Alive and Kicking – Recognizing the Signs of Reduced Fetal Movement

By Mindy Cockeram, LCCE

On the first night of my Lamaze Class, we always discuss fears that women and men have about pregnancy and childbirth. One of the most consistently expressed fears is the worry over the health of the baby before, during and after the birth. It is common for members of the class to know someone who has miscarried (before 20 weeks) or birthed a stillborn baby when everything seemed to be progressing smoothly in the pregnancy or labor. The sad fact is that although stillbirths are relatively rare (at roughly 1 out of every 100 births), they do happen with considerable regularity. Besides avoiding certain foods, drugs and alcohol, there seems little that women can do to positively affect the health of her baby.

However, much like using your instinct to avoid danger, some adverse outcomes can be pre-empted if the mother picks up a warning sign. A slowdown in the baby's movement (referred to as RFM - Reduced Fetal Movement) is one of those warning signs. Although the research is not strong in this area, there are hundreds of stories online and in the press about women who felt that counting movements (including kicks, flutters, swishes and rolls) and recognizing a change in her baby's patterns has saved her child's life. I even had a recent birth story from a class member who said she 'had become obsessed with kick counts' and credited her recognition of reduced fetal movement as the trigger that led her to seek help - ultimately leading to an emergency C-Section for a detaching placenta.

So what should you know about your baby's movements? First of all, babies movements tend to level out at 32 weeks. After 32 weeks gestation, there should be no reduction (or potential increase) in the frequency of fetal movements on a daily basis. Babies don't run out of room to kick, flutter, swish or roll despite their tight quarters in the uterus. The current recommendation from the American College of OB/GYNs (ACOG, 2014) is to look for "10 distinct movements in a period of up to 2 continuous or interrupted hours." If the baby is moving less than this, ACOG recommends contacting your care provider promptly for further assessment. Other organizations recommend monitoring the baby's movement from 28 weeks onward with the mother lying on her left side using the "10 in 2" (10 movements in two hours) rule.

Several charitable websites like www.CountTheKicks.org and www.kickscount.org.uk have popped up to support the monitoring of baby's movement as a deterrent to poor outcomes. CountTheKicks.org suggests women begin counting as the third trimester begins and get to know their baby's movements. Although CountTheKicks.org uses the "10 in 2" rule as a guideline, the site also points out that 'There is no magic number of movements a mother should feel. The most important thing is to monitor YOUR baby's movements every day so you will know what is normal for YOUR baby.' CounttheKicks.org also suggests counting the kicks at the same time every day when the baby is awake and active - possibly after a meal. Both offer a downloadable app for recording and tracking daily fetal movement. CountTheKicks.org also offers a downloadable, printable chart as an alternative to using a smart phone or device.

Are there any downsides or risks to women who monitor for reduced fetal movement? The only risk of making women aware of fetal movement guidelines is the possible raising of her anxiety levels and the potential for additional non-stress testing. Also, some women will feel a sense of guilt if their daily routine does not allow them the time needed to do the necessary monitoring. However, like so many aspects of being pregnant, we should remind each other that we can only do our best. Just being educated about fetal movement and using your instinct is a great start.

So if you can make some time today, possibly while you are relaxing in the evening after dinner, why not start monitoring and recording your baby's movements. And don't be surprised if you feel more in tune with your baby by getting to know them this way - every kick counts!

What has your care provider or childbirth educator said to you about kick counting?

References:

American College of Obstetricians and Gynecologists. (2014, July). Practice Bulletin No. 145: Antepartum Fetal Surveillance, Obstet Gynecol. 2014; 124:182-92450-463. Retrieved from http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/acog-guidelines-glance-antepartum-fetal-surveillance

http://www.countthekicks.org/how-to-count-the-kicks/ accessed June 5, 2016.

Macdorman MF, Gregory ECW (2015). Fetal and perinatal mortality, United States, 2013. National vital statistics reports; vol 64 no 8. Hyattsville, MD: National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf

Royal College of Obstetricians and Gynaecologists. (2011, February). Reduced Fetl Movements. Green Top Guideline no 57. Retreived from https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_57.pdf

About Mindy Cockeram, LCCE:

Mindy Cockeram is a Lamaze Certified Childbirth Educator teaching privately as well as for a large network of hospitals in Southern California. She has a BA in Communications from Villanova University and qualified as an Antenatal Teacher through the United Kingdom's National Childbirth Trust (NCT) in 2006. She is author of the recently published book Cut Your Labor in Half: 19 Secrets for a Faster & Easier Birth. Her website is www.learn4birth.com. A native of the Philadelphia area, she spent 20 years in London before relocating to Redlands, CA in 2010.

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