Do you notice decreased fetal movements? The perception of fetal movements is an indicator of a baby’s wellbeing. Once started, a pattern emerges, and this pattern is the first marker of how well the baby is doing, and how well the pregnancy is progressing. In this article we will cover the detection of movements, will look at this movements being an indication of wellbeing, what may be happening when movements decrease, a mother’s story, and what the responsibility of the medical professionals are.
A mother’s ability to feel her unborn baby moving is dependent on a number of factors. The detection of fetal movements usually begins from around 18 to 22 weeks, although this can vary. A mother on her first pregnancy may detect movement later than a mother on her second or third pregnancy due to a weakening of the abdominal muscles with each pregnancy.
Detection is also dependent on the muscle tone of the mother, how much excess weight she is carrying around her abdomen, and lastly, how much attention is actually paid to the baby. If a mother is tuned in to her baby’s movements, she may feel movements sooner than a mother who is busy and running from one thing to another each day.
A mother should feel movements whether the baby is cephalic (head down) or breech (feet down). The types of movements will be different, but there will be a pattern nonetheless. Generally, if the baby is head down, then the mother will feel kicks and movements on either side of her abdomen below her ribs. If the baby is breech, she will feel her movements and kicks down by her pelvis, almost where the top of her trousers sit. The movements are different, not non-existent.
2An indication of wellbeing
From the mother’s point of view, the pattern of movements is the only real indicator that everything is ‘normal’ with the baby and the pregnancy. A mother should feel at least ten movements in any one day. Although there is no medical measurement of fetal movements, the baby will become more active as the pregnancy progresses.
There will be times of the day when the baby will be most active, and other times when the baby will be less active. This is ‘normal’ and it is a generally held belief that the baby will be more active at night.
The baby does not know the difference between night and day. Some people will say that the baby, by becoming more active at night, is preparing you for the disrupted sleep which you will soon experience when they arrive. On the other hand, people say that the mother finally has time to sit down and be still at night, allowing her the time to feel movements, appreciate them, and recognize that they are there.
As the pregnancy progresses the movements will become more frequent and the kicks may get stronger. As the baby grows and gains strength, its ability to give you an almighty boot from the inside out also increases. A mother may also see limbs, or a hand or footprint through the skin as the baby stretches.
3Decreased Fetal Movements
In the past, there has been a belief that as the pregnancy progresses the baby’s movements will slow down as the room that is available in the womb decreases. This has unfortunately led to a very wrong and dangerous misconception about movements in the later stages of pregnancy.
I know of mothers who have noticed a change in their baby’s movements who have raised these concerns with midwives, doctors, and consultants. If they are at a late stage of pregnancy, all too often they are told that the baby has less room and therefore, there will not be many movements. Later, however, after a further visit to the hospital, it will transpire, as it so often does, that in fact there were reduced movements and the baby has sadly passed away.
A baby does not suddenly stop moving for no reason. There is always a pathological or medical reason as to why their movements reduce. As the mother is the only person who can truly know whether there is something suddenly wrong, or progressively wrong, with her baby’s movements, I find it heart rendering when these concerns are not paid attention too.
The type of movement may change in later pregnancy, but not the frequency. A healthy baby will move in the womb at later stages, even if it no longer has the room to kick. The amount of movement should stay the same (and the mother will know what is ‘normal’ for their baby), even if the type of movement changes.
4Reduced movements indicating impending death
In November 2015, an MBRRACE report highlighted the importance of recognizing a reduction in fetal movements as a sign of distress in the baby and the possibility of stillbirth. Moreover, stillbirths could be reduced by a staggering half if the recognition of reduced fetal movements, fetal growth mapping, and the detection of gestational diabetes were improved. These three factors were highlighted as indicators of stillbirth fifteen years ago. Fifteen years on, these areas have not been improved and the United Kingdom ranks an abysmal thirty-third out of thirty-five countries.
What else could reduced fetal movements signify other than, at the least, a baby is in distress, and at the most, impending death? What else could it show but a drastic change to the baby’s wellbeing and happiness inside the womb? And yet, so often, nothing is done. A mother is told to attend the hospital of she feels that her baby’s movements have reduced. However, so often, the mother is sent home and the baby dies.
5A mother’s story
A mother once told her story of attending a maternity unit because she knew, she instinctively knew, that something was wrong. No money can buy that type of medical expertise. Her baby had turned breech, and she was told that this was a reason why she could not feel the movements anymore. She had four cardiotocographs performed over an eight hour period. They showed no accelerations or decelerations. When she questioned this, however, she was told that the baby was simply sleeping. The reduced movements progressed.
Tests on the amount of amniotic fluid and the size of the baby were performed which were within the normal range. The lack of movements continued. She was sent home that evening, no happier. The next day her baby was dead. As it transpired, her baby had stopped moving because it was slowly being deprived of oxygen and was trying to conserve energy. The mother was hemorrhaging and her baby was in trouble.
This mother paid attention to her baby’s movements and went to the hospital when movements reduced. She put her faith and her baby’s life in the hands of medical staff. For all the mother did, what did the health professionals do? Nothing. Plain and simple. There are many similar stories.
6The responsibility of the medical staff
A mother knows her baby better than any health professional. Remember that. So many mothers in countless situations are turned away from hospitals by medical staff. Medical staff knows that reduced movements are a red flag, but nothing is done. It is an unfortunate situation.
Health professionals need to take these signs more seriously. The government has pledged to reduced the stillbirth rate. This is excellent news. However, if warning signs are not paid attention too then this will never happen. Baby’s are dying needlessly and families are being left with a lifetime of grief over the inability of medical professionals to act.
Are the health professionals no longer assessing each mother and child as an individual unique case when they present at the hospital? There are too many tick box sheets. There is no reason to check the amniotic fluid around a baby if the cardiotocograph indicating the baby’s heart rate is abnormal. It is pointless to feel reassured that the baby is a good size if there is a sign that the baby is in distress. More action needs to be taken from health professionals.
The bottom line is that a mother presenting with reduced fetal movements has a baby which is no longer healthy or happy. In too many cases the mother is left to go home and her baby dies in utero. This is unacceptable. Only when more attention is paid to a reduction in fetal movements, and the mothers’ concerns listened to more, will baby’s lives be saved and the stillbirth rate by reduced. Surely in this day and age, this outcome is overdue.
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