What is bloody show

Bloody show is the small amount of blood mixed with mucus that is known as a ‘show’. While you are pregnant, a plug of mucus is present in your cervix. Just before labor starts, or in early labor, the plug comes away and you may pass this out of your vagina. This small amount of sticky, jelly-like pink mucus is called a ‘show’.

It may come away in one blob, or in several pieces. It is pink in color because it’s blood-stained, and it’s normal to lose a small amount of blood mixed with mucus. If you’re losing more blood, it may be a sign that something is wrong, so telephone your hospital or doctor straight away.

A show indicates the cervix is starting to open, and labor may follow quickly, or it may take a few days. Some women do not have a show.

The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus that is known as a ‘show’. This occurs when the plug of mucus that has sealed the cervix during pregnancy comes away. This is a sign that the cervix is changing and becoming ready for the first stage of labour to start. It may happen a few days before contractions start or during labor itself.

Bleeding during pregnancy is relatively common. However, bleeding from the vagina at any time in pregnancy can be a dangerous sign, and you should always contact your midwife or doctor immediately if it happens to you.

Bleeding is not often caused by something serious, but it’s very important to make sure and to find out the cause straight away.

Contact your doctor or midwife if you notice bleeding from your vagina at any time during your pregnancy.

In early pregnancy you might get some light bleeding, called ‘spotting’, when the fetus plants itself in the wall of your womb. This is also known as ‘implantation bleeding’ and often happens around the time that your first period after conception would have been due.

Causes of bleeding

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy (when the fetus implants outside the womb, often in the fallopian tube). However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.

In the later stages of pregnancy, vaginal bleeding can have many different causes. Some of the most common are outlined below.

Changes in the cervix

The cells on the cervix often change in pregnancy and make it more likely to bleed, particularly after sex. These cell changes are harmless, and are called ‘cervical ectropion’. Vaginal infections can also cause a small amount of vaginal bleeding.

Placental abruption

This is a serious condition in which the placenta starts to come away from the inside of the womb wall. Placental abruption usually causes stomach pain, even if there is no bleeding. If it happens close to the baby’s due date, your baby may be delivered early.

Placenta previa

Placenta previa, sometimes called a ‘low-lying placenta’, is when the placenta is attached in the lower part of the womb, near to or covering the cervix. This can block your baby’s path out of your body. The position of your placenta is recorded at your morphology scan.

If the placenta is near the cervix or covering it, the baby cannot get past it to be born vaginally, and a caesarean will be recommended.

Vasa previa

Vasa previa is a rare condition, occurring in about 1 in 3,000 to 1 in 6,000 births. It occurs when the blood vessels of the umbilical cord run through the membranes covering the cervix. Normally the blood vessels would be protected within the umbilical cord. When the membranes rupture and your waters break, these vessels may be torn and this can cause vaginal bleeding. The baby can lose a life-threatening amount of blood and die.

It is very difficult to diagnose vasa previa, but it may occasionally be spotted before birth by an ultrasound scan. Vasa previa should be suspected if there is bleeding and the baby’s heart rate changes suddenly after the rupture of the membranes. It is linked with placenta previa.

Miscarriage

A miscarriage (also known as ‘pregnancy loss’) can occur over a few hours, or it may occur over days or weeks. A miscarriage usually shows up as vaginal bleeding and lower tummy pain. It is important to see your doctor or go to the emergency department if you have signs of a miscarriage.

• A miscarriage is the loss of your baby before 20 weeks of pregnancy.
• The loss of a baby after 20 weeks is called a stillbirth.

Up to 1 in 5 confirmed pregnancies end in miscarriage before 20 weeks, but many other women miscarry without having realized they are pregnant.

The most common sign of a miscarriage is vaginal bleeding, which can vary from light red or brown spotting to heavy bleeding. If it is very early in the pregnancy, you may think that you have your period.

Other signs may include:

• cramping pain in your lower tummy, which can vary from period-like pain to strong labor-like contractions
• passing fluid from your vagina
• passing of blood clots or pregnancy tissue from your vagina.

If you think you are having a miscarriage, see your doctor or go to your local emergency department.

Many women experience vaginal spotting in the first trimester that does not result in pregnancy loss.

Finding out the cause of bleeding

To work out what is causing bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels. Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness.

If your symptoms are not severe and your baby is not due for a while, you will be monitored and, in some cases, kept in hospital for observation. You might have to stay in overnight, or until the birth, depending on the cause of the bleeding and how many weeks pregnant you are. This will enable staff to keep an eye on you and your baby so that they can act quickly if there are any further problems.

Bloody show vs Mucus plug

Bloody show is the small amount of blood mixed with mucus. Bloody show occurs when the plug of mucus that has sealed the cervix during pregnancy comes away. This is a sign that the cervix is changing and becoming ready for the first stage of labor to start. It may happen a few days before contractions start or during labor itself.

Mucus plug is a plug of mucus that is present in your cervix. Just before labor starts, or in early labor, the mucus plug comes away and you may pass this out of your vagina. This small amount of sticky, jelly-like pink mucus is called a ‘show’.

