TRANSCRIPT EPISODE 16 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #16: feeling your baby move

Transcript

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00:00                                   This is a fun episode. We are talking about feeling your baby move.

00:06                                   Welcome to the All About Pregnancy and Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified OB/Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:43                                   Hello and welcome, welcome, welcome to the podcast. I appreciate you spending some time with me today. Your baby moving is such an exciting milestone during your pregnancy. Feeling my babies move, that was by far my favorite part about being pregnant and if I'm honest, actually it was the only thing I really enjoyed about being pregnant. To be honest with you, I really didn't enjoy pregnancy anyway. Feeling your baby move is so reassuring to feel those kicks, those roles, the hiccups, the twists, the punches, all of it just helps you feel reassured that everything's okay with your baby. Now, a normal amount of movement isn't only reassuring for you, it is actually a physiologic sign that your baby is doing well. When a baby is experiencing a lack of oxygen or is in distress, they compensate by slowing down their movements in order to preserve energy.

01:48                                   So needless to say, understanding your baby's movement is important. And in today's episode we're going to cover everything you need to know, including when you will start feeling your baby move, how often you should expect to feel your baby move and what to do if your baby is moving less than normal. Now, before we get into the episode, let me do a quick listener shout out. This is from lovebug1179 and she left me, I always presume it's a she, I dunno, I don't know if any guys listen to the show, so I'm just going to say she. Anyway, she left me a review in iTunes that said "very knowledgeable and easy to follow." Well that is short, sweet and to the point. Thank you for that review. Please keep the reviews coming guys. I love to read them and I love to give shout outs.

02:43                                   This podcast is growing so fast. I'm already over 5,000 total downloads and I average about 300 downloads per episode. That's growing every day. That's better than half of all podcasts and I cannot have that success without you. So leave me a review in iTunes so I can say thank you. You can also DM if you'd like. I just love hearing from you. So just send me a message. Let me know what you think.

03:08                                   All right, so let's get to talking about feeling your baby move. As I said before, a normal amount of movement, it virtually ensures that your baby's doing well. Now there's some other things that we can see on ultrasound that help us know that a baby's doing well... If a baby is breathing on ultrasound, and yes, actually babies practice breathing while they're inside your bellies. If we look at the amount of fluid around your baby on ultrasound, that is also reassuring and the tone meaning some movements that we see.

03:41                                   So moving the arms, moving the legs, those things help us to know that a baby's doing well, but your baby moving is something that you can monitor and you can do it, you know, pretty much all the time. So how exactly is it that your baby's movement helps us to know that your baby is doing okay? Well, as I said, when your baby's in distress because of a decrease in oxygen, usually that's because there's some issue with the placenta. What babies do when they experience a decrease in the amount of oxygen, they slow down their movements in order to compensate and save energy for the most vital functions in their bodies. It's the same thing that we do on the outside as grown adults, when we suffer from a lack of oxygen, we pervert preserve oxygen for the most vital parts of our bodies.

04:35                                   And babies do the same thing. If the oxygen deprivation that a baby experiences is very severe and prolonged and lasts a long time, and it's hard to say exactly what a long time is, but several hours for sure, then there will eventually be organ damage. And in the worst case, death or stillbirth. So the whole goal behind monitoring your baby's movement is to prevent organ damage and then that awful outcome of stillbirth. Now please know that both of those things are rare. Stillbirth is a rare thing that happens in about 1% of pregnancies. So I don't want you to overly stress about it or obsess about it, but I do want you to understand why we believe that monitoring your baby's movement is important.

05:23                                   Now, when will you start feeling your baby move? This is a really common question, especially for first time moms, when are you going to start feeling that exciting it movement? Well, we can actually see a baby moving on ultrasound as early as about seven or eight weeks of pregnancy. I know that's crazy. The baby is only about the size of a raspberry at that point and we can see the movement, but you won't perceive your baby moving that early, you actually won't start to feel movement until between about 16 to 20 weeks of pregnancy. At 16 weeks of pregnancy, the baby is about the size of an avocado. At 20 weeks of pregnancy, your baby's about the size of a banana. So that's like a period of rapid growth and that's when you start feeling that movement. Now if you've had a baby before, you're more likely to feel that movement closer to 16 weeks and if it's your first baby it's going to be closer to 20 weeks. You also may feel movement on the later side, if you have an anterior placenta, the placenta is what nourishes your baby. It's your baby's lifeline is truly a miraculous organ. And if the placenta is anterior, anterior means in the front, so if it's in the front part of your uterus, that kind of acts as something that's in between you feeling your baby's movement because your baby is there, then the placenta and then your uterus, you know on the outside. So if you have an anterior placenta, you may feel movement a little bit later.

