What's Normal, What's Not (And When to Call Your OB)

Common pregnancy symptoms like spotting and contractions can be harmless or signs of trouble. Here's how to tell the difference.


Early in her pregnancy, Deborah Johnson (not her real name) started having on-and-off light bleeding. "At first I was really freaked out," she recalls. "My immediate reaction was, 'Oh, this can't be good.' "

She called her doctor, who was concerned but calm. "She said she was going to play it safe by giving me progesterone, but that if the baby wasn't meant to be, no amount of progesterone was going to make a difference," Johnson says. Though the spotting continued throughout her entire first trimester, Johnson gave birth to a healthy baby boy six months later.

Few women pass through pregnancy without an anxiety-producing incident (or more) like this along the way. Fortunately, most go on to have normal pregnancies and healthy babies. While expectant moms with certain health conditions or a history of premature labor, or those who are carrying multiples, need to pay special heed when anything seemingly unusual occurs, most women can relax and let nature take its course.

We're here to help you do just that. The following are among the most common, and most distressing, pregnancy scenarios, with information about why you probably don't need to worry about them—and when you should. Keep in mind that these are only guidelines; call your doctor or midwife if you have questions or concerns specific to your pregnancy.

BLEEDING: Am I miscarrying?

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. While bleeding—especially when it's accompanied by cramping—is, unfortunately, one common sign of miscarriage, it often has other, more benign causes.

The most common has to do with implantation of the fertilized egg in the lining of the uterus, says Daniel Landers, M.D., a maternal-fetal medicine specialist at the University of Minnesota, Twin Cities. 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 expelled in early labor.

When to call your caregiver If you experience any bleeding at any time.

CONTRACTIONS: Am I in labor?

Why it happens Many pregnant women experience random uterine contractions, aka Braxton-Hicks contractions, after 24 weeks. These are irregular and sporadic, as opposed to real labor contractions, which occur at regular intervals and increase in frequency and intensity, Landers says.

When to call your caregiver If the contractions seem to be regular (e.g., every 10 minutes). Time them to be sure.

CRAMPING: Is my period—or a miscarriage—coming?

Why it happens Many women feel something akin to menstrual cramps very early in pregnancy. That achy heaviness is caused by increased blood flow to the uterus and other pelvic organs, and it's normal.

When to call your caregiver If you notice consistent cramping on only one side or if it's accompanied by bleeding; your doctor or midwife 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.

SWELLING: Am I going to explode?

Why it happens Hormonal changes cause pregnant women to retain excess fluid in their tissues. "This puffiness has little to do with how much or how little water or salt you ingest," says OB-GYN Richard Frieder, M.D., an assistant clinical professor at the UCLA School of Medicine.

When to call your caregiver If sudden swelling (especially in your feet, legs or hands) is accompanied by a headache, particularly after week 28; this may be a sign of preeclampsia, a dangerous high blood pressure condition.

UNUSUAL VAGINAL DISCHARGE: Do I have an infection?

Why it happens Your cervix is undergoing many normal changes that can result in unusual or even excessive mucus discharge, says Landers.

When to call your caregiver If burning, itching or a foul smell accompanies your vaginal discharge; you could have an infection.

DAMPNESS DOWN BELOW: Has my water broken?

Why it happens If you see a wet spot on your sheets or underpants, most 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 your caregiver If the wetness persists or seems excessive; your doctor will want to be sure you're not leaking amniotic fluid. This is a major concern after week 37 because it could trigger labor or lead to infection in the uterus.

It's when something scary happens that women are especially glad they made the effort to find a supportive caregiver. "It's critical to have a doctor who takes things seriously but doesn't completely freak you out either," says Deborah Johnson. "Right at the outset, mine told me that bleeding is just something that often happens in the first trimester, and she was right. Literally the day my second trimester started the bleeding completely stopped—for good. I felt like I could finally take a breath and enjoy my pregnancy."

How blue is too blue?

Pregnancy is "supposed" to be a blissful time, but just as many expectant women as nonpregnant ones suffer from depression: approximately 12 percent. Left untreated, it usually leads to postpartum depression. So seek help if you experience unusual fatigue; changes in appetite or sleep; lack of interest in normal activities; feelings of despair, hopelessness or guilt; or excessive crying. Safe treatments are available. For resources, go to postpartum.net.

Do you worry too much? How to beat the four biggest pregnancy stresses.