Tommy’s midwives are here to support you by telling you everything you need to know about week 4 of pregnancy: advice on common pregnancy symptoms, practical actions, such as the ‘booking’ appointment and what’s happening with your baby.
Before week 4
Congratulations on your exciting news! If your periods are usually regular, conception is likely to happen in the middle of weeks one to four. You are very unlikely to know you're pregnant at this stage.
It may sound odd but pregnancies are measured from the first day of your last period rather than the day you actually conceived your baby. This is because it's not always easy to be sure of the exact date you became pregnant.
“I spent the entire week my period was due running to the loo, just to double check I didn’t have my period. My boobs felt tender - but that can be a sign of PMT too. I took an early test in the end and couldn’t believe it when it showed positive.” Ayida, mum of one
Although a fertilised egg may have implanted in your womb just two weeks ago, if the first day of your last period was four weeks ago, you are officially four weeks pregnant! This may seem odd if you think you can definitely date the pregnancy more recently.
What does my baby look like?
The tiny person inside you is the size of a poppy seed. A little dot, measuring about 2mm.
The baby may be miniscule but big things are happening! The fertilised egg has snuggled into the side of your womb. It divides into layers of cells that will eventually become different parts of your baby’s body.
Your baby’s nervous system and heart are developing. Amazingly your tiny dot already has some of its own blood vessels and blood is starting to circulate. A string of these blood vessels connects you to your baby. This will eventually become the umbilical cord.
Right now, your poppy seed is known as an embryo. They get their energy and nourishment from a yolk sac (until the placenta takes over in a few weeks). Your baby is surrounded by amniotic fluid within the amniotic sac, providing a comfy cushion for them throughout your pregnancy.
Your symptoms - what happens in week 4
Early symptoms of pregnancy
Bleeding or spotting
You might notice some very light bleeding, or ‘spotting’, known as implantation bleeding. This can be caused by your little seed burrowing into the lining of your womb. It often happens around the time your period would have been due and is relatively common.
You may also have some period-like cramping in these early weeks.
If you notice any bleeding at any stage of your pregnancy, though, it's important to get it checked out by your doctor or midwife.
This week, a surge in progesterone can start to make your boobs feel tender, heavy and sore - a bit like how they might feel before your period.
Remarkably, these are pregnancy hormones already preparing your body to produce milk. This tenderness usually eases off by the end of the first trimester.
Things to do in week 4
Smoking and alcohol in pregnancy
It’s time to quit cigarettes and alcohol. Both can be harmful to your growing baby because the toxins pass through the placenta.
Here’s our guide to avoiding alcohol during pregnancy.
Find out more about the effects of smoking in pregnancy.
And if you’re still struggling to stop smoking, these ten steps towards quitting could help.
If you use street or recreational drugs, stop or ask your doctor for advice on stopping safely.
Sexually transmitted infections (STIs) such as chlamydia, gonorrhoea, syphilis and genital herpes can affect your baby's health during pregnancy or birth.
If you think you or your partner might have an STI, go for a check-up as soon as you can. Your doctor or midwife can tell you where you can find your nearest sexual health clinic.
Don't worry, nobody will judge you and it's important to be checked as soon as possible.
Continue (or start) taking these supplements
There are two vitamins that are very important in pregnancy and that you can take as supplements: Folic acid and vitamin D.
Folic acid is naturally present in leafy vegetables, fruits and berries, beans and wholegrain products - but keep taking folic acid supplements too, until at least week 12 because you can't get enough through food alone to build up the level of folic acid that your baby needs.
Folic acid helps in the formation of your baby's nervous system and reduces the risk of spina bifida, which is where the baby's spine doesn't close up properly.
You should take:
- 10 micrograms of vitamin D each day throughout your pregnancy and if you breastfeed
- 400 micrograms of folic acid each day – you should take this from before you are pregnant until you are 12 weeks pregnant
Find out more about important supplements in pregnancy.
