I was called to the hospital yesterday to evaluate a patient who reported that her baby was not moving as much as usual. Katherine was at 36 weeks’ gestation, about a month from her due date. She told me that her baby was normally very lively, but for the last day, he just seemed sluggish.
Have you experienced this, too? You’re not alone. Decreased fetal movement is a common concern – at least 40% of women report that their babies have quieted down at least once during the pregnancy.
So how much fetal movement is enough? When should you worry?
To answer these questions, let’s talk about typical fetal behavior:
- We can see babies move on ultrasound as early as 7-8 weeks into the pregnancy. Women begin to feel these movements when they are 16-20 weeks along. If you have had a baby before, you will feel fetal movement earlier than someone who is new to this.
- If you think your baby moves more at night, you are probably right – babies do tend to move more and later in the day and into the evening.
- Babies move in a variety of ways. They stretch their arms and legs, they wiggle their bodies, they turn their heads, they yawn and hiccup. But even though they are frequently in motion, you may only feel about half of those antics. How much movement you perceive depends on several factors – the position of the baby (if they are facing your spine, you may not feel as much), the location of the placenta (if it is implanted on the front wall of the uterus, some movement may be muffled), and whether the baby is moving the whole body or just an arm or leg.
Now back to our question – when should you worry about any decreased movement of your baby?
The simple answer is that if you notice a pronounced reduction in your baby’s movements, it’s always a good idea to contact your OB provider. You are the person who is most familiar with your baby’s routine. Some babies seem lively all the time. Some babies are naturally quieter. What you are looking for is a change. Here are some ways to monitor fetal movement over the course of your pregnancy:
- Develop an awareness of your baby’s habits. When you begin to feel movement, learn his schedule and pay attention when it changes.
- Understand that movement changes as the pregnancy progresses. Babies in the third trimester start to sleep for longer periods of time, so there may be long pauses between episodes of movement. This is usually a gradual process.
- Also, babies become more crowded as they grow, so movements may feel different later in pregnancy – maybe more squirms than big kicks.
- In a 20 minute period, the typical fetus (if this exists) moves 10 or more times after about 24 weeks. When you factor in sleep cycles, you should usually feel at least 10 movements within 2 hours. So “count to ten” if you think your baby may not be moving enough. In other words, count how long it takes you to feel 10 movements. If it takes more than 2 hours, contact your OB provider.
When you call your provider, what will happen?
- If you are more than 24 weeks pregnant, you will usually be seen the same day. If your decreased movement occurs at night or over the weekend, go to the hospital.
- The first thing someone will do is check for a fetal heartbeat. Once this is heard, you will probably be placed on a fetal monitor (a little fetal heart rate monitor attached to you with elastic belts). There are patterns in the fetal heart rate that tell us if your baby may be stressed versus happy.
- You may have an ultrasound, especially if there are any concerns about the baby’s heart rate tracing.
- If the evaluation is reassuring, you will probably go home with instructions to continue monitoring fetal movement. If you are still not feeling the baby move as much as usual, contact your provider again or return to the hospital.
There are plenty of reasons why babies depart from their routines and slow down sometimes. It may be simply that your baby has changed positions. Or you may have become so accustomed to feeling your baby’s movement that it becomes something you don’t really notice anymore.
On the other hand, decreased fetal movement may be a symptom of a more serious process.
So my most important advice for you is this: contact your provider or go to the hospital if you are concerned about your baby’s movement. Do it now. Even if you have an appointment the next day. Even if you saw your provider yesterday.
Never feel sheepish or apologetic about this, or worry that we think you’re overreacting. You are the most important advocate for your baby, so if you are worried, so are we. Call.