Falling in Pregnancy: When to Worry

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Falling while pregnant is scary. Even a tiny slip in the kitchen can send your brain straight to "IS THE BABY OKAY," followed closely by "do I actually need to call someone about this, or am I being dramatic?"

So let me answer that second one first: call. After any fall during pregnancy, call your OB provider or midwife (or your hospital's labor & delivery unit) and let them decide whether you need to be seen. If you're bleeding, leaking fluid, having contractions or belly pain, or baby isn't moving like normal, skip the phone tag and go in (or call 911 if it's serious). Falls are really common in pregnancy, and your baby is pretty well protected in there. But some problems aren't obvious right away, and that's the whole reason the check-in matters.

Below I'll walk through what to do right after a fall, when to go in, what getting checked actually looks like, and whether it matters how you landed.

What to do right after a fall while pregnant

First, don't pop right back up like nothing happened (I know the instinct, especially if anyone saw). Take a second, check yourself for obvious injuries, and then get up slowly. Rolling onto your side and pushing up to your hands and knees is a lot easier on a pregnant body than trying to stand straight up. If you hit your head, can't put weight on something, feel faint, or are in a lot of pain, call 911 instead of trying to get yourself somewhere.

Once you're up and safe, call your provider. They'll want to know how far along you are, how you fell, what part of your body took the hit, and whether you're having any of the symptoms below.

Now, I know what you might be thinking: "I didn't even land on my belly," or "Baby's moving, so we're fine." Those ARE good signs. But there can be something going on that isn't obvious yet, and a fall that felt minor can still occasionally cause problems. I worked in labor & delivery for 10 years, and this is one of those situations where I would MUCH rather you call and be told you're fine than talk yourself out of it.

When to go to the hospital after a fall

Even if your provider tells you that you don't need to come in, or you haven't been able to reach anyone yet, treat these as red flags. If you notice any of them after a fall, call your provider right away or go to the hospital to be evaluated:

• Vaginal bleeding or spotting

• Leaking fluid, whether it's a gush or a trickle

• Contractions, tightening, or cramping

• Belly pain, or a belly that feels tender or hard

• Baby moving less than usual (or just in a way that feels off to you)

• Dizziness, fainting, a head injury, or any injury that needs treatment on its own

A direct hit to your belly, a fall down the stairs, or any genuinely hard landing is also worth getting checked, even before symptoms show up. Plenty of providers want to see you after basically any fall in the second half of pregnancy, so don't be surprised (or offended lol) if they ask you to come in.

What happens when you get checked after a fall

This depends on how far along you are, how you fell, and how you're feeling, and it varies some from hospital to hospital. Here's what it commonly looks like.

Monitoring baby

Once you're far enough along (usually somewhere around 20 to 24 weeks, depending on the hospital), you'll typically get hooked up to monitors that track baby's heart rate and any contractions you're having. It's basically the same setup as a non-stress test (NST). Guidelines generally recommend at least four hours of monitoring after trauma (often four to six), and longer (sometimes up to 24 hours) if you're contracting a lot or something else looks concerning. So yes, bring your phone charger. Earlier in pregnancy, your provider may just check baby's heartbeat with a handheld Doppler.

Blood work and Rh status

If your blood type is Rh-negative, you'll likely get a shot of Rh immune globulin (you might know it as RhoGAM) after a fall, even one that seems minor. Trauma can cause a small amount of baby's blood to mix with yours. The shot keeps your body from making antibodies that could cause problems in a future pregnancy. Your provider may order other blood work too, depending on your injuries.

Ultrasound (and why it's not the whole story)

An ultrasound can check on baby, the fluid around them, and the placenta. It's useful! But it's actually not great at catching placental abruption, especially a small one, so a normal ultrasound doesn't mean you get to skip the monitoring. (Sorry.)

Does it matter how you fell?

Kind of. How you landed does affect your risk, but there's no type of fall that's automatically "safe," and the red flags above apply no matter how it happened.

Landing on your stomach

A direct hit to your belly is the one providers worry about most, because the force goes straight to your uterus and placenta. Your baby is surrounded by amniotic fluid and the thick muscular wall of your uterus, which protects them from a LOT. A hard hit can still cause problems like placental abruption, though, so if you land on your stomach, call your provider right away, even if you feel completely fine.

Falling on your side, knees, or bottom

Landing on your knees, your hands and knees, your side, or your butt usually means your belly didn't take the main hit, which is reassuring. It doesn't totally rule out problems, though, because the sudden jolt of a fall can still affect your uterus. Call your provider, tell them exactly how you landed, and keep an eye out for red flags. A bruised tailbone or banged-up knees can hurt like crazy without meaning anything is wrong with baby, but do mention it if the pain is getting worse instead of better.

Falling down the stairs

Stairs can mean more force and more than one impact, so take these seriously. Call your provider promptly, and don't be surprised if they want to see you in person.

Slipping but catching yourself

If you slipped and caught yourself on a railing, the counter, or your hands without really landing, your risk is lower. You might still be sore from the twist, and some people notice a few tightenings afterward. If those settle down and nothing else is going on, that's reassuring. It's still reasonable to give your provider a quick call, especially later in pregnancy. And definitely call if the contractions keep coming or anything from the red-flag list shows up.