Tell the GP you are pregnant
Once you know you’re pregnant, make an appointment to see your doctor or a midwife to get any advice you need and to be booked in for your pregnancy care appointments. pregnancy care appointments. If you make a GP appointment, they will set you up for midwife appointments or you can call the maternity unit in the local hospital and refer yourself that way.
However you book it, your first appointment with the midwife will not take place until after week 8, the ‘booking’ appointment. This can make it an anxious time but reading through these dos and donts of pregnancy may help.
This is an important time to talk about any health issues you have to make sure your pregnancy goes well. It is very important to tell your doctor about any medication you may be on, especially long-term medicines for conditions, such as asthma, epilepsy, mental health conditions, diabetes, hormone therapy, heart problems and so on. Your doctor can make sure you are on the safest medication for you and baby.
It is very important that you do not stop taking medication without talking to your GP or specialist
Find out what questions you'll be asked at the booking appointment.
If you have an existing mental health problem
If you have a pre-existing mental health condition and take medication, tell your doctor and the person who prescribed the medication that you’re pregnant as soon as possible.
They will talk to you about whether your medication is safe in pregnancy or whether you should consider a different treatment.
Find out more about your mental wellbeing in pregnancy.
What are my chances of miscarrying?
It’s a sad thing to think about, but up to one in five pregnancies will end in miscarriage in the first three months.
If you do have light bleeding, spotting or stomach pains, this doesn't mean you are going to miscarry. However, you should always speak to your doctor or midwife and ask for advice.
Find out the other symptoms you should contact your midwife about.
1. NHS Choices.You and your baby at 0–8 weeks pregnant, NHS Choices: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-4-5-6-7-8.aspx#close (Page last reviewed: 28/02/2017 Next review due: 28/02/2020)
2. NHS Choices. Vaginal bleeding in pregnancy http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vaginal-bleeding-pregnant.aspx (Page last reviewed: 26/01/2018 Next review due: 26/01/2021)
5. NHS Choices. Signs and symptoms of pregnancy http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/signs-and-symptoms-pregnancy.aspx (Page last reviewed: 06/10/2016 ;Next review due: 06/10/2019)Hide details
ℹLast reviewed on June 22nd, 2018. Next review date June 22nd, 2021.
By hayihu (not verified) on 14 Feb 2019 - 10:08
l 5weeks pregnancy and l just have priod two days now.is it normal or the pregnancy is no more?
By Melissa (not verified) on 25 Jan 2019 - 00:38
I just found out the 19th I was pregnant. And my ob sent me today for a ultrasound! I'm 4 weeks according to my lmp date but there was nothing seen during the ultrasound and it's making me worried. Is this normal?
By Midwife @Tommys on 29 Jan 2019 - 12:27
Hi Melissa. If they were unable to see anything on scan, this could mean two things - either that you are much earlier than you first thought and therefore it is too early to see anything. Or that the pregnancy may be a chemical pregnancy. Your OBGYN (as presume you are in the US.A) should have booked a repeat scan for 2 weeks time to follow up and to see if the pregnancy is viable or not. We are U.K based, so can only give advice based on the care we offer here. All the best, Tommy's Midwife
By Tania VD (not verified) on 15 Jan 2019 - 07:42
I am about 4 weeks pregnant, 4 days ago I awoke to stabbing pains in my tummy& had diarrhea, then I saw red blood,not as heavy as my periods , as I am a heavy bleeder, no cramps, just heaviness, it tapered off to brown , today its again red , but still sore boobs and feeling of nausea. this is my 1st pregnancy after 11 years. Fiance spoke to a OBGYN who said we need to wait 2 weeks to retest as she has seen heavier bleeding and clotting and still pregnancy progressed> can you please advise?