How long does bloody show last?

Bloody show may happen a few days before contractions start or during labor itself.

How long after bloody show does labor start?

Every woman’s labor is different. And your labor may be different each time you have a baby.

For most women, labor begins sometime between week 37 and week 42 of pregnancy. Labor that occurs before 37 weeks of pregnancy is considered premature, or preterm labor ¹.

Just as pregnancy is different for every woman, the start of labor, the signs of labor, and the length of time it takes to go through labor vary from woman to woman and even from pregnancy to pregnancy.

Bloody show and contractions

Table 1. Difference between Braxton Hicks and Real Contractions

Braxton Hicks contractions

Braxton Hicks contractions are called false labor or “practice” contractions that are common in the last weeks of pregnancy or earlier. Many women, especially first-time mothers-to-be, think they are in labor when they’re not. These contractions are called Braxton Hicks contractions. The tightening of your uterus might startle you. Some might even be painful or take your breath away. It’s no wonder that many women mistake Braxton Hicks contractions for the real thing. So don’t feel embarrassed if you go to the hospital thinking you’re in labor, only to be sent home.

Braxton-Hicks contractions soften and thin your cervix to help your body get ready for labor and birth. You may feel them in the weeks right before your due date. You may have Braxton-Hicks contractions on and off before true labor starts. Learning the differences between true labor contractions and false labor contractions can help you know when you’re really in labor. However, it can be hard to tell the difference between true labor and false labor. When you first feel contractions, time them. Write down how much time it takes from the start of one contraction to the start of the next. Make a note of how strong the contractions feel. Keep a record of your contractions for 1 hour. Walk or move around to see if the contractions stop when you change positions.

Braxton Hicks contractions:

• Are typically short
• Are not painful
• DO NOT come at regular intervals
• Are not accompanied by bleeding, leaking fluid, or decreased fetal movement

Real contractions (real labor)

In real contractions (real labor), your contractions will:

• Come regularly and get closer together
• Last from 30 to 70 seconds, and will get longer
• Not stop, no matter what you do
• Radiate (reach) into your lower back and upper belly
• Get stronger or become more intense as time goes on
• Make you unable to talk to other people or laugh at a joke

What is labor?

Labor is also called childbirth, is the process of your baby leaving the uterus (womb). You’re in labor when you have regular contractions that cause your cervix to change. Contractions are when the muscles of your uterus get tight and then relax. Contractions help push your baby out of your uterus. Your cervix is the opening to the uterus that sits at the top of the vagina. When labor starts, your cervix dilates (opens up).

As you get closer to your due date, learning the signs of labor can help you feel ready for labor and birth. If you have any signs of labor, call your health care provider.

What are stages of labor?

Labor is divided into three stages:

1. Labor
2. Pushing and birth
3. Delivery of the placenta

Every woman’s labor is different. And your labor may be different each time you have a baby. But there are patterns to labor that are true for most women. Learning about the stages of labor and what happens during each one can help you know what to expect once labor begins.

What happens in the first stage of labor?

The first stage of labor is the longest stage. For first-time moms, it can last from 12 to 19 hours. It may be shorter (about 14 hours) for moms who’ve already had children. It’s when contractions become strong and regular enough to cause your cervix to dilate (open) and thin out (efface). This lets your baby move lower into your pelvis and into your birth canal (vagina). This stage of labor ends when you are 10 centimeters dilated. The first stage is divided into three parts: early labor, active labor and transition to stage 2 of labor.

Early labor

For most first-time moms, early labor lasts about 6 to 12 hours. You can spend this time at home or wherever you’re most comfortable. During early labor:

• You may feel mild contractions that come every 5 to 15 minutes and last 60 to 90 seconds.
• You may have a bloody show. This is a pink, red or bloody vaginal discharge. If you have heavy bleeding or bleeding like your period, call your provider right away.

What you can do in early labor:

This is a great time for you to rely on your doula or labor support person. Try the methods you learned about in childbirth education classes about how to relax and cope with pain. During early labor:

• Rest and relax as much as you can.
• Take a shower or bath.
• Go for a walk.
• Change positions often.
• Make sure you’re ready to go to the hospital.
• Take slow, relaxing breaths during contractions.

Active labor

This is when you head to the hospital! Active labor usually lasts about 4 to 8 hours. It starts when your contractions are regular and your cervix has dilated to 6 centimeters. In active labor:

• Your contractions get stronger, longer and more painful. Each lasts about 45 seconds and they can be as close as 3 minutes apart.
• You may feel pressure in your lower back, and your legs may cramp.
• You may feel the urge to push.
• Your cervix will dilate up to 10 centimeters.
• If your water hasn’t broken, it may break now.
• You may feel sick to your stomach.

What you can do in active labor:

• Make sure the hospital staff has a copy of your birth plan.
• Try to stay relaxed and not think too hard about the next contraction.
• Move around or change positions. Walk the hallways in the hospital.
• Drink water or other liquids. But don’t eat solid foods.
• If you’re going to take medicine to help relieve labor pain, you can start taking it now. Your choice about pain relief is part of your birth plan.
• Go to the bathroom often to empty your bladder. An empty bladder gives more room for your baby’s head to move down.
• If you feel like you want to push, tell your provider. You don’t want to start pushing until your provider checks your cervix to see how dilated it is.