06:58                                   Now those first movements can be described as sort of a fluttering sensation and then as your baby gets bigger it gets to be a more pronounced and it's like, oh, there is obviously something that is moving inside of me. You know, I've always wondered when you watch those TV shows about like people who didn't know they were pregnant.

07:17                                   For me it was so obvious that there was something moving inside of my body. It would be hard to know that something's not going on. So I've just always been curious about how you can't know that you were pregnant.

07:27                                   Now once you get into the second and third trimesters, ultrasound can show like a wide range of movement of a baby. We can see babies bending, we can see them looking like they're startled, like they jump. We can see hiccups, we can see breathing as I mentioned before, they rotate around in there and move around. We'll see arms and legs stretch, a hand go up to the face, hands opening and closing. We'll even see things like sucking a thumb or yawning. So we can see lots of things on ultrasound. However, you may be surprised to hear that you will not actually feel all of those movements.

08:12                                   Studies show that women feel anywhere from as little as 33% to 88% of movements seen on ultrasound said you actually aren't going to feel all of the times that your baby is moving. When one study looked at how women matched up when they felt movement with what waws seen on ultrasound, about 50% of the time women could feel an isolated arm or leg move, so see it on ultrasound and about 50% of the time a woman would say that she felt like an arm or a leg move. But when it was bigger movements it makes sense that women felt it more so if it was like a twist or a roll, then women felt that more and in that case if you see it on ultrasound, women felt it about 80% of the time.

09:06                                   Now as far as how often you will feel your baby move, it really varies. The movement will vary depending on the time of day and how far along you are in your pregnancy. It tends to increase throughout the day and be at its highest at night, but everybody is a little bit different and you'll come to know what your baby's normal movements feel like. Now you will feel your baby move very consistently once you get into the third trimester, so 28 weeks and beyond. Between 20 and 28 weeks, things can kind of vary, but definitely by 26 or so weeks or you're going to start feeling regular movement for most women, but between 20 and 24 weeks you may feel periods or days where you feel lots of movement and then you may feel days where you don't feel much movement at all. A lot of women get concerned about that, but that is very, very common that between 20, 25, 26 weeks, you may not always feel movement consistently.

10:05                                   The baby's still small and they may get in a position where you're just not perceiving the movement the way that you're used to. So don't get super stressed out, especially between the 20 to 24 week range, if the movement sort of comes and goes. Also as you get further along in your pregnancy. So on the flip side that was just talking about the earlier part, that 20 to 24 weeks. So towards the end, so 37 weeks, you know, 36-37 weeks and beyond, your baby just has less room to move. So you'll feel movement, but it won't necessarily feel as strong just because they don't have the space to make those big movements like they used to.

10:45                                   There is no universally accepted definition of what is considered a normal amount of movement. You know, we can't say like you should feel at this time of day, this time of night. It really is what you perceive. And similarly, a decreased amount of a movement for your baby is based on what you perceive. Now you will quickly get to know kind of like the patterns of what your baby does in terms of their movement. And you'll learn when things feel a little bit off. It is really different for every woman and it is also different for every pregnancy. So for my part, my first pregnancy, my daughter moved all the time. Oh my gosh. She was so ridiculously active. It was crazy. She moved so much that my husband, Falcon, yes, Falcon, like the word, Falcon thought that something was wrong with her. She just moved like crazy. She still moves like crazy now that I think about it at 11 years old. But for my second pregnancy she was a little bit different. She didn't really get like good and moving later in the morning and then she was just kind of steady moving throughout the day.