By Midwife @Tommys on 16 Jan 2019 - 15:33
Hi Tania. I can only give evidence based on working as a midwife in the U.K, I do not know how things work in the U.S.A. But the OBGYN is right, sometimes time is needed to see if the pregnancy grows further, or to see if there is no growth or further bleeding if it is going to be an early miscarriage. If the bleeding or pain becomes very severe, then please seek urgent review in the emergency department. Early bleeding can sometimes be related to an implantation bleed so bleeding is not always as ominous as it seems. Wishing you the best. Tommy's Midwife
By George Dixon (not verified) on 21 Jan 2019 - 09:01
My girlfriend is 49 years old she’s 117 days late her phone said pregnant rate low And we went to the doctor and they took a pregnancy test and said she wasn’t pregnant What do we do
By Midwife @Tommys on 25 Jan 2019 - 15:57
This is more likely to be a medical issue or hormonal changes therefore she needs to see a doctor for advice.
By Jeaneth (not verified) on 13 Jan 2019 - 18:48
I have a sharp pain in my lower abdomen and I was expecting my period on the 10th I couldn't up until today I didn't see any periods but then today surprisingly I saw some blood kind of brownish I put on a pad but then it wasn't full it was just like few drops but when I take it out the drops way like more Brown than red but then when I pee that's when blood comes like maybe 2 to 3 Drops of blood as I pee and cramps and pain can be do unbearable.... please help
..4weeks and 3 days
By Midwife @Tommys on 15 Jan 2019 - 10:30
How are you today? Has the bleeding and cramping settled since you contacted us on Sunday evening. Please do give me a call today on 0800 0147 800 if you need to talk.
Thinking of you
By Nick (not verified) on 10 Jan 2019 - 09:39
I have had 2 ectopic pregnancies for 1 I lost my left tube the 2nd the pregnancy was taken out right tube repaired and was put back in.
I got pregnant 1yr after and had a healthy baby via c-section.
Now 5yrs later I'm pregnant again took pregnancy test at the 3 day of missed period and got a very bright positive.
However I went to my gp he did ultrasound and said I should come back 10 days time it's a bit early at 4wks and 3 days and if I feel any pain I should inform him.
He gave me a paper for 2 blood test 48hrs apart kept on repeating that he saw a big yoke...
Should I be worried or take it easy I'm a bit scared he did however gave me folic acid tablets for 30 days
By Midwife @Tommys on 10 Jan 2019 - 13:23
Hi Nick - Thank you for your message. As your GP has advised, 4 weeks is very early for a scan and it is best to wait a while before repeating it. A yolk sac - which your Dr saw during the scan is the first element seen within the gestational sac during pregnancy.
The blood tests are to check your HCG levels which is the hormone that is produced by the embryo after implantation. A raised level of this hormone shows that there is or has been a pregnancy.
The level of hCG in a pregnancy usually doubles every 2-3 days in early pregnancy, then doubles every 3-4 days later on until about week 14 -16 of pregnancy.
By Candy (not verified) on 10 Jan 2019 - 02:43
Was diagnosed with pcos can I still get pregnant?
By Midwife @Tommys on 10 Jan 2019 - 09:39
Hi Candy - Thank you for your message.
PCOS, short for polycystic ovarian syndrome, is a common condition related to hormones in which the ovaries don’t always release an egg at the end of the menstrual cycle (the start of a period to the start of the next one). It can lead to difficulty getting pregnant.
It is thought to be very common, affecting about 1 in every 5 women in the UK.
You might find some of the information on our page on PCOS and fertility of use:
By Maddy (not verified) on 24 Dec 2018 - 02:48
This is the very first time I am having very very light cramps before period due date. Today is my due date and I totally wish period not to come at all.. We are trying from very long time to get pregnant..
This time there is almost no cramps, I cannot even understand if an changes in my breast. What is this indication. Can you please help.
By love (not verified) on 26 Nov 2018 - 19:03
I missed my period and I took a home test and it shows negative, what should I do?
