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When to Call 111 in Pregnancy: Warning Signs

Knowing when to call 111, when to contact your midwife, and when to go straight to A&E can be genuinely confusing in pregnancy — especially in the first trimester when so many symptoms feel unfamiliar. This guide gives you a clear framework so you can act quickly and confidently when something does not feel right.

Table of Contents

  1. When to Call 999 or Go Straight to A&E
  2. When to Call 111
  3. When to Contact Your Midwife or EPU
  4. Red Flag Symptoms in Detail
  5. What Happens When You Call 111
  6. Frequently Asked Questions

When to Call 999 or Go Straight to A&E

Some symptoms in pregnancy are genuine emergencies that need immediate help. Do not wait, do not call 111 first — call 999 or get to A&E as quickly as possible if you experience:
  • Heavy bleeding — soaking through a pad within an hour, or passing large clots
  • Severe, sudden abdominal pain that makes you double over or is unrelenting
  • Collapse or loss of consciousness
  • Chest pain or difficulty breathing
  • Shoulder tip pain combined with any bleeding or dizziness — this can be a sign of internal bleeding from an ectopic pregnancy
  • Vomiting blood or vomiting material that looks like coffee grounds
  • Suspected ectopic pregnancy — one-sided sharp pain, shoulder tip pain, feeling faint, with a positive pregnancy test

If you are in any doubt whether something is an emergency, call 999. The operator will help you decide. It is always better to call and be told it is not an emergency than to delay in a genuine crisis.

When to Call 111

NHS 111 is available 24 hours a day, seven days a week, including weekends and bank holidays. Call 111 if you have concerning symptoms that need assessment today but are not a life-threatening emergency. Examples include:
  • Moderate bleeding — more than light spotting, but not soaking a pad within an hour
  • Persistent abdominal pain or severe cramping that is not improving
  • Fever of 38°C or above — a high temperature in pregnancy always needs assessment
  • Persistent vomiting — unable to keep any fluids down for more than 24 hours, or feeling severely dehydrated (very dark urine, dizziness, not passing urine)
  • Signs of a urinary tract infection (UTI) — burning when urinating, blood in the urine, or pain in your lower back combined with fever; UTIs in pregnancy can escalate quickly and need prompt treatment
  • Sudden severe headache that does not respond to paracetamol, particularly after 12 weeks
  • Visual disturbances — flashing lights, blurred vision, or seeing spots, especially later in pregnancy (these can signal pre-eclampsia)
  • Sudden swelling of the face, hands or feet, particularly if accompanied by headache
  • Reduced or absent fetal movement after 24 weeks — do not wait; call straight away

When you call 111, the adviser will ask you about your symptoms and pregnancy and direct you to the most appropriate service — this may be your midwife, your GP, the early pregnancy unit (EPU), or A&E.

When to Contact Your Midwife or EPU

For symptoms that concern you but are not urgent, your first port of call during working hours is usually your midwife or, in early pregnancy, the early pregnancy unit (EPU). Contact them for:
  • Light spotting or pink discharge without pain
  • Mild cramping similar to period pain that comes and goes
  • Questions about medications — never stop prescribed medication without advice, but always check before starting anything new
  • Morning sickness that is worsening or making it hard to eat and drink
  • General worries about symptoms, changes to how you feel, or what is normal
  • Arranging appointments such as follow-up scans after spotting or cramping

Most EPUs do not take self-referrals before 6 weeks, and some require a GP referral first. Your midwife or GP can guide you on the correct referral pathway in your local area.

Red Flag Symptoms in Detail

The following symptoms always need urgent medical attention — either 999/A&E or 111 depending on severity. Do not sit at home hoping they will pass:

Bleeding: Any bleeding in pregnancy should be assessed. Light spotting after sex or an internal exam is common and usually harmless. Fresh red bleeding, bleeding with pain, or passing clots warrants urgent assessment.

Pain: Mild cramping similar to period pain is very common in early pregnancy. Sharp, one-sided pain, severe constant pain, or pain accompanied by bleeding needs urgent review to rule out ectopic pregnancy or miscarriage.

Fever: A temperature of 38°C or above in pregnancy is always taken seriously. Infection can affect your baby, and some infections — such as listeria or group B strep — carry specific risks. Always seek assessment promptly.

Vomiting and dehydration: Nausea and vomiting are extremely common in pregnancy but become a medical concern when you cannot keep any fluid down. Signs of dehydration include very dark urine, dizziness when standing, and a dry mouth. This can develop into hyperemesis gravidarum, which requires medical treatment.

Shoulder tip pain: Pain felt at the very tip of the shoulder, distinct from muscle ache in the neck or upper back, can indicate blood pooling under the diaphragm — a sign of internal bleeding. This is a red flag for ectopic pregnancy. Call 999.

What Happens When You Call 111

When you call 111, you will speak to a trained adviser who will ask you a series of questions about your symptoms. Tell them clearly at the start that you are pregnant and how many weeks you are. They will triage your call and may:
  • Advise you to go to A&E or call 999
  • Transfer you to a clinician (nurse or GP) for further assessment
  • Book you a GP appointment
  • Direct you to your midwife or EPU
  • Advise you to wait and monitor, with instructions on what to do if symptoms change

You will not be judged for calling, and you will not be wasting anyone's time. 111 is designed for exactly these situations. If your symptoms worsen while you are waiting for a callback, call 999 immediately.

Frequently Asked Questions

### Should I call 111 or my midwife first?

For non-emergency concerns during working hours, call your midwife first — they know your pregnancy history and can often advise quickly. Outside of working hours, or if your midwife is unavailable and you have a new concerning symptom, call 111. For emergencies involving heavy bleeding, severe pain, or collapse, call 999 without delay.

Is it OK to call 111 for pregnancy concerns?

Yes, absolutely. NHS 111 is available around the clock and is well used to pregnancy-related calls. Advisers can direct you to the right service and, if needed, connect you with a clinician. Never feel you are overreacting — pregnancy symptoms that seem minor can occasionally signal something that needs prompt attention.

What is the early pregnancy unit (EPU) and how do I access it?

An EPU is a specialist NHS clinic that assesses women in the first 16 weeks of pregnancy who have concerning symptoms such as bleeding, pain, or previous miscarriage. Access varies by area — some allow self-referral, others require a GP or midwife referral. Call your GP surgery or 111 if you are unsure how to access your local EPU.

This article is for informational purposes only and does not constitute medical advice. Always consult your midwife, GP, or call 111 if you are concerned about any symptoms in pregnancy.

Last reviewed: June 2026

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