Monitoring Fetal Movement

Important Things To Know About Your Baby’s Movements

There are few events more exciting (or emotional) than the first time you feel your baby give you a little kick. And while you might grow a little less enthused with all of that kicking later on, it's an incredible experience when you first feel that life moving inside of you. Some babies are little more restless than others, it's true – but fetal movement is an important step in any pregnancy, and fetuses that don't move as much may be carefully monitored later on in your pregnancy. During your first pregnancy, you will most likely begin to feel your baby moving during the 18th and 22nd week. In future pregnancies, you will begin to feel movement between the 16th and 18th week. At first, the movements will be very faint, but they will become stronger as the weeks go by. The position of your placenta may play a part in when you begin to feel movement. For example, if the placenta is anterior (in front of the baby), you may begin to feel your baby's movements a little later than you would if the placenta was posterior (in the back of the uterus).1 You may notice that you feel your baby moving more when you are lying down than when you are sitting or standing. After you eat, you may notice that your baby is very active. This is due to the increase in blood sugar.

Nonstress Tests And Fetal Movement

If your child is not moving as much as he or she normally does, or if you have been diagnosed with gestational diabetes, your doctor or midwife may order a non-stress test. You may also be asked to undergo this type of test if:
  • You have chronic high blood pressure (Primary hypertension)
  • You have been diagnosed with pre-eclampsia
  • You have been diagnosed with chronic renal disease
  • You have sickle cell disease
  • You have been diagnosed with heart disease
  • You have too little amniotic fluid (Oligohydramnios)
  • You have too much amniotic fluid (Polyhydramnios)
  • You had a past pregnancy that ended in stillbirth
  • Your baby is not growing at a normal rate (Intrauterine growth restriction)
  • You are beyond 41 weeks into your pregnancy
A non-stress test involves monitoring a baby's heartbeat over a certain amount of time. You may be given a button and asked to push it each time that you feel the baby move. This will place a mark on your baby's heart rate tracing, telling the physician or nurse that you felt your baby move. When the baby moves, her heart rate should rise (accelerate) at least 15 beats above the baseline heart rate. For example, if a baby's baseline heart rate is 140, it should rise by at least 15 beats per minute for at least 15 seconds. This should occur at least two times in a 20-minute period. In addition to the rise in heart rate, the variability of the heart rate will also be examined, along with the presence of any decelerations (decrease in heart rate). Variability is measured best when the baby is at least in the 32nd week of gestation. An electronic fetal monitor will be attached to your abdomen. There are two parts to the monitor. One measures your baby's heartbeat, and the other detects any contractions that you are having.

The Contraction Stress Test (Oxytocin Challenge Test)

A contraction stress test may be ordered to see how your baby will respond to uterine contractions. This test is not performed before you are at least 34 weeks into your pregnancy. It is normal for the amount of oxygen that your baby receives to be decreased during a contraction. During the test, you will be asked to lie in bed. A pillow may be placed under your right side to prevent too much pressure being placed on your blood vessels. You will be connected to a fetal monitor. Pitocin (one of the medications that may be used to induce labor) is given to you through an intravenous infusion (IV). During a contraction, your baby's heart rate will be monitored. Your baby's heart rate pattern will be examined during a 10-minute period of time in which you have at least three contractions. If the heart rate drops in a specific manner after a contraction begins (late deceleration), it may be an indication that the baby will not be able to remain healthy during labor. A negative contraction stress test indicates that there were no late decelerations present during the test. A positive test indicates that the baby's heart rate decreased after a contraction; therefore, he may have difficulty during labor.

Developing A Biophysical Profile For The Baby

If you have any of the conditions that might lead to a non-stress test, or if your non-stress test came back less than reactive, your doctor or midwife may order a biophysical profile. This test is done by ultrasound, and is performed by an ultrasound technician for a maximum time period of 30 minutes. During that time, five specific areas will be evaluated, and a score will be given for each item.
  1. Breathing. A score of 2 will be given if the baby displays one or more breathing movements within the 30-minute period. A score of 0 will be given if this is not observed during the ultrasound.
  2. Movement. A score of 2 will be given if the baby displays 3 or more separate body or limb (arms or legs) movements. If 3 or movements are not observed within the 30-minute time period, a score of 0 will be given.
  3. Muscle tone. If the baby shows one or more movements where the arms or legs are flexed or extended, or the hands are opened and closed, a score of 2 will be given. If there is no flexion or extension, or if the extension is slow, or minimal flexion is observed, a score of 0 will be given.
  4. Amniotic fluid index. This is the amount of fluid that surrounds the baby. A normal range is 8.1 to 24. If the amount of amniotic fluid falls within this range, a score of 2 will be given. If there is not enough fluid where the amniotic fluid volume is less than 5, or too much fluid, where the amniotic fluid volume is greater than 24, a score of 0 will be given.
If a baby scores 8 out of 8, he is considered to be healthy. A baby that scores 6 out of 8 is considered to be at an increased risk for developing problems if he is not delivered. If the mother is at least 37 weeks into her pregnancy, delivery is recommended. If she is under 37 weeks, a repeat biophysical profile in 24 hours is recommended. If a baby scores a 4 out of 8 or fewer, and the mother is at least 32 weeks into her pregnancy, it is recommended that he be delivered. If she is under 32 weeks, it is recommended that she receives steroids injections (Betamethasone) and continuously monitored.2
  1. Hijazi, Z., & East, C. (2009). Factors affecting maternal perception of fetal movement. Obstetrical & Gynecological Survey, 64(7), 489-497. doi: 10.1097/OGX.0b013e3181a8237a
  2. Practice Bulletin ((2014). Antepartum Fetal Surveillance. Journal of Obstetrics & Gynecology, 124(1), 182-192). doi: 10.1097/01.AOG.0000451759.90082.7b