By Lindsey Wimmer, MSN, CPNP
Kick counting during pregnancy seems too easy to be valuable – right?!? Many healthcare providers and pregnant women do not recognize the importance and potential benefit of something so simple. Despite all the controversies and unknowns surrounding stillbirth, nearly all major health care, obstetric, pregnancy care, and babyloss organizations around the world recommend kick counting!! Yet, many women do not do them and their doctors, midwives, and nurses don’t talk to them about it. That needs to change!
First – How do I count my baby’s kicks?
There are many ways to do this, but below is what I have found to be the most simple and most effective. It is not hard to understand, shouldn’t take a long time, and allows you to make decisions based on what is normal for this pregnancy.
1 – At the same time each day when the baby is usually very active, lie down or sit quietly. Focus your attention on baby’s movements.
2 – Note how long it takes for you to feel 10 movements. These can be kicks, rolls, jabs, swooshes, flutters, etc. Anything except hiccups should be counted.
3 – Mark this time on your kick chart. You should begin to see a pattern develop. If at anytime the time is significantly different, you have concerning symptoms, or you have a feeling something is not right, call your doctor or go to the hospital right away.
Second – What should I do if I notice a change in my baby’s movements??
Report your concerns to your health care provider IMMEDIATELY. This cannot wait for your next visit, until the office opens in the morning, or until you have more symptoms. If you cannot reach your provider, go to the Labor and Delivery unit or Emergency Room of the closest hospital and tell them you need to be evaluated. Babies DO NOT slow down at the end of the pregnancy and they DO NOT usually sleep for longer than 90 minutes at a time. If you notice either of these changes, see your health care provider to be evaluated immediately.
Most of the time, this evaluation will consist of at least listening to fetal heart sounds and a non-stress test. An ultrasound to look at the baby, the placenta, the cord, the amniotic fluid, and Doppler blood flow would provide a lot more information. If you are still concerned, ask to continue to be monitored until your concerns have been resolved. Studies have shown that women who report a decrease in fetal movement have 3 times the risk of having a stillborn child. You must be completely comfortable that you and your baby are healthy before leaving the hospital and you should have a plan to follow up with your provider soon after. Mothers need to trust their instincts and advocate for their babies. They know their babies better than anyone, and they should feel comfortable asking for the best care for their child.
Finally – why aren’t women counseled about counting kicks regularly?
There are many theories on this, and the truth is probably a combination of all of them. Some health providers just haven’t kept up on the latest data about kick counting. Some providers are afraid to mention it to their patients because they don’t want to scare a pregnant mom. Some women won’t do kick counting because they don’t see how it could help or know what they are watching for. Some providers don’t suggest it because they aren’t sure how to do it and when to be concerned. Some providers don’t recommend it because they don’t know what they should do if a concern is found. And many more.
Recognition of a change in fetal movements has been associated with baby’s poor growth and stillbirth. A change in movement may be a baby’s way of telling us that he/she is not ok. THIS is why it is important. Yes, it can be scary to think about. But families need the information to do what they can to monitor and protect their child’s well-being. So many families (women in particular) are devastated by guilt after their child is stillborn – and it can be worse if they find out later that they could have been, and should have been, counting kicks.
The major healthcare organizations in developed countries have recommendations for kick counting, but there are many different “methods” – and research hasn’t determined which one is “best”. So far, studies indicate that it doesn’t really matter how you do it, as long as you do it. These organizations have also not created a clear protocol for healthcare providers about responding to a pregnancy with a change in fetal movement. At the Stillbirth Summit 2011, Dr. Alexander Heazell from the UK spoke on this topic and was very clear about the importance of responding appropriately to this major symptom. The Royal College of Obstetrics and Gynecology has published a guideline on Fetal Movements with suggestions for providers on how to evaluate these pregnancies. Again, much research is needed. But it is a wonderful start and proves that there is much that could be done to find a baby in trouble.
Stillbirth prevention could have a huge boost if kick counting was more common. It’s easy, it’s safe, it’s free! We tend to think that major advancements come in the form of new, risky, expensive, and mind-blowing technology. While that may be true some times, we can’t forget to look at methods that are simple and widely available. The best part is that this is a test done by the parents – those who know and love this baby better than anyone. That is where the best health care comes from.
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Lindsey Wimmer, a Pediatric Nurse Practitioner, is Mom to four children; Garrett who was stillborn in 2004, Grant, Bennett and Austyn. Lindsey and her husband Trent founded the Star Legacy Foundation shortly after Garrett’s birth when realizing that the numbers of stillbirths in the US were staggering and that very little was being done to determine the causes or find prevention initiatives. Visit the Star Legacy Foundation to learn more.