By Midwife @Tommys on 28 Nov 2018 - 13:02
Check out the Tommy's link below, about the best time to do a pregnancy test in order to get an accurate positive or negative result. All the best
By Reddy (not verified) on 19 Nov 2018 - 12:20
I am Reddy, and my wife got pregnancy recently after 2 miscarriages due to Growth effect. Now she had 4 weeks 2 days baby and her first scan reveals that the baby size is about 0.67 CM. Please advise me that this baby size is normal or any abnormality is present. After the scanning the doctor told us that she can only confirm the actual result after 10 days only. Please tell us that as this is normal growth or not?
By Midwife @Tommys on 19 Nov 2018 - 12:31
Hi Reddy, It is too early to reassure you that all is well. The baby is still forming and it will be a few more weeks before the 12 week scan. Just try to ensure that your wife is taking folic acid and eating a healthy balanced diet. She should also stop alcohol and smoking and if you drink or smoke I recommend that you also try to quit. Best wishes to you both
By Anonymous (not verified) on 17 Nov 2018 - 05:14
I tested positive to a pregnancy test kit at week 4 but my scan shows an empty uterus. Im a student and do not want to keep it what do i do
By Midwife @Tommys on 19 Nov 2018 - 12:33
Hi, Have you been given an appointment for a re-scan in about a week? It may be that you have already miscarried, but this should be confirmed if you are still testing positive.
By Sarah (not verified) on 8 Nov 2018 - 17:30
Hi I’ve recently found out I’m approx 4 weeks 3 days pregnant. I keep having period like pains in the bottom of my stomach although they not as bad as when I’m on my period and I cant sleep through tossing and turning. My friend recently had a miscarriage and it’s worring me about my pregnancy. Is the pains normal? Does bleeding always come with misscarriage? Thank you
By Midwife @Tommys on 12 Nov 2018 - 15:39
Any abdominal pain or bleeding in pregnancy, at any gestation, would ideally need to be reviewed to rule out miscarriage. You do not need both, one or both symptoms would warrant review.
Please visit your GP who can refer you to your local Early pregnancy assessment unit - you may be scanned.
Please take care. Tommy's Midwife
By Anon (not verified) on 2 Nov 2018 - 13:49
Hi, i am quite regular with a 21 day cycle. Approx 4 days before spotted, then went on to have a heavy period. Have continued to have light bleeding which has been constant for about a week since my period. Took a test 5 days ago and had a faint positive line, took another yesterday and have a strong positive. Am I pregnant or could i have mc? Bu a due date calculation i should be 5wks now
By Midwife @Tommys on 5 Nov 2018 - 14:26
Hi there .You may need to repeat the pregnancy test again at your GP surgery. They will then be able to do a blood test if the urine test is inconclusive or if they are concerned by your symptoms. They may also decide to refer you to a gynae Dr if this is not your period and they are unsure why you have continued to bleed. Please make an appointment to be seen soon. Tommy's Midwife
By Elikem (not verified) on 25 Jul 2018 - 14:20
I want to know if it’s safe to travel by road for a program. The journey is about 7 hours by road. I just found out that am 3 weeks pregnant
By Midwife @Tommys on 27 Jul 2018 - 12:18
It is fine to be travelling by road for a long period of time, the advise we give is the same for any gestation. It is very important to still wear a seat belt, keep hydrated and take regular breaks out of the care to move around and stretch your legs. Make sure you have some snacks with you also.
By Bridget Corcoran (not verified) on 25 Oct 2018 - 13:44
I think I might be around 4weeks pregnant could nd my nephew is getting married on the 15 th Nov in Derry north is it safe to travel that far nd by car
By Midwife @Tommys on 25 Oct 2018 - 14:18
Hi Bridget, Thank you for your comment.
