The importance of your baby's movements in pregnancy

Your baby's movements during pregnancy are the best indicator of their health and wellbeing. Studies show a link between absent or reduced fetal movements and poor health outcomes, such as:

• Giving birth to smaller babies.
• An increased likelihood of preterm birth.
• And in the worst cases, stillbirth.

Research shows as many as 55% of women who had a stillbirth noticed their baby's movements had slowed or stopped the week before. 

During your booking appointment, your midwife will ask questions about your medical history, lifestyle and family history to identify any risk factors that might increase your likelihood of developing pre-eclampsia. 

If you have two or more of the following risk factors, you may be slightly more likely to develop pre-eclampsia:  

• First pregnancy or first pregnancy with a new partner.
• A gap of more than 10 yrs since you last gave birth.
• Aged 40 yrs or older.
• A family history of pre-eclampsia (mother or sister).
• Multiple pregnancy – twins, triplets or more.
• Obesity (BMI of 35 or higher).

If you have more than one of these risk factors, your midwife (or doctor) will advise you to take 75-150mg of aspirin daily until your baby is born. Doing this can reduce the likelihood of developing pre-eclampsia. 

Studies show several factors associated with a much higher likelihood of developing pre-eclampsia. These include:

• A history of hypertension.
• High blood pressure in a previous pregnancy.
• Type 1 or 2 Diabetes.
• A history of chronic kidney disease.
• An autoimmune disease, e.g. Lupus or antiphospholipid syndrome (also known as Hughes syndrome).

If you have any of these risk factors, your midwife (or doctor) will advise you to take 75-150mg of aspirin daily until your baby is born.  

They will also offer additional antenatal appointments to monitor your baby's growth. It is essential not to miss any antenatal appointments during pregnancy and to take anti-hypertensive medications your doctor prescribes - even if you are feeling well. Not doing so can lead to serious complications for you and your baby.

You can buy many devices that tell you they can measure your baby's heart rate, from mobile phone apps to home dopplers. But it is not advised you do so!

These are dangerous claims, as it takes midwives and doctors years of training to recognise what they hear through a doppler! For starters, it may not be your baby's heartbeat you hear. It could be your own or other noises you can mistake for a heartbeat, such as blood flow into the placenta. That's before you even consider how high quality the product you purchased on the high street is.

The other important thing to consider is that even if it is your baby's heartbeat you hear, it doesn't tell you anything other than the fact they have a heartbeat. They could still be unwell, in the same way your heartbeat isn't affected by every illness you have. As mentioned, the NICE guidelines don't recommend midwives routinely listen to it for this reason.

Finally, home dopplers can give people a false sense of security. There have been cases where women have noticed a change in their babies movements but not contact a midwife because they can 'hear' a heartbeat. Devastatingly, in some cases this has resulted in babies dying.

It's easy to miss your baby's movements in the early weeks of pregnancy and, in first-time pregnancies, can easily be mistaken for wind or indigestion.

The majority of pregnant women feel their baby's distinct movements in the womb by around 18-20 weeks' gestation; however, this can vary between women:

• Women expecting their first baby often notice movements by 20 weeks.
• Those expecting their second or subsequent baby may feel movements much earlier – often around 16 weeks.

Contact your midwife if you haven't felt your baby move by 24 weeks. They will listen to your baby's heartbeat and may send you for an ultrasound.

The first time you feel your baby move inside the womb is a really exciting moment. It often feels like a slight 'fluttering', 'swishing', or 'rolling' sensation in early pregnancy. 

However, as the pregnancy advances and the baby develops, movements become more pronounced, like 'kicks', and a pattern of activity quickly develops. 

Research indicates there is no set number of movements that babies should make in 24 hours. Each baby is individual - some babies will be more active than others. 

The critical point to highlight here is that you need to focus on recognising your own baby's usual level of movements and peak times of activity. Don't worry if it's different to your friends, or even a previous pregnancy! Then, any reduction in movements or changes to the pattern of activity can be identified and promptly referred to a midwife or doctor for assessment. 

