Guideline from the Society of Obstetricians and Gynaecologists of Canada
In September 2023, the Society of Obstetricians and Gynaecologists of Canada (SOGC) published a new clinical practice guideline for antenatal fetal health surveillance in order to allow for timely intervention to prevent perinatal morbidity and/or mortality. This guideline is intented for use by all health professionals who provide prenatal care in Canada.
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Recommendations 4 and 5 of Guideline No. 441 –Antenatal Fetal Health Surveillance – pertains to fetal movement counting:​
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All pregnant individuals should be advised to regularly monitor fetal movements starting at 26 weeks gestation.
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If a reduction of fetal movements is identified, regardless of the technique used to assess fetal movements, pregnant individuals should be advised to present to their care provider or local obstetrical unit immediately for further evaluation.
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Management of women reporting decreased fetal movements is important. Many women who present with reduced fetal movements and a living fetus (30%) were falsely reassured only to have a subsequent stillbirth. Data also suggest that with decreased fetal movement counts, electronic fetal heart monitoring alone may not be sufficient to ensure fetal well-being.
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For more information, please consult:
Significance of Fetal Movements
According to Statistics Canada, every year, there are more than 3,000 stillbirths in Canada . The Hunter Medical Research Institute estimates that for each stillbirth, 99 other births narrowly escaped death.
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The association between a reduction in fetal movements and stillbirth has been known for a long time. This was formalised from the 1970s onwards in a series of studies that noted the increased incidence of stillbirth and fetal growth restriction in women presenting with reduced fetal movements, which preceded fetal death by several days. Decreased placental perfusion, fetal acidemia and acidosis are recognized as being associated with decreased fetal movements.
Moreover, reduced fetal movements are linked to adverse perinatal outcomes such as:
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birth asphyxia
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stillbirth
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developmental delays
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infections
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haemorrhage
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emergency c-sections
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umbilical cord complications
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fetal growth restriction
Fetal movements are therefore one of the best indicators of the well being of an unborn child. Maternal monitoring of fetal movements requires no technology and is available to all women. As the third trimester approaches, have an honest discussion with your patients about the significance of fetal movements. Use this occasion to give them the pamphlet "Learn to count your baby's kicks".
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Click here to view the pamphlet Learn how to count your baby's kicks
Also touch on myths that persist within the community and the medical profession.
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Click here to read the section on Myths surrounding stillbirth
A daily count of fetal movements within the third trimester can help prevent adverse perinatal outcomes. There is no magic number of fetal movements a pregnant woman should feel. Every baby moves differently, some more than others. What’s important is for each woman to learn what is normal for her baby. To do so, she must pay attention to her baby’s movements.
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More and more, pregnant women are busy at work or at home and face many distractions. Unless they take the time to stop and pay attention to their baby’s movements, it can easily happen that a woman will not remember feeling her baby move or that she will have no knowledge of what is normal or not for her baby.
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Ask your patient to take a moment, every day, to stop and count her baby’s movements. To take that time and bond with her baby. Counting her baby’s movements will help her learn their movement pattern.
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Click here to read the section on How to count my baby's movements
If your patient perceives that her baby is moving differently than usual, or if the baby is moving less, ask her to contact you without delay or go to the nearest maternity. Many women who feel reduced fetal movements delay contacting their health care professional or going to the hospital. This lost time could be crucial to intervene and prevent adverse perinatal outcomes such as stillbirth.
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As a doctor or health care professional, when a patient reports a change in her baby's fetal movements, you should complete a thorough evaluation of the maternal and fetal status, including a non-stress test, in accordance with the SOGC Guideline: Antenatal Fetal Health Surveillance.
BabyKicks.ca’s mission is to inform parents and health care professionals about the importance of a baby’s movements during the 3rd trimester of pregnancy in the hopes of reducing the number of stillbirths in Canada.
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