Bloody Show: What You Need To Know

As the end of pregnancy approaches, it is nearly impossible not to start symptom spotting, anticipating, and guessing when labor will begin and when you will meet your new baby. A due date is an estimate, but the mind games we play toward the end of the third trimester can be all-consuming. Every twinge leaves you wondering if you are having a contraction. Did your water break, or is that just pee or discharge?

The bloody show is one sign of impending labor many women hear of and look out for. A bloody show can indicate that your cervix has started to dilate in early labor. Still, it is essential to differentiate the bloody show from other, more concerning sources of bleeding. It is also necessary to know that is what you are looking at and what it could mean about the timing of your labor.¹

What is a Bloody Show?

A bloody show is a mixture of blood and mucus from your vagina before or during labor. As a common sign of labor in late pregnancy, you may also experience cramping, contractions, and pelvic pressure.¹

What is a Mucus Plug?

A bloody show is often confused with the mucus plug, which is understandable because they are similar. However, the mucus plug is a clump that fills the cervix during pregnancy, blocking the entrance to the uterus from the vagina. This prevents the migration of vaginal bacteria into the uterus, protecting your baby from infection.²

The mucus plug is expelled before or during delivery for the baby to exit through the vagina. If the mucus plug contains blood from the cervix, it is called a bloody show. If there is no blood, it is called the mucus plug.^1,3

What Does a Bloody Show Look Like?

As the name suggests, the bloody show can appear like blood-tinged mucus or resemble light vaginal spotting. It may be slimy and slippery, stringy, or jelly-like; it could also be thicker and more like a clump or plug. It may be passed in one blob or come out more gradually in your underwear or on toilet paper. Regardless of the texture, a bloody show will have a red, pink, or brown color, often mixed with clear or white mucus.^1,4

What Causes a Bloody Show?

The cervix is highly vascular, meaning it has many tiny blood vessels. Because of this, it is susceptible to irritation and change. When the cervix starts to ripen and dilate in preparation for labor, it is common for some tiny vessels to break or rupture and cause light bleeding. This blood mixes with cervical mucus and exits out of your vagina.^1,4

Since the cervix is so vascular, particularly in the last weeks of pregnancy, the bloody show can also be caused by other irritations to the cervix. These irritations include having sex, having a vaginal exam, or having your membranes swept or stripped.^1,4,5

What Does It Mean?

A bloody show means some blood vessels in your cervix have ruptured, causing light bleeding, and that blood has mixed with vaginal discharge or your mucus plug. This is normal. Because there are many causes of light cervical bleeding, passing your bloody show may or may not mean labor is imminent.¹

How Long After Passing Bloody Show Does Labor Start?

Depending on the cause of light cervical bleeding, a bloody show may or may not indicate that labor is near. If you recently had sex that caused light cervical bleeding, it may not indicate when labor will start. On the other hand, if your cervix dilating is what is causing the bloody show, you could already be in early labor. Cervical dilation may also cause loosening of the mucus plug, so if you pass a large chunk of mucus along with some blood, this could be a good indication that labor is very near.

One study showed that women experiencing preterm labor due to an incompetent cervix often report passing their mucus plug and then a sudden, notable increase in vaginal secretions, so having your bloody show and mucus plug could mean labor will start soon.⁶

The passing of the mucus plug and bloody show often precede term and preterm labor by a few days. However, the mucus plug regenerates and always consists of fresh mucus, so even if you pass your mucus plug, it can “grow back,” and you may still be pregnant for weeks.^3,6

What To Do If You Have a Bloody Show

Contacting your provider if you think you have passed your mucus plug or have a bloody show is never a bad idea. If you are full-term, they will probably tell you to monitor for increased bleeding, water breaking, or contractions. You are likely safe to continue with regular activity after you have passed your bloody show unless you think your water has broken. If you are preterm, your provider may want you to come in to make sure you are not going into labor too soon.

Keep an eye on the amount of blood you shed. Your bloody show should not exceed a tablespoon or two in volume and should not require you to wear a pad or liner. If you experience a moderate to a heavy amount of bleeding, contact your provider immediately for your and your baby’s safety.¹

Bloody show looks different for every woman and even from pregnancy to pregnancy for the same woman. Some women never see theirs, or it stays in place until the water breaks or the baby is delivered. Other women shed little bits of it for days or weeks before labor. Unfortunately, there is no magic way of knowing the hour that labor will start based on when you have it or you pass your mucus plug. However, it could be a good sign that labor is near. Differentiating the bloody show from other sources of bleeding is essential but can be difficult. Knowing what it is and what to look for can help.

Resources

1. https://my.clevelandclinic.org/21605

2. https://my.clevelandclinic.org/21606

3. https://www.ncbi.nlm.nih.gov/PMC7663572/

4. https://www.aafp.org/pubs/afp/2007/0415/p1199.html

5. https://www.ncbi.nlm.nih.gov/PMC7032890/

6. https://obgyn.onlinelibrary.wiley.com/doi/10.1080/00016340902852898