11:57                                   She was a little bit more laid back. She wasn't as crazy and over the top with the movements as my first daughter was. Now normal movement is more formally assessed by doing something called kick counts. This is the way that we kind of keep track of how your baby's moving. Again, kick like kick counts, so feeling we say kick there really it can be any kind of movement. It doesn't exactly have to be kicks. It's really just movements. The most common way that we measure kick counts are that you should feel at least 10 movements in two hours when you are focused on counting the movements. So really concentrating on counting those movements. 10 movements in two hours. That's the most common method you'll see some other ones used, but again, that's the most frequent one.

12:49                                   And if you want to keep track or you need help keeping track of your baby's movements. And again, this is not something that I want you to obsess about. I want you to be aware of it but not like stress yourself out about it. There are apps you can download to help you. I haven't previewed any apps or looked at any apps so I can't give any specific recommendations about how things are good or bad. You'll have to do that research for yourself. But if you search for kick counts wherever you get your apps in the App store, then you'll find plenty of options for you there.

13:19                                   Now what should you do if you feel like your baby is not moving like normal? Well, at least 40% or so of women will become concerned at some point that their baby isn't moving as much at, you know one or more times, during her pregnancy. But usually that concerned is short lived and when you stop and you do the kick counts and you focus, you'll realize that your kick counts are okay and you won't need to contact your doctor. So even though it's really common that you'll get concerned about the movement, most of the time it resolves and only about 15% of women will actually experience enough of a period of decreased movement for their baby that they need to call their doctor.

14:03                                   Now there are a couple other reasons other than a lack of oxygen that can cause a transient decrease in your baby moving. One common one is a fetal sleep cycle. So babies actually go to sleep. That is a very common and benign cause of not feeling your baby move as much and your baby's sleep cycle can last for up to 40 minutes. So that's why we say you got to watch the baby's movement for a couple hours before you decide that it's truly decreased.

14:31                                   Another thing that can affect how you feel your babies move, how you feel your baby moving is you're just not perceiving it. Again, it may be that it's early in the pregnancy and you're just not feeling it as much. Extremes of amniotic fluid can cause you to not feel your baby move as much, even though we see it on ultrasound. So if you don't have as much fluid, then your baby may not have enough, you know, space to move around. If you have a lot of fluid, then it acts as kind of a cushion. So you may not feel the movement as much. Sometimes if your baby is facing where their back is towards your front, so their feet and legs are pointing towards your back, you may not feel the movement as much. And again, the interior placenta may decrease the amount that you feel movement. And then sometimes if you're just distracted, if you're going along doing your thing, you know, you're at work, you're shopping, whatever, you just aren't really paying full attention to it. So your baby may have been moving, but you just weren't like, focused on it. So that's why we say you really have to stop and focus for those two hours to count those 10 movements when you're concerned about decreased fetal movement.

15:42                                   So if your baby isn't moving as much, the first thing I want you to do is drink or eat something sweet to try and stimulate your baby, wake your baby up. So some juice, a piece of candy, even as soda, that's not going to hurt you one soda and then concentrate on your baby moving. If you don't feel those 10 movements within two hours, then you do need to call your doctor for sure. And what she's gonna do, she's probably going to tell you if it's during their day to come into the office or even the hospital for something called a non stress test.

16:14                                   It's where you get put on the monitor and your baby's heart rate is monitored for at least 20 minutes. A lot of offices have the ability to do that in their office, but if not, then they're going to send you to the hospital labor and delivery unit. We'll also going to look over your history in the course of your pregnancy and your health history and everything and see if there are any risk factors for stillbirth. So if you have hypertension, if you have diabetes, those things can increase your risk for stillbirth. So we're going to look over everything really carefully because again, we're trying to avoid that dreaded outcome of stillbirth. Now the NST or non stress test alone is going to be reassuring more than 95% of the time. And during that time that you're on the NST, the vast majority of women will start to report, oh, now I'm feeling movement.