Falling during each trimester

First trimester

In early pregnancy, your uterus is still small and tucked down inside your pelvis, which protects it really well from outside force. Most miscarriages happen because of chromosome problems that keep the pregnancy from developing (not because of something you did), and a typical fall is unlikely to cause one. That said, bleeding or cramping after a fall is still worth a call, same as it would be at any point in early pregnancy.

Second and third trimester

As your uterus grows up and out of your pelvis, it's more exposed, and your belly is a lot more likely to be the thing that takes the hit. Your center of gravity is also shifting, which makes you a little less steady on your feet (more on that below). Once you're far enough along, monitoring becomes a standard part of the workup after a fall. And in the third trimester especially, a fall can bring on contractions, so pay attention to any tightening in the hours afterward.

Possible complications after a fall

Keep in mind these are all potential complications. I'm by no means saying that if you fall you'll experience any or all of these things. Your uterus and amniotic fluid protect and cushion your baby, so even a fall that involves your belly doesn't guarantee a problem. These are just the things your provider is watching for.

Contractions

There are actually several things besides labor that can cause contractions in pregnancy (dehydration is a big one), and falls can make your uterus contract too. It can be close to impossible to tell true, cervix-changing contractions apart from other contractions just by how they feel, so any contractions after a fall are worth a call. Frequent or intense contractions after a fall can also be a sign of placental abruption, which is another reason providers keep a close eye on them during monitoring.

Placental abruption

Abdominal trauma, falls included, is one of the known risk factors for placental abruption. An abruption is when part or all of the placenta separates from the wall of your uterus before baby is born. The placenta is baby's source of oxygen and nutrients, so this is the complication providers are most concerned about after a fall.

Abruptions range from small to severe. A small separation might cause few or no symptoms and can sometimes be managed with close monitoring. A large or complete separation is an emergency for both you and baby. Signs can include vaginal bleeding, belly pain or tenderness, back pain, frequent contractions, or a change in baby's movement. But bleeding isn't always visible, and an abruption can show up hours after the fall, which is exactly why the monitoring takes as long as it does.

Breaking your water

It is possible for the impact from a fall to break your water, and it's one of the things your provider may check for if you go in. If you notice ANY fluid leaking after a fall, let your provider know. I know it can be tough to tell the difference between normal pregnancy discharge, pee, and amniotic fluid (pregnancy really does come with approximately 47 mystery fluids), but if there's any doubt, get checked.

Injuries to you

Ouch! Broken bones, sprains, and other injuries are never fun, but especially not when you're pregnant. I'm not going to go into much detail on this one, mainly because I'm far from an orthopedic nurse, but also because treatment depends so much on the injury. The main thing is to get it treated and make sure everyone taking care of you knows you're pregnant.

What to watch for in the days after a fall

If you got the all-clear (or your provider decided you didn't need to come in), keep paying attention to how you feel for the next day or so. Abruption has been reported up to about 24 hours after trauma, so symptoms don't always show up right away. If any of the red flags from earlier show up, call or go in.

Being sore, bruised, or achy where you landed is normal after a fall. Belly pain that's new, getting worse, or coming with tightening is a different story and worth a call. And if you're far enough along to feel regular movement, pay attention to baby's usual pattern and call if something feels off.

How to prevent falls during pregnancy

Falls during pregnancy are actually more common than you might think. In one large study of working pregnant women, about 1 in 4 fell at least once during pregnancy. A growing bump shifts your center of gravity and changes the way you walk, which can make you clumsier and less steady. You can't prevent every fall (if you could, nobody would be googling this), but there are a few things that help.

Wear flat, supportive shoes

The first thing I recommend is comfortable, flat shoes with good grip. Take these nine months as a pass on the high heels and put on the comfiest flat shoes you own. Nobody, I mean NOBODY, is going to call out a pregnant person for this. And if they do, I highly recommend you let them have it.

Slow down and watch your footing

Another simple but good reminder is to take your time getting from place to place. Rushing is when a lot of falls happen (in that same study, most of the falls at work involved slippery floors, hurrying, or carrying something). Pay attention to your surroundings, especially somewhere new or on wet floors, ice, or uneven ground. And don't be too cool to use the handrail on the stairs!

Don't carry heavy things up and down the stairs

This probably goes without saying, but leave carrying stuff up and down the stairs to your partner or someone else. A laundry basket or a heavy bag blocks your view of your feet and throws off your balance, and you definitely don't need any additional obstacles tripping you up.

Get up slowly

Pregnancy can make you lightheaded when you stand up too fast, especially if you haven't eaten or had enough to drink. Sit up for a second before standing (particularly first thing in the morning or getting out of the bath), and sit right back down if you feel dizzy. A non-slip mat in the shower or tub doesn't hurt either.

Skip activities with a high risk of falling

Exercise is great during pregnancy, but ACOG recommends skipping contact sports and activities with a higher risk of falls or injury, like gymnastics and horseback riding. If you're not sure where your favorite activity lands, ask your provider.

Final thoughts

I really hope falling is something you never have to deal with during pregnancy. But if it does happen, the one thing I want you to remember is that "I didn't land on my belly" isn't a reason to skip the phone call. Call, let your provider decide, and go in for any red flags.

It's better to have the information and not need it than to need it and not have it... at least that's my theory!

~Liesel

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