Implantation bleeding

Implantation refers to when the fertilised egg attaches itself to the wall of the womb, and it occurs around the same time your period would’ve been due. Some women experience implantation bleeding around 8 weeks into their pregnancy, and it tends to show up as spotting/ light bleeding that you’ll likely become aware of after wiping when you use the toilet. “During the first trimester, many women will experience some sort of bleeding”, explains Abbas Kanani, pharmacist at Chemist Click. “This is caused by implantation, when the fertilised egg implants itself into the womb. This type of bleeding can last for a few days and is often mistaken for a light period. Other common causes can include infection, as the flora inside the vagina changes. This is not life threatening to the mother or baby and your doctor will advise whether antibiotics are required. Your immune system may even be able to clear the infection without treatment.”

Blood clot around the sac

Another potential reason why women may discover blood during their pregnancy is due to blood clotting around the sac. This manifests as a mass of blood situated between the placenta and the uterus walls, and although it’s not quite understood why it happens, it can be alarming for pregnant women although it doesn’t signal an impending miscarriage. Michelle Swer, consultant gynaecologist at London Gynaecology says, “Blood clots around the sac are often seen on a scan and does not usually affect the pregnancy but can lead to bleeding until the sac resolves. The bleeding usually turns brown in colour in keeping with old blood. She continues, “It is important that any bleeding especially as a first occurrence, or if you have a known underlying placental complication, is investigated to ensure it is not something more serious and that there is no need for further investigations or management.”

Cervical changes

When we become pregnant our body goes through so many changes, one of which is changes to our cervix that becomes softer and has a richer blood supply. This, as a subsequence, can often lead to bleeding. “During pregnancy, your body experiences changes, including changes to the cervix, where more blood vessels grow” says Abbas Kanani. “This can cause the cervix to bleed more easily during pregnancy.”

Early pregnancy problems

Sadly, bleeding during pregnancy can also be an indicator of an impending miscarriage, and this will occur in 1 in 4 women. “Bleeding with pain is associated with miscarriage”, says Michelle Swer. “This can be identified on a scan or women may need more than one scan to confirm the diagnosis. It is also important to rule out an ectopic pregnancy which is when the pregnancy implants outside the womb. As you can see there are a number of reasons for bleeding in pregnancy but the one that causes the greatest anxiety is the risk of miscarriage and rightly so. The ordeal women go through when bleeding due to a miscarriage varies so much hence it has been difficult to make sure that all accounts are taken into consideration. However, I feel it is important that each presentation is acknowledged, and women should be aware of each end of the spectrum so they can know when to seek advice in a timely fashion.”

Causes of bleeding in late pregnancy (24 weeks onwards)

Bleeding is rare during the 2nd trimester, but during the 3rd, there are three conditions that are uncommon but are still worth noting so that women are aware of them. Michelle Swer, consultant gynaecologist at London Gynaecology, outlines them.

Low lying placenta.
This is when the placenta lies low in the womb close or lying over the cervix. This will be identified on scan usually at 20 weeks and women will have a repeat scan to identify where the placenta is closer to delivery. Any bleeding in a woman diagnosed with a low-lying placenta should be seen by a doctor to ensure there is no risk of delivery which would not be suitable naturally.

Placenta Accreta Spectrum.
This occurs when the placenta attaches deep through the muscle wall and does not easily detach. This is also identified on a scan and urgent review is needed if there is bleeding in women diagnosed with this presentation.

Abruption of the placenta.
This is when the placenta comes away from the womb and is a serious and acute condition. There is often pain and bleeding and women should seek urgent medical advice.