You are fine to travel by car in pregnancy, just take regular breaks and drink plenty of fluids to keep you hydrated. Take care, Tommy's Midwives x
By Anonymous (not verified) on 28 Jun 2018 - 09:19
I always get my periods on the 15 of each month but this minth I am in a last days of a month but I dont see my periods instead my womb is paining as if I am getting periods but if I am going to check there is nothing and I am scared to check by now , please advice....
By Midwife @Tommys on 29 Jun 2018 - 11:03
I sorry you are feeling so worried and anxious. A pregnancy test is the only way that can give you an answer as to whether you are pregnant and if this is why your period is late. If this is negative then do have a talk with your GP if you are concerned. Periods and your natural cycle can vary for a variety of reasons, sometimes stress, diet, smoking etc so worth bearing in mind.
If we can support you further then please do be in touch
By trudy (not verified) on 13 Sep 2018 - 04:45
you can be pregnant but I'm worried because l have seen a doctor he told me l have blood in my womb but when he test l'm not pregnant but l even fill like period pain even the heart beat in my womb and l even had n discharge blood in 2days like brown n red but is it possible being pregnant but l don't vomit l even eat food which have oil
By Midwife @Tommys on 13 Sep 2018 - 12:22
Hi Trudy, Thank you for your comment.
It is difficult to understand what you are trying to say? Has your Dr said that you aren't pregnant because you are having a period and this is the blood that you are seeing? If you are having bleeding and you have had a negative pregnancy test then this bleeding may be your period. If you are still unsure then please go back and see your GP for further advice. Take Care, Tommy's Midwives x
By Anonymous (not verified) on 21 Jun 2018 - 07:13
I just found out that I am pregnant (1st!!!)
Is it ok to carry heavy things and bend down to pick up things?
At this stage are we fragile to falls?
By Midwife @Tommys on 21 Jun 2018 - 16:09
Congratulations! We always say to listen to your body during pregnancy, if it hurts or feels uncomfortable then to stop. Your body releases hormones so that your ligaments stretch more easily, however this means that it can be easier to over-stretch so just to be a little careful.
If you were to fall then your baby is very well protected in your pelvis so it is very unlikely that your baby would be at risk. If you do fall and have any concerns then of course do speak with your GP.
By Tammy (not verified) on 10 Jun 2018 - 18:14
I just found out im 4 weeks pregnant and my bf tells me that i should abort tge baby because he took perscribed drugs for Rhumatoid Arthritis than will probably disable the baby 2 or 3 years ago. Will this contribute to my pregnancy? Im 46 years old..im a bit nervous as if this will harm the child i think i need to find out. Please help
By Midwife @Tommys on 11 Jun 2018 - 15:39
I think you should discuss your options with your GP. Without knowing the medication that he was on and how it affected him, I can't advise you. Best wishes x
By Sandra (not verified) on 18 Jun 2018 - 01:13
I was told didn’t matter what he took matters what you take st least that’s what I was told. I’m 47 and I’m always on time 27 days and now I’m 6 days late peeing all the time felt some pressure down there cramps and fatigued. I took one test in the afternoon one day late and it was negative. I told my bf and he doesn’t give a crap so if I am be raising this baby on my own from what it looks like. I just pray that I am when he was in town we were together everyday and I’ve never missed a period I’ve been regular but my age I can’t imaine just no
Period all of a sudden when I’ve always had one and been checked and still have eggs so I am taking the assumption that I am... at least hope so. I am praying it’s going to be good. Good luck to you.
By Emma (not verified) on 1 Jun 2018 - 14:15
I have recently found out that I am pregnant for the 7th time. I had two miscarriages before having my son, then I lost my second baby at 27 weeks due to a fatal conditon, and have since had a further two miscarriages. I have been put on aspirin and progesterone for this pregnancy but I am so scared that I'll only miscarry again (or worse). Would you be at all able to tell me honestly if the medication is actually likely to make much of a difference please? I am so worried. Many thanks in advance.
