Written by Roxane McAllister and Kimberly Isburg In pregnancy, there are so many things to keep in mind to make sure you and your baby are healthy, and it can get overwhelming. By the time you reach the third trimester, adding one more thing, like counting your baby’s movements, can seem daunting and anxiety producing. However, getting to know your baby’s normal movement patterns is of utmost importance. Your baby’s movements are their way of communicating with you about their well-being. A change in your baby’s movements signals a need for further evaluation by a provider. This communication with your baby is a way for you to bond with them even before you are holding them in your arms. By tracking your baby’s movements (such as kicks, jabs, and rolls) at the same time each day, you can learn your baby’s normal movement pattern so that if any changes were to happen, you feel the confidence and empowerment to notify your provider for further evaluation. Although there are many ways of tracking your baby’s movement. One evidenced-based way is by using a free mobile application called Count the Kicks. This application sends you a daily reminder to track how long it takes for your baby to move 10 times. It also allows you to track the strength of their movement from fluttery to fierce. Count the Kicks can also help you track the movement of twins! As you start to count your baby’s movements each day, you will notice it takes about the same amount of time each day for your baby to have 10 movements. This is a way for your baby to communicate with you and a way you can bond with your baby, and most app users (77%) report that counting every day helps to reduce anxiety about the well-being of their baby. If you were to notice a change, trust your instincts! Reach out to your provider, let them know your baby’s movement has changed, and ask to be evaluated. Why Does Movement Matter? Babies are a lot like us. Think about how you move when you are healthy compared to when you are not feeling your best. Babies do the same thing. When we are feeling well, we can do all the routine things we usually do – run errands, workout, go to work, etc. However, when we aren’t feeling our best, we usually slow down, lay on the couch, and maybe feel a little bit weak. A baby’s movement can become decreased or weaker than normal when they aren’t feeling well. A change in your baby’s movement is an early sign, and sometimes the only sign, that they are in need of evaluation. This is why it is important to track your baby’s movements to understand their normal movement pattern. How to Count the Kicks The American College of Obstetricians and Gynecologists recommends for parents to start tracking fetal movement at 28 weeks or 26 weeks if you have twins or a high-risk pregnancy. To count your baby’s movements: Download the Count the Kicks application on your phone, use the website, or print the paper chart from the website. Pick a time of day that your baby is the most active and track your baby’s movements around the same time every day. Count kicks, jabs, pokes, and rolls as movement. Hiccups are not to be counted as movements as they are involuntary. The feeling of hiccups is more rhythmic and spasmic than other movements your baby makes. Take note on the app, online, or the paper chart of how long it takes your baby to get to 10 movements as well as the strength of the movements. Enjoy bonding with your baby! And let your provider know if you notice a change in movement. Tell Me More about Count the Kicks Count the Kicks is an organization that was started in Iowa by five women who were driven by their own grief to find a way to help prevent other families from experiencing the grief they had experienced. They discovered research published in Norway that showed monitoring a baby’s specific movements and notifying a provider if there was a change, helped to reduce 30% of stillbirths in Norway. These women helped to implement this same method by using Count the Kicks in Iowa. In the first 10 years of the program in the state (2008-2018), Iowa has seen a 32% decrease in stillbirth. Count the Kicks is a free mobile application offered in more than a dozen languages. Tracking a baby’s movement is also available web-based at www.countthekicks.org where parents can also download a paper charting system if they are unable to use the internet. The app and website also provide education for providers and parents as well as free community resources for parents in need. Through evidence-based research, Count the Kicks can help reduce stillbirth (Heazell, 2023), increase maternal bonding with their baby, reduce the anxiety of tracking movement, reduce preterm births (Bryant, 2020), and may help providers recognize maternal and fetal complications (Bryant, 2020 & Wall-Wieler, 2019). In fact, in a survey of 809 women who used the Count the Kicks App, 77% of users reported feeling less anxious about counting their baby’s movements and 84% of users reported feelings of bonding with