People like to ask me how I performed kick counts in my pregnancy after loss, probably mostly because I made no secret of how obsessed I became with doing them… So I figured I’d devote a post to this topic.
When it comes to kick counts, medical professionals generally give poor, inconsistent advice, which is unfortunate, and they really should be ashamed of themselves. I’ve heard so much conflicting guidance on the subject, and, after carefully considering all of it, here’s what I think every mom should know:
- Between 24 and 28 weeks, it’s advisable to make sure you feel baby move relatively consistently each day. Upon reaching 28 weeks, it’s advisable to start performing official kick counts.
- Medical professionals often advise counting “10 in an hour” or “10 following each meal.” In my opinion, it’s much more important to get to know your specific baby’s personality and movement patterns. An arbitrary number like 10 means very little if, for example, your baby usually moves 100 times following each meal. Any time you perceive a change in fetal behavior (i.e. decreased fetal movement, hyperactivity, etc.), a visit to Labor & Delivery (L&D) is warranted.
- Babies do NOT slow down towards the end of pregnancy. Movement could change in character, but it should never actually slow down. Movement should continue during labor as well.
- Babies spend lots of time sleeping in utero, but their sleep cycles last between 45 and 90 minutes (at most), which means babies should also have wake cycles (when you’ll feel movement) at least once every 60 minutes on average (give or take).
- Movement is unequivocally the best indicator of fetal well-being. While a Doppler can be a helpful tool in providing momentary reassurance, the mere presence of a heartbeat really tells very little about a baby’s condition.
- Kick counting certainly can’t (and doesn’t) save all babies, but it could (and does) save some.
I used an iPhone app called Baby Kick Counter App by Michael Kale to count Joel’s kicks. I researched several apps and concluded that this one would best meet my needs as it possesses several specific capabilities that other apps seemingly lack:
- It allows a user to count kicks all day, every day.
- It can be set to remain on an iPhone’s home screen, making it easy for the user to hit a button each time a kick is felt.
- It continuously saves time of last kick, allowing a user to remind herself how long it’s been since baby last kicked and also review a running total of how many kicks were recorded in the last hour, day, etc. (I found this particularly helpful in that I’d often imagine I hadn’t felt a kick in an hour, but then I could check and realize I’d felt one just five minutes ago.)
NOTE: Some of my baby loss mom friends have used this app in their subsequent pregnancies, and they liked it too, for the same reasons I did.
I began kick counts at 28 weeks. (Though at 24 weeks a baby is considered viable, it would be extremely rare that medical professionals would ever consider delivering based on concerns over decreased fetal movement, so I *tried* to keep my anxiety at bay until week 28 and was surprisingly semi-successful in doing so.) Once I started counting, I attempted to count kicks all day, every day. I say “attempted” because I couldn’t be perfect with it – I have a full-time job, and I had to sleep, etc.
Sleep was incredibly difficult though. I know Matthew slipped away from us at night, so I considered the night to be my enemy. As a result, I tried to sleep as little as possible. In fact, I’d wake up each morning at around 6:00am, look at my phone, and quickly realize I’d logged kicks at 3:00am, which I had no recollection of doing.
Starting around week 32, I became even more vigilant. Ideally, I wanted to see at least 10 movements logged in every hour. So any time I was paying attention and encountered an hour with little to no movement, I began to consider making a trip to L&D. And any time I was paying attention and encountered a 3 to 4 hour span with no highly active period (normal for Joel), I also considered making a trip to L&D. I found this approach to be reasonable based on my knowledge of baby sleep/wake cycle length and also based on my history. Overall, this approach sent me to L&D ~15 times between week 32 and week 37, which I consider to be not-so-bad given my stringent requirements (and given that I had an anterior placenta, which made it difficult to feel kicks).
For 9 weeks, kick counting ruled my life, and there were times I could hardly function because of it. My struggles went far beyond my sleep issues. I drove to the hospital instead of to my office every time I felt the least bit off, leaving my boss to ponder my whereabouts. I cancelled dinner plans and abandoned shopping carts in the middle of grocery stores. I demanded extra non-stress tests and biophysical profiles and ultrasounds and continuous, overnight monitoring, because, though an important part of the picture, movement is still just one part of it. I visited L&D with complaints of decreased fetal movement and with complaints of hyperactivity, and I received the side-eye for it a couple of times. By the end, my total number of kicks logged was in the tens of thousands. And I didn’t stop counting until medical professionals pried my phone away from me to take me back to the operating room for my C-section on July 27, 2016.
I was this obsessive knowing, like really knowing, that kick counts provide absolutely no guarantees. I’m sort of a hypochondriac, so I also counted kicks pretty darn compulsively with Matthew. (If people didn’t know better, they might have thought I was a baby loss mom before I ever lost my baby.) I thought by being hyper-aware and by taking action, I could prevent my exact tragedy. But Matthew still died. The terrifying truth is that sometimes, maybe many times (no one can really say for sure how often), these types of things can happen acutely. Life can end in a split second.
But even with this knowledge, I felt compelled take the approach I did with Joel, as this provided me with a much-needed sense of control in a situation over which my control was limited. I also found my approach helped me to learn Joel’s personality and movement patterns, which I considered to be one of my only ways to bond with him during a high-stress pregnancy. Additionally, I reasoned that although some (maybe many) deaths are acute in nature and thus can’t be prevented, maybe, just maybe, I could potentially identify a problem not-so-acute in nature, which could be possibly life-saving. This thought, even if only a one in one thousand type scenario, seemed plausible enough for me to succumb to my compulsion, sacrificing my sanity completely for those 9 weeks.
No one advised me to take the approach I did. In fact, I’m absolutely certain most medical professionals with whom I associated considered it to be ridiculous, and possibly unhealthy. I think most (decent) medical professionals, if asked about kick counts, would recommend picking a couple of consistent times each day and making sure baby is moving consistently, day-to-day at said consistent times. (This is also what Dr. Collins recommends, though his specific recommendation he communicated to me was to monitor movements in the late evening, before bedtime.)
I ultimately think that, when it comes to counting kicks, each mom needs to decide which approach is best for her. There isn’t much hard data to support a single “best way” to perform kick counts, but there is some data to show that being aware of the possibility of stillbirth and getting to know baby’s movement patterns (in one way or another) improves outcomes. Different strategies are going to work better for different moms depending on a plethora of factors. What’s most important is that a mom knows the facts about baby movement, selects a strategy with which she feels comfortable, and visits L&D any time she perceives a change in fetal behavior.
My pregnancy after loss was the second most traumatic experience of my life, and though I’m immeasurably grateful for it, and I feel as though I’ve been rewarded for it in the best way possible (with Joel!), I’m also irreparably scarred by it. I can’t say for sure that my kick counting approach was the best, but I can say that it worked for me, and I survived, and I don’t have any regrets, so, if I’m ever again in a similar situation, I will likely behave similarly.
And this is all anyone can really do… Act in a way we think will minimize regrets, and then just hang on for dear life through the terrifying weeks knowing this too will pass.