When the baby in the womb moves for the first time, she is elated. It is the first perception of the new life within her body! From then onwards,the fetal movements or kicks become regular and some times painful too. She is bombarded with instructions… “keep a count, be vigilant”. Most of the websites on pregnancy stress so much on fetal kicks that these pregnant girls almost get into the role of a “detective on high alert”. Now a days there are mobile apps that help the mother to count!On the other hand you might come across articles from reputed medical journals stating that keeping kick count is not as useful as it is told!!! (1) Confused?
In this article I am going to explain the need, importance and correct ways of counting movements.
Remember the sentence, Watching for fetal movements is important but very inaccurate method.
What is fetal movement or kick?
Baby is floating in the fluid in the mother’s womb and it does move frequently. Any kind of movement kick, jab, rotation of the baby is called as fetal movement. Many a times woman complaints that she cannot feel the kick but she feels movements! This is perfectly fine.

initially they may be felt just like a “butterfly inside” or ” something like rumbling of gas” and as the baby grows big they can be felt strongly.
When does one start to feel the movement?
Generally around 20 weeks of pregnancy women can feel some kind of movement. First time mothers may feel it little late and experienced mothers may feel it little early.
Before 20 weeks, what is felt unlikely to be the baby’s movements but movements of intestines.

What are various types of movements?
Not only kicks, but role overs, jabs, small rotations, small movements even hiccup is also a movement. Generally the number of movements increase up to 32 weeks. After that the number of movements may stay same but the type of movement will change. Generally women experience that big movements like kicks become less and small movements increase at the end of pregnancy. This is because of less space for the baby to move.

Hiccups type movement donot suggest that there is some thing wrong there.
Which factors influence feeling of movements? (2)
Lying down position is the best position to perceive the movements. In Sitting and standing positions you are less likely to feel all the movements.
If a woman is moving or engrossed in something else she is less likely to feel movements.
If placenta is close to the abdominal wall called “anterior placenta”, it works as a shock absorber and hence some movements may not be well felt.
In early weeks of pregnancy, movements may not be felt strongly as the baby is small.
Fetal movements are better felt when the mother’s glucose levels are elevated, typically after food.
If the baby is in certain position (when spine is anterior) many a times movements are not felt that well. n specific position
Studies have shown that maximum movements are felt during late evening hours. (3)
Obese patients may not feel movements that well as fat on the tummy may again work as shock absorber.
Most importantly the babies do sleep for 20—40 minutes, rarely up to 90 minutes when in the womb. Naturally you will not feel the movements at that time. (4)
It is clear that the mother may not be able to feel movements or feel them less due to many reasons. So even if baby is doing well in the womb, woman may feel reduced movements. Mothers become very anxious if they feel less movements. They panic regarding the health of the baby. That is why why I say that this method is quite inaccurate at the beginning. There is a lot of scientific medical evidence that only women with certain high risk conditions may benefit by keeping a chart on daily basis.
Of course the feel of the movement ensures the mother that the baby is doing good. And more over, it is the easiest and cheapest way check that out !
So the right balance between unnecessary anxiety and vigilant watch can be achieved by the strategy that I suggest to my patients.
Do not keep watching for movements all the time. Don’t become a detective.
Be aware of your baby’s pattern. Studies have shown the babies can move 4-100 times in an hour. (5) So it is your baby’s pattern and not the count just because some websites says so.
Keep a dedicated time of the day, for say one hour .. where you can lie down or sit at one place, preferably after having food to watch for movements. Even if there are small movements it is absolutely ok.
There are many methods of keeping count of movements. If you don’t get even 10 movements in 2-3 hours 12 hours it is advisable to go to the hospital. (6) Most often the doctors will check you and the baby. The doctor may check the growth, heart sounds , may do a sonography. Most often the doctor confirms that all is good and you come back home happy and relaxed.
Bibliography:
1. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2931543-5. [Online]
2. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg57/. [Online]
3. https://www.webmd.com/baby/fetal-movement-feeling-baby-kick#1. [Online]
4. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-your-babys-movements-in-pregnancy.pdf. [Online]
5. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.11.4.245.27527. [Online]
6. https://www.ncbi.nlm.nih.gov/books/NBK470566/. [Online]