Pregnancy

Fetal Development | Fetal Movement and Kick Counts

Fetal Movement Facts

A fetus usually spends about 10 percent of its time moving its body.

In general, fetal movement is first felt during the 5th month of pregnancy (around week 18 to 20, a bit earlier if you’ve been pregnant before, later if this is your first pregnancy). “Fetal movements are at first very weak and moms may just think it is ‘intestinal activity,'” says Dr. Mary B. Munn, director of Ultrasound/Prenatal Diagnosis, University of Texas Medical Branch. “As the pregnancy progresses, they begin to feel more limb movements and ‘kicking’ and then later on more of a ‘rolling’ or ‘squirming’ type of movement.”

According to Dr. Munn, a fetus usually spends about 10 percent of its time moving its body, with 70 to 80 percent of these movements perceived by the mother. Arm and leg movements may occur more often, but may not be felt by the mother quite as much.

Fetal movements generally begin to fall into patterns of activity around 24 to 26 weeks. “Each baby has sleep cycles and typically has certain times during the day where he or she typically moves more than others,” says Dr. Diep Nguyen, a Los Angeles OB/GYN. “Mom can actually identify her baby’s active periods whether her baby is a night, afternoon or morning baby.”

Monitoring Movements

Generally speaking, your physician will ask about your baby’s movement at each office visit – how often you feel movement, if there have been any changes, etc. But why is this information important?

“Doctors only see the moms every two to four weeks,” Dr. Nguyen says. “Fetal movement is the best indicator of pregnancy health and is the best yardstick in between those times. If the baby is not growing well, it probably will slow down its activity way before it will stop moving all together.”

Not all physicians will ask for formal monitoring of fetal movement. “Most patients who have a high-risk pregnancy are given instructions for fetal movement counting in addition to other testing they may be having (fetal heart rate monitoring, ultrasounds, umbilical cord Doppler testing),” Dr. Munn says. “It may also be of some benefit in low-risk patients as well.”

Thankfully, monitoring fetal movement was stressed to Trish Dittenhafer. At 6 1/2 months pregnant, Dittenhafer of Ashland, Mass., was diagnosed as having a below average amount of amniotic fluid. After seeing a maternal fetal medicine specialist, Dittenhafer was monitored twice a week with ultrasounds, and she monitored her baby’s kicks at home, too.

“Because of the low fluid problems, I [kept] track of fetal movement throughout the day by keeping a log,” Dittenhafer says. “This was the best way for me to determine if there was anything wrong or out of the norm for daily fetal movement.” With this careful monitoring, Dittenhafer’s baby was born healthy.

Unfortunately for Tiffan Yamen, whose second child was stillborn at 37 weeks, awareness of the importance of fetal movement came too late. “With my first two pregnancies, I was under the impression that as I got closer to my due date the baby would run out of space and may not move as much,” says the Waukee, Iowa, resident. “The afternoon prior to losing our daughter, Madeline, I went into labor and reported to labor and delivery at our hospital upon the request of my OB’s office. The baby and I were monitored in a triage area for nearly six hours before I was sent home that same night. While I was being monitored, the nurses kept commenting that I had a sleepy baby.”

Though Yamen’s contractions continued, her daughter’s movements didn’t increase, and a biophysical profile was done. She had a perfect score, so Yamen was sent home, but wasn’t advised to monitor the baby’s movements. At her doctor’s visit the next day, the baby’s heartbeat couldn’t be found. A knotted umbilical cord had cut off her oxygen and blood supply. It’s possible that Madeline’s decreased movement the night before was a sign that she was in distress.

According to Dr. Nguyen, decreased fetal movement has been associated with impaired intrauterine growth and stillbirth (unexpected death of the baby after 20 weeks of pregnancy). Dr. Nguyen admits not all stillbirths are preventable. “However, the majority are, with increased awareness of the importance of fetal movement so that doctors can make timely intervention,” she says.

Kick Counting

Counting Baby’s kicks is simple. Dr. Nguyen, who founded Babykick Alliance promoting healthy pregnancy through Kick Count Awareness, provides these easy steps, which she recommends starting around 26 weeks of pregnancy, especially if you have a high-risk pregnancy:

  • Once a day, simply choose a specific time when the baby is usually most active. Sit in a comfortable position.
  • Note the time it takes for the baby to have 10 movements (kick, twist, turn, etc., but not hiccup). “Most usually take less than 15 minutes,” Dr. Nguyen says. “By doing so every day, Mom gets to know her baby’s pattern.”
  • If the baby is taking longer than usual or if there is a significant change, counting may be repeated after taking some juice or walking for a few minutes.
  • Notify your doctor or provider if the baby is taking longer than usual, if there is a significant change or if there are fewer than five movements in an hour.
  • Counting kicks doesn’t require a doctor’s orders. Feel free to count kicks on your own and get to know your baby’s habits. It’s good to have a baseline with which to compare if fetal movements change later on.
  • Yamen has since given birth to another healthy baby and, along with her husband, has vowed to work with the medical community and expectant parents in creating awareness for stillbirth, cord accidents and kick counting. “I have spent the past five years working with a small group of Des Moines-area stillbirth moms,” she says. “All five of the women in our group learned about ‘kick counting’ after our pregnancy losses. The more we learned about kick counting – it’s easy, safe and free – the more astonished we were that the majority of OB doctors don’t promote it with their expectant patients.”
  • Yamen is now part of a nonprofit organization called “Healthy Birth Day,” which advocates for advancements in stillbirth and fetal movement research, as well as promotes increased education and awareness of maternal health issues.
  • Of course, kick counting isn’t foolproof. Remember to trust your instincts about your baby. “If you think there is something not quite right, call your doctor immediately or go to the hospital,” Dittenhafer says. “Your instincts of how you are feeling and that there is something not right is usually correct and should be checked out to be safe – for you and the baby.”