Many women in my practice are confused about fetal kick counts. Some have been told they need to do kick counts every day, as soon as they can feel the baby move. Others have been told that if they don’t feel a certain number of movements in a two-hour period, to call their provider. The number of movements varies–I’ve had women tell me they were supposed to feel anywhere from ten movements in a day to ten movements in an hour! If anything gets a pregnant woman stressed out, it’s worrying about too little fetal movement.
Many factors can contribute to fetal movement and perception of movement. Some of these are:
- Position of the placenta. If it’s toward your stomach, you essentially have a two or three-inch thick “cushion” between you and the baby. This will delay your perception of fetal movement and may make the movements less noticable.
- Your level of activity. Very physically active women often do not perceive fetal movement as much as sedentary women.
- Your body mass index (BMI). If you have a higher BMI, perception of movement may be diminished.
- The baby’s position and size.
After looking at the value of kick counts in a study of 65,o00 women, Tviet¹ concluded that unexpected fetal losses after 37 weeks of pregnancy were decreased by 33% when women were instructed in a standardized method of fetal kick counts, and a routine response to reports of decreased fetal movement was instituted.
If a woman reported decreased fetal movement, she was asked to come into the office for a non-stress test (an extended period of observing the fetal heart rate on a fetal monitor) and an ultrasound. While this method reduced the number of late pregnancy losses, it also increased the number of interventions, and the author admits that a fair percentage of the interventions were probably unnecessary. It simply is not possible to always know which babies truly need help and which are doing OK, thus we err on the side of caution.
Many women get very stressed about fetal kick counts. All babies go through periods of time when they are quiet, or sleeping. Mothers can be concerned during these periods with how to differentiate between a normal sleep cycle, and a baby who is not moving normally.
When a mother calls to tell me she isn’t feeling her baby move normally, I ask her how far along she is. If she is early enough in her pregnancy that she is just starting to feel fetal movement, it is too soon to worry about kick counts. So let’s suppose you are 30 weeks pregnant, and you haven’t felt the baby move much today. What should you do?
- Drink something sugary–juice or a soda. Low blood sugar can make baby sluggish.
- Lie down on your left side. It’s OK to gently move the baby to stimulate kicks.
- Get an alarm clock (the old-fashioned kind with the irritating bells is terrific) and place it against your belly, right where you think the baby’s head is. Let the alarm go off. One study found that this procedure was just as accurate as a non-stress test in predicting fetal well-being.² You should feel movement after the alarm goes off. If you don’t have a loud alarm clock, try a loud radio, or anything else that makes a loud noise.
- If you have tried all these things and have not gotten a response, do call your provider for further investigation.
When and how should regular kick counts be done? By the time you are 28 weeks, baby is big enough to begin kick counts. You should also have an idea of baby’s “busy” times throughout the day. Most women report that the baby is active early in the morning and at bedtime. Let’s take a common-sense approach to this: if someone was observing you during your time of deepest sleep, would they see much activity? Of course not. Your baby is not going to be terribly active during his or her sleepy times. Count the kicks during baby’s “busy” times. Some babies are more active than others; as a veteran of seven pregnancies, I can attest to that fact! Consider whether your baby is moving normally during his/her busy time, as s/he typically does. If there is a change in what is normal for your baby, talk to your provider.
1. Tveit JVH,Saastad E,Stray-Pedersen B, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement. BMC Pregnancy Childbirth. 2009;9:32.
2. Brezinka C, Lechner T, Stephan K, Pfeiffer K. Vibroacoustic stimulation of the fetus using a conventional mechanical alarm clock. Journal of Maternal Fetal Investigation. 1998 Dec;8(4):172-177.
My first was really active, so it was almost scary that my second was a quiet child. There were times I’d have to bother her to get some movement. She always slept during the lull of the afternoon at work. Usually by the time I’d really start to get concerned, she’d start moving again. No surprise she is the quieter child, happy to sit and play with toys while the older one that was so active is very much running around doing things all the time. I’ve not progressed far enough in this pregnancy to feel consistent movement yet, though I’m sure I’ve felt a few flutters.
I appreciate your comment. It would be very interesting to do a study comparing fetal movements with level of activity after birth. I do believe that babies have their own personalities and activity levels, even before birth.
Thank you! It’s what I have been telling people! A nurse at my OB’s practice flipped out when I only had 2 kicks in an hour even though I explained to her FOUR TIMES that baby was more active at night since I had just switched from 3rd shift to 1st shift. She got snotty with me and told me that she guesses I just don’t care about my baby. I didn’t even call her about kicks, I had called her about the amount of braxton hicks contractions I was experiencing. The nurse just made me so mad I have yet to call her again. I just wait until the office is closed and talk to the OB’s who don’t ask you to count kicks, they ask you if your baby’s movement is normal and if it’s not they tell you to change what you are doing for an hour.
I have found that this is a major cause of stress for many women–constantly monitoring the number of kicks and feeling fearful if they don’t continually feel a specific number of kicks/hour.
In my first pregnancy my baby was VERY sedate, he had maybe 2 brief periods of movement, one in the morning, one in the late evening. While he did respond to loud noise pretty much anytime the other things you’re supposed to try to illicite movement never worked. He also was in almost the exact same position from about 20 weeks til about 37 weeks, so his brief periods of movements were mostly flutters of his arms and legs. I was scared in later pregnancy because the kick counts didn’t ‘work’ for us, he was never that active. I was nervous because if I did experience ‘decreased fetal movment’ it would be about 24 hours before I would even begin to notice it! But once he was born he was one of the most active babies I’ve ever seen (and still is as a toddler). I’m in my second pregnancy and she’s extremely active, during any 2 hour time period she’ll absolutely have 10 movements, and at least 5 active periods a day where she’ll easily make 10 movements in 10 minutes. Its so reasuring to feel her move about but, again, normal ‘kick count’ doesn’t really help, just because I’ve gotten 10 kicks in 2 hours (my OBs gold standard for healthy baby), doesn’t mean I’m not experiencing significantly reduced fetal movements! Its happened twice, once I went in for a non stress test, the monitor ‘woke’ her up and she started kicking at it, the second time I didn’t, because they said as long as I was getting 10 kicks in 2 hours they wouldn’t be worried. Now waiting to see if she’s getting all her activity out of the way or if she’ll be active baby too!