By Dr. Abdul Aziz
Obstetrician and Gynaecologist
MBBS (S'pore), MRCOG (UK)
From the moment you know that you’re pregnant, it is natural that you will anxiously wait for your first ultrasound scan to see the little bundle of joy growing in your tummy for the very first time. If your scan is done after 8 weeks, you can even see your baby’s subtle, tiny wriggly movements and hear his or her heartbeat. However, it is only when you actually feel your baby’s first movement inside of you (called ‘”quickening”), he or she will then seem more real rather than just an ultrasound image.
Fetal movement refers to the motion of a foetus caused by its own muscle activity. Muscles begin to contract as soon as they are innervated. These first movements are not reflexive, but are arise from self-generated nerve impulses originating in the spinal cord.
As the nervous system matures, muscles can move in response to stimuli.
Variations in activity level
Foetuses aged between 14 to 18 weeks show a pronounced circadian rhythm in their activity level, i.e. day and night variation. Active and quiet periods of the foetus do not correspond to those of the mother’s; foetuses are most active from 9am to 2pm and again from 7pm to 4 am. Before 24 weeks, the baby’s movements will be few and random; there may be days when he or she moves a lot and other days when you do not feel any movements at all. Despite the way it seems, the baby is moving and kicking all the times. It is only in the late second trimester, the baby’s movements will develop into a regular pattern. Fetal movements generally begin to fall into pattern of activity around 24 to 26 weeks, and these patterns will usually continue until the day of the delivery or sometimes a few weeks before the delivery. Each baby has his or her own sleeping cycle and there are certain times in a day, he or she will typically move more. You can actually take note of your baby’s active periods to identify whether the baby is a morning, afternoon or night baby.
Monitoring fetal movements – “Kick-counting”
After “quickening”, which was mentioned earlier, you my start to count the number and types of movements you feel that your baby is making. This tally is informally known as “kick-counts”. The advantages of conducting kick-counts include giving a pregnant woman the opportunity to bond with her baby and reducing the risk of stillbirth.
Counting your baby’s kicks is simple. Use these easy steps, which most obstetricians recommend, starting around 24 weeks to 26 weeks of your 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 down in a comfortable position. Note the time it takes for the baby to have 10 movements (kick, twist, flutter, turn, etc, but not hiccup). Most babies usually take less than 30 minutes. By doing so regularly, mum gets to know her baby’s movement pattern. If the baby is taking longer than usual or if there is a significant change, counting may be repeated after taking some juice, walking for a few minutes or lying on mum’s left side (which maximises blood flow to the fetus) to gently stimulate the baby physically.
Notify your doctors or midwife if the baby is taking longer than usual. If there is a significant change or if there are fewer than 10 movements in 2 hours.
Counting kicks doesn’t require a doctor’s supervision. Feel free to count the kicks on your own and get to know your baby’s habits. It is good to have a baseline of which you can compare with if the baby’s movements changes later on. Keeping track of your baby’s movement can also help to ensure he or she is strong and healthy.
Of course, kick-counting is not all fool proof. Remember to trust your own instincts about your baby as well. If you feel that there is something not quite right, call your doctor immediately or go to the nearest hospital. Your instincts are usually correct and should be checked out to ensure the safety of both mother and child.
Generally, your doctor will ask about your baby’s movements during each visit: how often do you feel the movements? If there have been any changes? So on and so forth. So why are all these information so important to both the doctor and yourself? Your doctor only sees you once every two to four weeks. Fetal movements is the best indicator of a healthy pregnancy; if the baby is not growing well, he or she will be probably slow down his or her activities way before stopping all movements eventually.
Monitoring babies with slow movements
Not all doctors will ask for formal monitoring on fetal movements. More often than not, most mothers will complain about how much discomfort their babies have been giving them because of the ‘aggressive’ fetal movements. Most mothers who have high-risk pregnancy are given specific instructions for counting and monitoring of fetal movements. They may subjected to more detailed monitoring, such as foetal heart rate monitoring (cardio-tocogram, CTG), ultrasounds (biophysical profile) and umbilical cord Doppler testing. It is undoubtedly that mothers who have low-risk pregnancy will also benefits from monitoring of their fetal movements.