Transition to the second stage of labor

This can be the toughest and most painful part of labor. It can last 15 minutes to an hour. During the transition:

• Contractions come closer together and can last 60 to 90 seconds. You may feel like you want to bear down.
• You may feel a lot of pressure in your lower back and rectum. If you feel like you want to push, tell your provider.

What happens in the second stage of labor?

In the second stage of labor, your cervix is fully dilated and ready for childbirth. This stage is the most work for you because your provider wants you to start pushing your baby out. This stage can be as short as 20 minutes or as long as a few hours. It may be longer for first-time moms or if you’ve had an epidural. And epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It’s the most common kind of pain relief used during labor. The second stage ends when your baby is born.

During the second stage of labor:

• Your contractions may slow down to come every 2 to 5 minutes apart. They last about 60 to 90 seconds.
• You may get an episiotomy. This is a small cut made at the opening of the vagina to help let the baby out. Most women don’t need an episiotomy.
• Your baby’s head begins to show. This is called crowning.
• Your provider guides your baby out of the birth canal. She may use special tools, like forceps or suction, to help your baby out.
• Your baby is born, and the umbilical cord is cut. Instructions about who’s cutting the umbilical cord are in your birth plan. What you can do:
• Find a position that is comfortable for you. You can squat, sit, kneel or lie back.
• Push during contractions and rest between them. Push when you feel the urge or when your provider tells you.
• If you’re uncomfortable or pushing has stopped, try a new position.

What happens in the third stage of labor?

In the third stage of labor, the placenta is delivered. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. This stage is the shortest and usually doesn’t take more than 20 minutes.

During the third stage of labor:

• You have contractions that are closer together and not as painful as earlier. These contractions help the placenta separate from the uterus and move into the birth canal. They begin 5 to 30 minutes after birth.
• You continue to have contractions even after the placenta is delivered. You may get medicine to help with contractions and to prevent heavy bleeding.
• Your provider squeezes and presses on your belly to make sure the uterus feels right.
• If you had an episiotomy, your provider repairs it now.
• If you’re storing your umbilical cord blood, your provider collects it now. Umbilical cord blood is blood left in the umbilical cord and placenta after your baby is born and the cord is cut. Some moms and families want to store or donate umbilical cord blood so it can be used later to treat certain diseases, like cancer. Your instructions about umbilical cord blood can be part of your birth plan.
• You may have chills or feel shaky. Tell your provider if these are making you uncomfortable.

What you can do:

• Enjoy the first few moments with your baby.
• Start breastfeeding. Most women can start breastfeeding within 1 hour of their baby’s birth.
• Give yourself a big pat on the back for all your hard work. You’ve made it through childbirth!

What are the signs of labor?

You know you’re in true labor when:

• You have strong and regular contractions. A contraction is when the muscles of your uterus tighten up like a fist and then relax. Contractions help push your baby out. When you’re in true labor, your contractions last about 30 to 70 seconds and come about 5 to 10 minutes apart. They’re so strong that you can’t walk or talk during them. They get stronger and closer together over time.
• You feel pain in your belly and lower back. This pain doesn’t go away when you move or change positions.
• You have a bloody (brownish or reddish) mucus discharge. This is called bloody show.
• Your water breaks. Your baby has been growing in amniotic fluid (the bag of waters) in your uterus. When the bag of waters breaks, you may feel a big rush of water. Or you may feel just a trickle.

​If you think you’re in labor, call your health care provider, no matter what time of day or night. Your provider can tell you if it’s time to head for the hospital. To see for sure that you’re in labor, your health care provider measures your cervix.

What are signs that you may be close to starting labor?

You may be close to starting labor if:

• Your baby drops or moves lower into your pelvis. This is called lightening. It means that your baby is getting ready to move into position for birth. It can happen a few weeks or even just a few hours before your labor begins.
• You have an increase in vaginal discharge that’s clear, pink or slightly bloody. This is called show or bloody show. It can happen a few days before labor starts or at the beginning of labor.
• At a prenatal checkup, your health care provider tells you that your cervix has begun to efface (thin) and dilate (open). Before labor, your cervix is about 3.5 to 4 centimeters long. When it’s fully dilated (open) for labor, it’s 10 centimeters. Once labor starts, contractions help open your cervix.
• You have the nesting instinct. This is when you want to get things organized in your home to get ready for your baby. You may want to do things like cook meals or get the baby’s clothes and room ready. Doing these things is fine as long as you’re careful not to overdo it. You need your energy for labor and birth.

If you have any of these signs, you may start labor soon. Learn the signs of labor so you know when to call your doctor.

1. Fleischman, A. R., Oinuma, M., & Clark, S. L. (2010). Rethinking the definition of “term pregnancy.” Obstetrics and Gynecology, 116(1), 136–139.[↩]