Are you concerned about reduced movement of your baby?
These instructions will help you know what to expect in each week, depending on the stage of your pregnancy. Counting movements is a wonderful and simple way to connect with your unborn baby.
When do we feel the first movements?
This is influenced by several factors, including the number of previous pregnancies, maternal BMI, placental position, and more. Most women feel the first movements between weeks 16 and 20 of pregnancy. At first they are gentle, like butterflies in the belly, then they become stronger. Over time, you will recognize your baby’s movement pattern.
Start counting movements from week 28 of pregnancy onward.
Less than 24 weeks pregnant
Most women become aware of their baby’s movements somewhere between weeks 16 and 24 of pregnancy. If you have not felt any movements by week 24, this is the time to contact your chosen midwife, who will check the fetal heartbeat (or in our case, your obstetrician/maternity ward). An ultrasound examination by a specialist may be needed to check the baby’s condition.
Some describe the first movements as “butterflies in the belly” 🙂
In a second pregnancy, you may start feeling movements sooner.
If the placenta is on the anterior wall of the uterus, you may feel movements less clearly throughout the pregnancy.
Between 24-28 weeks pregnant
If you do not feel movements, you must contact your midwife and meet with her the same day if possible (or in our case, your obstetrician or maternity ward). If you cannot meet with your midwife, she will likely refer you to the maternity ward, where the heartbeat will also be checked and you will receive a complete assessment, which should include:
- checking your baby’s size with a clinical examination (fundal height) or, in our case, an ultrasound is performed. click – baby bump
- checking blood pressure
- urine test for protein
If your baby is smaller than expected, an ultrasound will be performed to further check the baby’s growth.
Over 28 weeks pregnant
Your obstetrician will advise you to count movements from week 28 of pregnancy until delivery.
You need to contact your midwife or obstetrician/maternity ward if you do not count 10 movements. Do not wait until the next day. During the assessment, they will:
- Ask you how many movements you counted, when, how, etc.
- Perform an antenatal examination, which also includes checking the baby’s heartbeat and movements, and growth.
- A CTG (cardiotocogram) will be recorded, which monitors the baby’s heart rate and any contractions, for approximately 20 minutes
You may be admitted to the maternity ward. You should not be discharged if the movements are still not reassuring to you. It is also possible that you will have an ultrasound to check:
- if the baby is smaller than expected
- if other risk factors are involved that may be associated with a higher risk of stillbirth
The ultrasound is usually performed within 24 hours. These examinations usually show that everything is fine. Most women have at least one episode of not feeling their baby well.
Even if you have a Doppler at home to check the heartbeat (e.g., Angel Sound), detecting your baby’s heartbeat should not reassure you, as you do not know what is normal and the baby may still be at risk! It is essential to see a healthcare professional.
WHAT DO I DO IF MY BABY’S MOVEMENT DECREASES AGAIN?
When you are discharged, you will be advised to pay attention to your baby’s movements. If your baby has another episode of reduced movement, see a healthcare professional again. Always inform your midwife/obstetrician whenever you do not count enough movements or do not feel your baby well; or go to the maternity ward. You are never going for no reason!
COUNTING MOVEMENTS
As mentioned, movements are counted from week 28 of pregnancy until delivery. Before starting to count movements, it is important that the baby is awake. You can encourage activity by, for example, walking for a few minutes.
- Then get comfortable. Lie on your side or sit comfortably.
- Place one or both hands on your belly.
- Check the time and start counting movements.
Some obstetricians instruct that one series of movements with a beginning and end counts as one movement. However, Slovenian guidelines from 2019 state that during a series of movements, you count each movement.
- When you count 10 movements, check how much time has passed from the start of counting to the tenth movement.
- Enter the measured time in the table column according to the gestational age.
- Count movements only once a day and for no more than 2 hours!
Nevertheless, I recommend that you pay attention to fetal activity outside of these two hours as well. Some will still advise that there should ideally be a few minutes’ pause between individual series so that we can definitely count them as multiple movements, but this is not a strict rule. See below “When should I contact my obstetrician?”
By counting movements, you ensure there are at least 10 in two hours. Choose a time of day when your baby is most active. Try to count movements at approximately the same time each day.
Movement counting chart: For counting movements, only the squares at the top are relevant; those at the bottom simply indicate the hour at which you counted the 10th movement. So if you were diligently marking movements as you go, you would cross off the top squares for each individual movement, and when you crossed off the last one, you would check the time and cross off the corresponding square below (so if the last movement is at 5:40 PM, for example, you would cross off the square indicating 6:00 PM).
Fetal Movement Counting Chart (from the brochure “Counting Fetal Movements“)
You must count at least 10 movements in one day!
WHEN SHOULD I CONTACT MY OBSTETRICIAN?
- If you have counted fewer than 10 movements in two hours.
- You notice a significant change in your baby’s movement pattern.
- You notice significantly reduced activity of your baby.
- The time it takes to count 10 movements is significantly longer (so if you previously counted 10 movements in 45 minutes, but now it has been taking an hour and a half or two for several days) and remains prolonged for several days.
Possible reasons for reduced perception of movements:
- the placenta is on the anterior wall of the uterus
- your position – you will feel movements best if you lie down, least when standing
- if you do not take the time, you will not be as aware of movements
- the baby is sleeping
- you have an elevated body mass index (BMI)
- the perception of movements is also affected by the amount of amniotic fluid (too much or too little)
- maternal conditions (metabolic diseases, autoimmune diseases: thyroid, anemia)
- some bad habits and substances: smoking, methadone, sedatives, alcohol, corticosteroids
- fetal growth restriction
- fetal conditions: neurological diseases, fetal anemia, muscle and bone abnormalities.
This article is a compilation of instructions written according to the recommendations of the Royal College of Obstetricians and Gynaecologists on the management of women reporting reduced fetal movement. It was developed by Tommy’s and supported by NHS England. Source
Another source is the latest Slovenian guidelines from 2019, “Counting Fetal Movements“, prepared by:
Vid Janša, MD, UMC Ljubljana, Department of Gynecology and Obstetrics, Division of Perinatology
Gabrijela Bržan Šimenc, MD, UMC Ljubljana, Department of Gynecology and Obstetrics, Division of Perinatology Asst. Prof. Tanja Premru Sršen, MD, UMC Ljubljana, Department of Gynecology and Obstetrics, Division of Perinatology
Abstract of the article:
“Reduced fetal activity or a change in the pattern of fetal movement may be associated with poor perinatal outcome. It has been found that an inadequate response by the physician – obstetrician and midwife when encountering a pregnant woman reporting reduced fetal movement is a factor contributing to stillbirth. All pregnant women should receive information about normal fetal movement. We recommend uniform delivery of information on monitoring fetal movements, a uniform method of monitoring fetal movements (modified “count to ten” method), and the use of a uniform table for recording fetal movements for pregnant women. If a pregnant woman has counted fewer than 10 movements in two hours, she should not wait and should arrange for an examination immediately. She should also arrange an examination with her chosen obstetrician in case of a change in the pattern of fetal movement and a sudden significant prolongation of the time to count 10 movements that persists for several days. Through history and clinical examination, we must identify pregnant women at higher risk for complications. At each examination, blood pressure must be measured and proteinuria excluded; the examination should also determine whether fetal growth is appropriate for gestational age. After week 28 of pregnancy, CTG should be used to assess fetal well-being. In case of risk factors for intrauterine fetal death or fetal growth restriction, in case of a suspicious CTG recording, and in case of a normal CTG recording with persistent reduced fetal movement, an ultrasound examination is required.”
