for sure what purpose these contractions serve, the important difference between Braxton-Hicks contractions and the contractions of real labor is regularity," Landers says.
When To Call The Doctor: If the contractions seem to be regular (e.g., every 10 minutes). Time them to be sure.
Why It Happens: Many women feel something akin to menstrual cramps very early in pregnancy. (They often think their period is coming.) That achy heaviness is caused by increased blood flow to the uterus and other pelvic organs, and it's normal.
When To Call The Doctor: If you notice consistent cramping on only one side or if it's accompanied by bleeding (your doctor will need to rule out an ectopic pregnancy or ovarian cyst). Serious cramping in the second or third trimester is more worrisome, as it could indicate early labor.
Why It Happens: Hormonal changes cause pregnant women to retain excess fluid in their tissues; in addition, blood volume increases by 30 to 50 percent. Unfortunately, there's not much you can do about the puffiness.
"It has nothing to do with how much or how little water or salt you ingest," says OB-GYN Richard Frieder, M.D., a clinical professor at the University of California, Los Angeles School of Medicine. If your legs and feet are swollen, elevating them will help; so will swimming. Even sitting in a pool up to your chin will help redistribute the fluids in your body.
When To Call The Doctor: If sudden swelling is accompanied by a headache, especially after week 28; this may be a sign of preeclampsia, a dangerous high blood pressure condition.
Why It Happens: Your cervix is undergoing many changes that can result in unusual or excessive mucus discharge, says Daniel Landers, M.D.
When To Call The Doctor: If your vaginal discharge is accompanied by burning, itching or a foul smell; you could have an infection.
Why It Happens: When a pregnant woman sees a wet spot on her sheets or underpants, she thinks, "My water has broken!" But more likely, the moisture is only urine. Because the growing uterus puts pressure on the bladder, many women leak urine without realizing it.
When To Call The Doctor: If the wetness persists or seems excessive; your doctor will want to be sure you're not leaking amniotic fluid, which is a concern before the 37th week because such leakage could trigger labor or lead to infection in the uterus.
Besides her bleeding scare, Schuler admits she had other worries during her three pregnancies, including chronic vomiting with one and what she perceived as lack of movement in utero with two. "Now that I've had three perfectly healthy babies," she says, "I look back and realize I could have worried a lot less."