By Midwife @Tommys on 4 Jun 2018 - 14:07
Unfortunately the results of a large study PROMISE - progesterone in recurrent miscarriage found that those who received progesterone were no less likely to miscarry than those who received a placebo. You can read about the study here https://www.tommys.org/our-organisation/research-by-cause/miscarriage/research-by-cause/miscarriage-trials
In the absence of APS (anti-phospholipid syndrome) there is no clear evidence that aspirin is helpful either but research continues in a hope that we may find treatments. This guidance from the RCOG is helpful https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_26.pdf
Please don't hesitate to contact us if we can support you through this pregnancy. Best wishes
By Emma (not verified) on 5 Jun 2018 - 09:14
Thank you for your reply. It does not contain the reassurance or even encouragement I was hoping for but at least I know now not to get my hopes up. I shall just try not to think about this pregnancy until the probable miscarriage. I am grateful, though, for your honesty.
By Midwife @Tommys on 6 Jun 2018 - 15:13
We are always here if you need any further support or information. We are contactable via email and phone line (which is best) rather than on a public web page for any future queries to be addressed privately for you. I hope everything works out for you and hope that we do hear from you again soon
By Naomi (not verified) on 27 Jun 2018 - 13:43
I just realised I am pregnant after having 2 miscarriages and right now I have problem with palpitations and and high Bp...i am worried and I really don't want to loose this pregnancy.
By Midwife @Tommys on 28 Jun 2018 - 12:28
I'm sorry to hear about your miscarriages and hope everything goes well for you in this pregnancy.
I would advise that you see your GP asap to discuss your symptoms and start treatment if needed. If you become very unwell or your symptoms worsen suddenly then you should go to A&E
By Anonymous (not verified) on 29 May 2018 - 05:47
Hy I so worried I have took 3 pregnancy test but the are both negative .... I even went to sonar the said the can't see the baby but on Doppler we can hear the heartbeat is it possible
By Midwife @Tommys on 29 May 2018 - 16:26
Hi, i'm sorry to hear this is causing you so much worry. If you have x2 negative pregnancy tests, then it is likely that you are not pregnant.
The Doppler can easily pick up your pulse, which is what you may be hearing. It is impossible to hear the fetal heart rate with the Doppler unit about 14 weeks at the very earliest as a pregnancy would be very deep in your pelvis before this and make it impossible to hear before then.
If you need to call and talk this through in more detail, you can call us Mon to Fri 9 am to 5pm on 0800 0147800
Take care of yourself
By Gemma (not verified) on 2 May 2018 - 10:58
I'm so worried that I'll lose this baby too. I've got very mild Back ache, had cramps yesterday which seem to have gone or are very slight. Is there anything I can do to help this baby? Thank you
By Midwife @Tommys on 3 May 2018 - 13:17
It is understandable that you are very anxious at this time. Please feel reassured that mild cramping can be normal in early pregnancy as all the ligaments and muscles are stretching. You don't say how many weeks you are but your GP may be able to refer you for an early scan due to your past history, this may give you some reassurance. Make sure you are taking your pregnancy vitamins and eating healthy, this can give you pregnancy the best start. Hope this helps, Take Care Tommy's Midwives x
By Hayley (not verified) on 28 Apr 2018 - 17:24
Hi , I have just recently got a BFP after trying to fall with my partner for 7 months .We miscarried over a yr ago which broke our hearts .Im just so scared of it happening again I have been getting period like cramping but only mild (no bleeding) & have been getting lower back pain I will be 4 weeks 2 days :)
By Midwife @Tommys on 30 Apr 2018 - 11:48
Hi Hayley. It is very early days so there are no guarantees but with only 2% of women experiencing two miscarriages in a row you have every reason to be positive. I hope the mild cramping will resolve very soon. Take care
By Melissa (not verified) on 18 Apr 2018 - 07:39
If my boyfriend has a low sperm count and we have unprotected sex all the time when we do it how high are the chances of me becoming pregnant?