Fetal Kick Counts
Fetal movements or “kicks” is how baby tells us that they are thriving inside the womb. If baby is moving normally during pregnancy and labor, this tell us that baby is not in any distress at this time!
Why should you do fetal kick counts??
Fetal kick counts tell how baby is doing on the inside to help potentially identify and prevent intrauterine fetal death, and is a way to avoid preventable stillbirth!
When a baby is thriving, they move a lot and it’s in a cyclical pattern of high activity to low activity.
When a baby is in distress or not thriving, usually the earliest indication is a decrease in that fetal movement. Whenever there is a decrease in the fetal movement that you notice GO IN TO BE ASSESSED!!!! DO NOT try to drink juice or sugary things to see if “baby wakes up,” head in to be assessed. You can try to juice, ice water, or sugary items on the way to the hospital.
When and how to do fetal kick counts:
When do we recommend starting?
We recommend starting actually doing kick counts around 28 weeks. This is when their movements are consistent enough to be able to track it.
Some will feel movements earlier than 28 weeks, it can range from as early as 14 weeks to sometimes not till 24 weeks.
If you start noticing movement earlier we don’t recommend doing traditional kick counts, but can still monitor it and if it stops all together maybe go in and be seen.
The difference of when you feel baby’s movement can be dependent on the location of the placenta, baby’s position, or even your own body. We usually feel it earlier in subsequent pregnancies too.
How do we do kick counts?
It is taught that once a day, usually the same time each day, sit down for 2 hours to just count baby’s movement. Once you get 10 movements then you can stop, whether it takes the full 2 hour or only 10 mins.
This is supposed to tell you that baby is doing well on the inside! But it may not be the best assessment on baby’s wellbeing. Instead, it may be recommended to track your baby’s overall movement trends throughout the day as a sign of their wellbeing instead of just 10 movements in 2 hours.
If you find yourself overwhelmed with counting, you can also track baby’s active times throughout the day, such as at 10am baby seems to move a lot and the same at this time and this time throughout the day. Kick counts can help you notice if your baby’s normal movement patterns are off, which can be an indicator of an issue.
What counts as fetal movement?
Most voluntary movements count! So any rolls, punches, kicks, flips, or jabs. They all count! As baby grows and there is less room these movement may change in how we feel them, but they should not decrease as baby gets larger. The kicks may not be the same as when they had more room to wind up or they may not be able to roll over as much as they once would, but they should still be moving! If there is a decrease in movement that is a sign baby needs to be assessed, it is NOT normal as baby gets bigger.
Movements that don’t count are involuntary movements such as hiccups. Just like we are not able to control when we have hiccups, babies have no control over them as well!
Is it the best way to measure fetal well-being?
There is recent information to suggest that the traditional way of monitoring baby of sitting down for 2 hours may not be the best way to measure fetal well-being.
A better way is to learn your baby’s normal movement pattern along and notice when there is a change in that normal movement pattern.
Such as your baby is normally very active around 2pm… then a few days later at 2pm you notice your baby isn’t moving as much as usual.
This could be a sign baby needs to be assessed and possibly be born sooner rather than later.
This is the newer way of doing kick counts because not all baby’s move the same and the 10 kicks in 2-hour could possibly make some more anxious because their babies don’t move a lot or others falsely reassured their babies are okay.
Example: Some babies when doing kick counts will routinely only do 8 or 9 movements in that 2-hour period, but that’s their normal. So this person is going to triage daily because they aren’t getting their kick counts.
While another baby could move 30 times in that 2-hour period and then one day their movement could drop to 15 kicks in 2 hours, but because it’s above the 10 kicks they don’t go into triage.
Except this is a HUGE change in their normal and potentially baby could benefit from being assessed.
How will they assess baby for decreased movements?
When you do your daily kick counts and baby has decreased movement or no movement the recommendation is to GO IN IMMEDIATELY!
Whenever I have a patient come in for decreased fetal movement and I ask “When is the last time you felt your baby move?” and their response is “yesterday” or “its been a few days” I am immediately worried and try to quickly put baby on the monitor to find a heartbeat. DO NOT WAIT, GO IN! You are not wasting anyones time, they are at the hospital to help you!
What do we do when you come in for decreased or no fetal movement?
1. Non-Stress Test (NST): This is when we put you on the fetal monitoring system with the ultrasound and contraction monitor. This can take 20-40mins. What we are looking at are signs in baby’s heart rate that they are doing well
2. Ultrasound Machine: The provider will then look at baby with an ultrasound machine, they will usually do what we call a BPP, Biophysical Profile. This is when they look at a five things and give baby a score out of 10. Each item is 2 points. This score then tells us if baby is doing well (8-10), needs to be reassessed in 24 hours (6), or needs to be delivered(0-4). the BPP includes:
- NST
- Amniotic Fluid Volume (if fluid volume is low this would be considered oligohydramnios, this is a reason to be induced because if there is not enough fluid surrounding baby this increase the risk of injury to the umbilical cord. This would also explain why baby’s movement decreased)
- Fetal breath movements
- Fetal movements
- Fetal tone
Based on these two tests they will determine what to do for baby!
Prevent Stillbirth with Kick Counts
Some will say that they prefer one method over another for their own anxiety. Honestly, for me, either method is beneficial because either way you’re monitoring your baby’s movement. I always educate to get to know your baby’s movement and come in when their movement is off. It’s so much better for you to come in and baby be fine than the alternative.