their baby (Bryant, 2020 & Lyndi Buckingham-Schutt, 2022). Common Myths about Kick Counting “My baby is always active, so I don’t need to count kicks.” A baby’s movement is the way they communicate their well-being with their parents. It is important to know the normal movement patterns of the baby so that if there is a change, the parents can quickly notice it. Plus, counting kicks is a way to learn about your baby’s personality and bond with them as you learn when they are most active during the day. “Only those experiencing a high-risk pregnancy should pay attention to their baby’s movement.” During pregnancy, we cannot physically see a baby to know they are doing well, so we must pay attention to their movement. Every baby and every pregnancy is different. Babies communicate their well-being by their movement, so even if a person doesn’t have a high-risk pregnancy, it is still important to learn their baby’s movement so they can notify a provider if that movement pattern changes. “My baby should get 10 kicks in two hours.” Every baby is different, and the recommendation to expect 10 kicks in 2 hours is outdated. Current research indicates moms should work to understand the normal amount of time each day it takes their baby to get to 10 movements. If a baby normally takes two hours to make 10 movements, then that is the baby’s normal. However, if a baby usually takes less time than two hours to make ten movements and it is taking them much longer to make 10 movements, this is a sign to notify the provider since we know babies move less and may have weaker movements when they are not feeling their best and need evaluation. “I can just use a doppler device to monitor my baby’s well-being.” Every doppler device is different, and a change in heart rate can be one of the last signs that a baby’s well-being needs evaluation. A change in movement is one of the earliest signs, so that is why it is important to count a baby’s movements and know what the baby’s normal movement pattern is. “If my baby isn’t moving, I should drink something cold or eat something sugary to get my baby moving.” A change in a baby’s movement is one of the first signs that the baby’s well-being needs evaluation. A baby’s movement pattern should be the same with or without something cold to drink or something sugary to eat. Therefore, it is best to have the baby evaluated if the parent needs to do something to get the baby moving. Research has moved away from the idea that sugary drinks and the like are a good way to get babies to move. A baby's movement is best monitored without interventions like juice, candy, etc. If a baby isn't moving like normal, expectant parents should get checked right away. “Baby’s kick less near the end of pregnancy.” Babies do not slow down or run out of room at the end of pregnancy. Babies should move throughout the pregnancy, even throughout labor. The way the baby’s movement feels may change near the end of pregnancy as the baby has grown, but the time it takes for a baby to make 10 movements should be the same throughout the pregnancy, even towards the end. Count the Kicks in the Media Video: https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGtwqMCkGLRrHTgQFGKhsgTHTTh?projector=1 How to Get Involved Count the Kicks has countless ways to get involved. Check out our website at www.countthekicks.org Share this information and free mobile app to anyone you know who is pregnant or works with pregnant people. If you are a healthcare or community worker, participate in the Count the Kicks continued education course and/or webinars posted on our website. Order pamphlets and posters on our website to share with your patients and clients. Join our team as an ambassador to network and spread the word about Count the Kicks in your community. Connect Count the Kicks with funding changemakers such as individuals from the public health department or hospital system in your state to get all of Count the Kicks materials and resources free in your state. Bryant J, Jamil RT, Thistle J. Fetal Movement. [Updated 2020 Nov 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470566/ Heazell, AEP, Holland, F, Wilkinson, J. Information about fetal movements and stillbirth trends: Analysis of time series data. BJOG. 2023; 130(8): 913–922. https://doi.org/10.1111/1471-0528.17426 Lyndi Buckingham-Schutt, PhD, RDN, LD, Pamela A. Duffy, PhD, PT, OCS, Benjamin Williamson, DMU-MPH-24, Ashley Armantrout, DMU-DO-20, & Kerry Biondi-Morlan, MA. The Harkin Institute for Public Policy & Citizen Engagement, Drake University 2DMU Department of Public Health Healthy Birth Day, Inc. “Using Technology to Monitor Baby: the Use of mHealth to Improve Fetal Outcomes.” https://doi.org/10.1016/j.ajog.2021.11.774 Wall-Wieler, E., Carmichael, S. L., Gibbs, R. S., Lyell, D. J., Girsen, A. I., El-Sayed, Y. Y., & Butwick, A. J. (2019). Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California. Obstetrics and gynecology, 134(2), 310–317. https://doi.org/10.1097/AOG.0000000000003370