It can be frightening to experience surprise bleeding or cramping during your first few months of pregnancy. These symptoms always warrant a call to your doctor because they can indicate what's called a threatened miscarriage. This doesn’t mean that you’ll necessarily lose the pregnancy, but you are at higher risk. 

Some bleeding in early pregnancy is very common, so you're far from alone. Up to 1 in 4 women experiences vaginal bleeding during the first half of pregnancy, and about half of them will go on to have healthy pregnancies and babies.

What causes a threatened miscarriage?

It’s hard to know exactly why bleeding in early pregnancy happens. The most common cause of a miscarriage is a random genetic abnormality in the pregnancy. But bleeding itself can have many other causes such as:

  • Polyps or other lesions on the cervix
  • Intercourse
  • Bleeding around the pregnancy, which is called a subchorionic hematoma

What are symptoms of a threatened miscarriage?

It's hard to know on your own whether or not you are having a threatened miscarriage, which is why you should always contact your doctor right away. There are two key symptoms to look for:

  • Abdominal cramps
  • Vaginal bleeding

You can have one symptom without the other or both at the same time. You may also have:

  • Low-back pain or abdominal pain, which can feel dull, sharp, constant or occasional 
  • Tissue- or clot-like material that passes from your vagina

What happens if you’re diagnosed with threatened miscarriage?

If you do experience bleeding or cramping, see your health care provider immediately. He or she will perform the following tests:

  • A pelvic exam to check whether your cervix is open or closed and gauge bleeding 
  • An ultrasound to check for fetal cardiac activity 
  • Blood tests to check your body’s hCG levels over several days if it's too early for an ultrasound. If levels continue to rise, that’s a good sign your pregnancy is continuing. 

Remember, your pregnancy can sometimes progress normally even if you experience bleeding early on. The sooner you see your doctor, the faster you can get checked and prescribed treatment to help keep you and your baby healthy. Depending on the results of these tests, your provider may recommend the following:

  • Bed rest. Very few providers prescribe full-on bed rest these days, but they’ll usually recommend that you stay off of your feet as much as possible. This may mean lying down for an hour every few hours during the day, or, in some cases, being instructed to work from home so you can sit all day, and keep activities like going up and down stairs to a minimum. Your practitioner will discuss the plan that best fits you — and your baby’s — needs.
  • Pelvic rest. Sometimes, your provider just instructs you to give your pelvic area a break. Usually this means no sex and not inserting anything into your vagina.
  • Supplemental progesterone. If your progesterone levels are low, your provider may decide to try supplemental progesterone. You can get more progesterone through injections, suppositories or oral tablets. While past research on this treatment has been mixed, a review of ten studies found that it did increase live birth rates for women who experienced bleeding during early pregnancy.

If an exam shows that your cervix has opened or if there is no fetal cardiac activity, sadly there's no way to prevent the miscarriage, but know that you will most likely be able to get pregnant again in the future.

How to take care of yourself 

It can be scary, lonely and isolating if you experience bleeding in early pregnancy, especially if your provider puts you on bed rest. While lying in bed watching Netflix under doctor’s orders may sound nice at another time, you’re most likely worried sick. Some ways to cope include:

  • Keep active. If your doctor gives the green light to go on short walks or do some easy stretching, go for it. Light exercise can help boost mood and buffer some of the effects of stress.
  • Stay connected. Reach out to family and friends, whether it’s in person or via Zoom or text, so that you can vent to those who love you most.
  • Focus on a healthy diet. It’s tempting to alleviate your anxiety with food, but try to keep an eye on nonstop stress nibbling, and make sure you have healthy snacks handy. And if the stress makes you forget to eat, remind yourself to nosh on something wholesome. A well-balanced diet rich in whole and unprocessed foods like fruits, vegetables, fish, nuts, dairy and whole grains supports healthy bacteria in the gut, which in turn may help lessen anxiety.

If you do experience a miscarriage, it can feel devastating, even if you were very early on in the pregnancy. You can help cope by trying the following:

  • Take the time you need. Allow yourself to go through the entire grieving process, which can include feelings of denial, isolation, anger and depression before you arrive at acceptance.
  • Write about it. Journal all your emotions, especially the ones you don’t feel comfortable sharing with others.
  • Let go of guilt. It’s easy to beat yourself up about everything you ate or drank during your pregnancy, or that day you forgot to take your prenatal vitamins. Stop. Your miscarriage is not your fault.  

Although bleeding while pregnant is scary, it doesn’t automatically mean you will lose your pregnancy. Take a deep breath, call your doctor and follow whatever advice you receive.