Louise Hinton, Lead Nurse at Kari Health says, “It’s extremely common, actually 1 in 5 women experience a level of anal incontinence after a vaginal delivery, ranging from a few embarrassing “accidents” to lifelong OASI (Obstetric Anal Sphincter Injuries). This will be temporary for some as they recover control after pelvic floor trauma, which can stem from pushing or stretching during labour. But for others who suffer nerve damage or sphincter injuries, it could be permanent. Your pelvic floor looks like the number 8 and controls both your vaginal opening and anus. Doing pelvic floor exercises is vital to reducing the chance of this happening and improving the condition. Faecal incontinence can be worse if you don’t eat enough fibre, drink too much alcohol and caffeine and don’t stay hydrated. Some women will have a dietary trigger, which can worsen it, and some will have no warning whatsoever. Establishing a bowel habit can help, but not in all cases. If you are experiencing anal incontinence, speak to your GP, Midwife or Health Visitor and ask for a referral to a physiotherapist who can help with pelvic floor injuries. You can also talk to an Obstetrician/Colorectal surgeon who deals with sphincter injuries and nerve damage to see what can be done.”

Kari Health‘s Integrative Counsellor and Psychotherapist Chloe Pollock says, “Also known as ‘baby blues’, low feelings commonly occur 3-5 days after birth and typically last 2ish weeks. You might experience unexplainable crying over small triggers, significant mood swings or be noticeably irritable. There may also be higher worry and anxiety. Roughly 80% of mothers will experience this, and it’s due to changes in hormone levels, tiredness, changes in routine and feeling overwhelmed. Simple things like eating well, resting as much as possible and doing something you love can all help. You might not be getting enough sleep, but you can look after yourself with self-care.

Louise Hinton, Lead Nurse at Kari Health, says, “It’s so normal to feel clunky after giving birth. And many women find that they continue to look pregnant for a few weeks. This is because it takes this time for the funds (the top of your uterus) to descend back into the pelvic cavity. It is an excellent idea (for weight loss and mental health) to do exercise post-partum. However, waiting until 3 – 6 months post-delivery is advised to allow for any internal and external healing. Running too soon can cause incontinence, injury or prolapse. So please don’t rush! Extra caution is needed to avoid injury for those who did not run pre- or during pregnancy. During pregnancy, the hormones relaxin and progesterone increase, allowing your ligaments to become looser to accommodate and support your body shape and size change. It takes 6 – 12 months for the ligaments to return to normal, so therefore some women find exercise more difficult post-partum, especially high impact or core strength workouts.”

Kari Health Psychotherapist Chloe Pollock says, “Bonding can be immediate for some, but for others, it can take time. And this is entirely normal. The process isn’t linear. You may find the attachment grows as you provide care for your newborn. Having a c-section or having a traumatic birth, which meant you did not get to see your newborn straight after birth, can make the bonding process challenging. Post-partum depression can also impact the mother’s ability to bond with their child. Challenging family dynamics can also be a factor. Bonding occurs in many ways, like skin-to-skin touch, feeding time, breastfeeding, and general care like bathing or rocking them to sleep. The love you have for your child grows and grows, and it’s ok if you don’t feel an instant rush of love. If a few months have passed and you still feel a lack of connection, speak to your GP or Health Visitor, and they can determine if a psychological or health issue may be playing a part in the challenges.”

Nurse and Midwife, Jasmine Sneyd says, “Hormone levels are high during pregnancy, and after birth, they decline. This fluctuation and your body’s attempt to regulate itself leads to night sweats. The most apparent sign of post-partum night sweats is waking up from sleep drenched or soaked in sweat. It’s completely normal and should only last a couple of days. You might get a mild fever when you first start producing milk, and it happens because the breasts can swell too much and become inflamed when your milk starts to come in. However, there are a few reasons why you might have a high temperature after birth, and it’s always best to get checked out by your GP or midwife, especially if you’ve had a c-section.”

Midwife Jasmine Sneyd says, “When one resumes personal and sexual relationships is a very individual and often cultural decision”, so please don’t feel there’s a rush. “Due to hormone changes during pregnancy and after birth, vaginal dryness may occur. It is important to have a postnatal check-up so you can discuss any concerns with a Midwife but try not to worry as it does take time. When you want to have sex and you’ve been given the go-ahead, a lubricant can moisten the area if you’re experiencing dryness. And your pelvic floor exercises are essential in this area too! As they can help with sexual health by bringing a good blood supply to the area.” And all of the things that help improve your emotions can also help here! If you’re happy and well-nourished, you’ll be far more likely to want to get it on with your partner.”