17:04                                   So do not feel bad if you feel decreased movement, you don't get the 10 counts in two hours and then you go and you get an NST and you're like, all of a sudden the baby's moving and everything looks good do not feel bad. That's really common. That's actually what we want. We want you to start feeling your baby move and we want things to look good. So 95% of the time the NST alone is going to be enough to reassure us that everything is okay. If the NST is not reassuring then we're going to go to the next step which is ultrasound. We do something called a biophysical profile while we look at your baby's movement by ultrasound, whether or not your baby is breathing, has tone, so moving some of the limbs and the fluid around the baby, we'll also check potentially for how your baby's growing to make sure that your baby's growing okay,

17:52                                   Because if your baby's not growing, okay, again that's an indication that there may be issues with the placenta. So what happens if your baby's movement doesn't improve so you're not feeling that the movement is getting better. If you're less than 37 weeks and we're probably going to do closer monitoring where we're going to test you a couple of times a week, more frequent visits, you may even need to be in the hospital depending on some other factors that we look at on an ultrasound. If you're between 37 and 39 weeks, although 37 weeks is considered full term, that 37 to 39 is kind of early full term and 39 is when we know babies are almost always okay being born, whereas between 37 and 39 they could have some issues if they're born a little bit early. Most don't, but it's possible, so we don't like to induce unless we have to before 39 weeks, but if you're not feeling your baby move or there's some other things that are concerning, we may recommend delivery or you may fall into that closer monitoring category until you get to 39 weeks.

18:53                                   Now, if you're 39 weeks and things don't look like they're improving, if the heart rate tracing isn't good or if there's something on the ultrasound that's concerning, then absolutely we're going to recommend induction because we know that baby is going to be better on the outside then in.

19:09                                   All right. Now, just to close things out, there is a little bit of a caveat about monitoring your baby's movement. Truthfully, research actually hasn't conclusively shown that there's a benefit to monitoring for decreased fetal movement, that it actually decreases the risk of stillbirth. It's not really clear why that's the case. Part of it is because stillbirth is a very rare thing. So in order to study whether or not movement affects that, you have to study thousands and thousands and thousands of women. So that's a really big deal to do. There is research being done to help determine if monitoring your baby's movement is useful.

19:50                                   But if you happen to Google, if you're a research kind of person and look for studies, there actually isn't a lot out there. However, in the meantime, recommendations remain the same despite the lack of research. We know that common sense, you know, kind of tells us that we know that if your baby is suffering from a lack of oxygen, they decrease their movements. So we just want to be mindful of that and you really want to keep track of the movement. Again, not stress over it and not obsess over it, but be mindful of your baby moving.

20:20                                   So to summarize, you are going to start feeling your baby move between about 16 to 20 weeks. If it's your first baby, it'll be closer to 20 weeks. If it's not your first baby, it'll be closer to 16. Normal movement will vary between each pregnancy in each woman and you will quickly learn what feels normal for you by the third trimester or 28 weeks you'll definitely feel movement on a more regular basis. Between that 20 and 25 ish weeks or so, it may kind of come and go. You may have days even where you don't feel the movement as much and that's perfectly normal. If you don't feel your baby move like normal, especially after 28 weeks in the third trimester, then drink something sweet, focus, do your kick counts. You want to see if you can feel 10 movements in two hours when you're truly focused on counting and if you don't hit that 10 then definitely call your doctor. If you don't get a response from your doctor, then just go to the hospital to be evaluated.

21:24                                   Okay, so that's it for this episode. What has your experience been with feeling your baby move? Let me know. In the podcast community Facebook group, it's called all about pregnancy and birth podcast community. And if you're not already a part of it, the link is in the show notes so you can come on in and join us. And be sure to subscribe to the podcast in iTunes or wherever you listen to podcasts. And if you feel so inclined, I'd really appreciate you leaving an honest review in iTunes. It helps other women find my show and like I said, I love to give people listener shout outs and say thank you thank you.

21:57                                   Thank you for listening. Now next week on the podcast, it's a birth story episode and I had doctor Ooh Cima, Ooh, May, Aka Dr Lou Lou, Dr Lou Lulu is a pediatrician or a momatrician as she calls herself and she will be the one talking about her experience giving birth three times without an epidural. So come on back next week. And until then, I wish you a healthy and happy pregnancy and birth.

22:23                                   Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan, as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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