You may start to recognise a regular pattern emerging between 24 and 28 weeks, although this can vary! As your pregnancy advances, you will feel your baby move more, peaking at around 32 weeks. 

After 32 weeks, the pattern of movements will stay roughly the same until your baby is born. The movements may feel a little different as your baby grows and the available space in your womb decreases. However, as already mentioned, their frequency should not, and you should continue to feel your baby moving right up to and throughout labour.

We recommend you take some time out of your daily routine to focus on your baby's movements inside the womb, no matter how hectic life might be.

Your baby will move when awake - day or night, as they do not learn to recognise the difference until they are born. They will sleep for 20-40 minutes periods (rarely longer than 90 minutes) and are unlikely to move during these short periods. 

Studies examining fetal movement patterns show that afternoons and evenings tend to be babies' peak activity times. Don't worry if your baby is active outside of these hours! Everyone is different; focus on your baby and ask yourself:

• How many times do they move in a day? 
• Do they move more in the morning, afternoon or at night? 
• Do they wake up when I eat? 
• Do they wake up when I exercise? 
• Are they more active when I relax?

Building this knowledge will help you piece together a pattern and notice if it changes.

We lead increasingly busy lives! Work, daily responsibilities, chores, and the care needs of any other children can all impact your ability to keep track of your baby's movements. For this reason, we recommend taking some time out to learn to recognise your baby's pattern of activity.  

Some research suggests a woman's posture can affect her perception of fetal movements. It indicates that women feel their baby's move most when they lie down, less when sitting, and the fewest while standing upright.

The baby's position inside the womb can also affect how much you feel them move. For instance, if the baby is lying with their spine against your spine (back-to-back), you are more likely to feel them kick than when your baby's back is facing towards the front of the womb. However, if your baby is head down or bottom/feet down (breech), you're unlikely to notice a difference. 

If the placenta is in an anterior (at the front of the womb) position, particularly before 28 weeks, it can cushion the baby's movements, making it harder to feel them. Try to focus on when you notice any kicks or flutters on the sides of your bump or lower down. You should still be able to recognise your baby's regular pattern. Always contact your midwife if it slows down - don't assume it's just because the placenta cushions them. 

Substances

Certain substances can cross the placenta and enter the unborn baby's circulation, causing them to become sleepy and impacting their activity levels. These include:  

• Alcohol.
• Tobacco smoke.
• Medications (including sedatives and potent painkillers).

Congenital abnormality

Certain congenital conditions affect the central nervous system, muscles and skeleton of the unborn baby, reducing fetal movements. 

Illness

If your baby is unwell, they will be less active than usual. 

Seek help immediately if you notice a change in your baby's regular pattern, so they can get the help and support they may need.

It is worth mentioning that just because you haven't felt your baby move as much as expected does not mean they are unwell! It could simply be that you were busy and haven't noticed them move as much as usual. But without a check-up, you won't know either way.

Contact your midwife immediately if: 

• You think that your baby is moving less than usual.
• There is a change to their typical pattern of movements.
• You have not felt them move for a while.

Never delay in contacting them, day or night. Don't wait until the morning because reduced activity can signify that the baby is unwell, and their health might deteriorate quickly with potentially terrible consequences.

You can contact your community midwife or day assessment unit during the daytime for a same-day appointment. It may be in the community or up at the hospital.

You can contact the obstetric unit or delivery suite at your local maternity hospital out of hours. They will invite you into the hospital for an assessment. 

It is also important to highlight that research confirms that most women who experience one episode of reduced movements go on to enjoy a straightforward pregnancy and give birth to a healthy baby.

Less than 24 weeks

If you are less than 24 weeks pregnant, the midwife will listen to your baby's heart rate with a handheld doppler. They may also recommend having an ultrasound scan. In some circumstances, you may be referred to a specialist Fetal Medicine Unit so that your baby's wellbeing can be closely monitored more regularly.

