Vaginal Discharge in Pregnancy: Normal or Not?

You change your underwear twice a day, check the colour and wonder whether it is normal. Vaginal discharge in pregnancy worries many mums-to-be, especially when it becomes heavy. In the vast majority of cases it is perfectly normal, and it even has a protective role.

Still, you need to be able to spot three situations: thrush, bacterial vaginosis and, above all, a leak in the bag of waters, which can look like discharge. Here is how to tell them apart, and the hygiene habits that really help.

Why do you have more discharge when pregnant?

Because of hormones. Quebec's INSPQ explains that vaginal discharge, also called leukorrhoea, is often heavier during pregnancy, and that it is usually whitish, sticky and odourless. The UK's NHS adds that it helps stop infections from travelling up to the womb.

It increases further as your due date approaches. In the last week it may contain sticky mucus, pinkish or streaked with blood: this is the mucus plug coming away, a sign that your body is getting ready for labour.

How can you recognise normal discharge?

Normal discharge has three features, according to the French National College of Gynaecologists and Obstetricians (CNGOF) and the NHS:

• it is thin or slightly sticky, clear or milky white;
• it has no unpleasant smell;
• it comes with no burning and no itching.

If that describes yours, there is nothing special to do, apart from wearing cotton underwear and changing it as often as needed.

Normal discharge, thrush, vaginosis, amniotic fluid: a quick guide

Thrush during pregnancy: why, and what to do

Vaginal thrush is caused by a fungus, Candida albicans, which normally lives in the vagina. The CNGOF explains that placental hormones encourage it to multiply: that is why thrush is more common in pregnancy. It causes thick white discharge, a red and irritated vulva, itching and sometimes painful sex.

It responds well to treatment, usually a local one: a cream, a pessary or a vaginal tablet. But the NHS stresses that some thrush medicines are not suitable during pregnancy. So do not reuse treatment from an old prescription and do not buy one on your own: ask your doctor, midwife or pharmacist first, telling them how many weeks pregnant you are. The French National Health Insurance also states that pregnant women need follow-up until the birth, to check that the infection has cleared and has not come back.

Bacterial vaginosis: a fishy smell not to ignore

Bacterial vaginosis comes from an imbalance in the vaginal flora. It causes thin, greyish discharge with a strong fishy smell, often more noticeable after sex. The NHS points out that half of the women affected have no symptoms, and that it does not usually cause pain or itching.

During pregnancy it needs to be treated: the NHS says it carries a small risk of complications, such as premature birth or miscarriage, although most pregnancies go ahead without problems. Your doctor can take a vaginal swab to identify the germ and prescribe the right treatment. For your love life during this time, see our article on sex during pregnancy.

Discharge or amniotic fluid: how can you tell?

This is the real question, especially in the third trimester. Amniotic fluid is clear and pale and can look like urine. According to the NHS, it comes out either as a slow, steady trickle or as a sudden gush that you cannot hold back. It may be slightly tinged with blood at first.

A few practical pointers:

1. Put on a sanitary pad, not a tampon, as the NHS advises.
2. Check it: if it gets wet again and again with clear, runny fluid, think of your waters.
3. Look at the colour and smell: green, brown, foul-smelling or bloody fluid must be reported straight away.

If in doubt, the maternity unit can check whether it is amniotic fluid: a wasted trip is better than a leak that goes unnoticed. Before 37 weeks, leaking fluid is a warning sign, the INSPQ reminds us: the other signs are detailed in our article on threatened preterm labour. At term, everything you need to know about when to go to the maternity unit is in the signs that labour is starting.

Intimate hygiene when pregnant: the right habits

The less you do, the healthier your flora. The advice from the French National Health Insurance, the CNGOF and the NHS all points the same way:

• wash the outside only, once or twice a day, with water and a mild product;
• never douche, use intimate deodorants or wash inside the vagina: the NHS advises against it, because it upsets the flora;
• no scented products: scented soaps, shower gels or bubble baths cause irritation;
• cotton underwear, not too tight, washed without harsh detergent;
• showers rather than long baths if you are prone to vaginosis, according to the NHS.

At the hammam (the traditional steam bath), the same principles apply: mild soap on the outside, nothing inside, and spotless hygiene for your towel and sandals. For heat and pregnancy-specific precautions, read our article on going to the hammam while pregnant.

After the birth, discharge changes: this is lochia, bleeding that lasts several weeks. Postpartum intimate care, with a few practical products, is gathered in our new mum hygiene section.