24 – 28 weeks

The midwife or doctor will take a complete history of how you are feeling and your pregnancy to date. They will also perform a full antenatal check to ensure that all is as it should be and you have no underlying illnesses or pregnancy conditions that may affect your baby. This check-up will include:

• Recording your temperature, pulse, blood pressure and respiratory rate.
• Testing a urine sample for protein (proteinuria).
• Measuring the size of your bump to see how well your baby is growing.  

They will also check your baby's heartbeat with a handheld doppler, listening to see if the heart rate increases each time your baby moves. 

Should their assessment raise any concerns about the baby's size or health, your midwife or doctor will recommend an ultrasound scan to check fetal growth and development.

28 weeks or more

You will have a complete antenatal check-up as detailed above. A midwife or doctor will ask to monitor your baby's heart rate and movements for at least 20 minutes using a CTG. Many expectant parents find it reassuring to listen to their baby's heartbeat and see it on the printout.

If there are any concerns regarding the baby's heart rate or how it relates to their movements, the midwife or doctor will advise that the CTG be left on for longer. They may also ask you to change position to get a more precise reading. Once the midwife or doctor is happy with your baby's heart rate, they will stop the CTG monitoring.

The doctor will usually recommend an ultrasound scan within 24 hours to assess the baby's growth and volume of amniotic fluid if: 

• There are concerns about the baby's size, i.e. they measure small for dates.
• There are concerns you have any underlying medical or pregnancy factors that put you at a higher risk of stillbirth.
• When monitored, your baby's heart rate is normal, but you still feel they're moving less than usual.
• You've experienced reduced movements before. 

If you notice a change in movements again in the future, you should contact your maternity unit immediately for another check-up. They will be glad you called! They will invite you in and assess you and make sure your baby is well. Never worry that your maternity team will be annoyed with you for getting in touch with concerns about your baby's movements. They would rather see you and rule out a problem than the alternative.

If there are concerns about you and/or your baby's health and your doctor is concerned that continuing the pregnancy is placing you or your baby at risk, they may advise you to deliver early. Usually, this would be an induction of labour unless a caesarean section is a safer or preferred option. 

This decision is never taken lightly and will depend on the stage of the pregnancy and individual circumstances. Your doctor and midwife will explain their concerns fully so that you understand the reasons behind their recommendations and can make an informed decision. 

Read our blog article on the B.R.A.I.N. communication tool to help your discussions with your medical team:

We recognise that reading around this topic may leave you worried about your baby's movements, particularly if you haven't yet felt them or recognised their natural pattern. Please call your midwife and discuss your concerns. They are there to support you in these important aspects of pregnancy and will be pleased to hear from you.

The information contained above is provided for information purposes only. The contents of this article are not intended to amount to advice, and you should not rely on any of the contents of this article. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this article. New Life Classes disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article.

Kicks Count

Medicines and Healthcare products Regulatory Agency (MHRA), Guidance: Medical Devices: information for users and patients, updated 2021. [accessed Dec 2021] Source

Norman JE, Heazell AEP, Rodriguez A, Weir CJ, Stock SJE, Calderwood CJ, et al (2018) Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. The Lancet, Volume 392, issue 10158, P1629-1638, November 03, 2018 https://doi.org/10.1016/S0140-6736(18)31543-5  Source

NHS, Saving babies lives, a care bundle for reducing stillbirth, 2016. [accessed Dec 2021] Source

NHS, Your baby's movements [accessed Dec 2021] Source

NICE Guideline [NG201] Antenatal Care, 2021. [accessed Dec 2021] Source

Royal College of Obstetricians and Gynaecologists (RCOG), Your baby's movements in pregnancy [accessed Dec 2021] Source

Royal College of Obstetricians and Gynaecologists (RCOG), Green-top Guideline No. 57, Reduced Fatal Movements, 2011. [accessed Dec 2021] Source

Royal College of Obstetricians and Gynaecologists (RCOG), RCOG advises against the use of fetal home dopplers, 2020. [accessed Dec 2021] Source

Tommy's, Baby's movements in pregnancy [accessed Dec 2021] Source

Tommy's, No home scanning device, doppler or app can tell you if your baby is well [accessed Dec 2021] Source