03 Aug 2010

Your baby’s movements

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From around 20 weeks of pregnancy you will begin to feel your baby moving inside you. Some women begin to feel movements a week or so earlier than 20 weeks and some a week or so later.

The time at which you begin to feel movements depends upon whether you have previously had a baby and the location of your placenta (afterbirth). Your baby’s movements are important because they are a significant sign of your baby’s wellbeing – indeed a more important sign than, say, a strong sounding heart beat. Babies are like children and adults – if they are sick they are less active. Tragically every year we see one or two women whose baby has become unwell inside them and the baby has died. Often such stillbirths are sudden and unpreventable but sometimes a baby can begin to slow down a day or more prior to dying – thus a theoretical opportunity might exist to save such a baby by delivering it urgently if it is mature enough to survive outside the womb.

Accordingly I feel it is important that by around 28 weeks of pregnancy you are aware of what is normal activity for your baby. It is very difficult to say what constitutes “normal” movements as every woman and indeed every baby is different. You really just need to make yourself aware of what is normal for your baby. Some features of babies’ normal activity might be helpful:

  • Before birth babies behave like they do after birth – they have periods of sleep (low activity) and periods of wakefulness (increased activity),
  • There is no such thing as a baby that is too active,
  • It is normal for your baby to be more active in the late evenings than at other times of the day. This relates to the baby receiving glucose from your evening meal and the normal decrease in your own endogenous steroid production that occurs in the evening,
  • The location of your placenta (afterbirth) affects your perception of your movements – if the placenta is anterior, or on the front wall of your womb, it is likely that you will feel fewer movements and they will be less strong,
  • While it is sometimes true that babies can feel less active as the pregnancy progresses (”running out of room”) and in the day or so prior to you going into labour, you should never simply attribute a reduction in movements to such changes – it is always better to get your baby checked out,
  • Similarly some medications – especially blood pressure tablets – are thought to reduce fetal activity. Again you should not assume this to be the case. If you are in doubt or concerned we should check your baby.

OK, so what should I look out for?

  • In general, you should look out for a REDUCTION in your baby’s movements that represents a SIGNIFICANT CHANGE for your baby.
  • You should be concerned if your baby is NOT ACTIVE IN THE EVENINGS if it has been previously active in the evenings.
  • You should be particularly aware of your baby’s movements if you have high blood pressure, the baby has grown a little slowly or you are around or beyond your due date of delivery

What should I do if I’m concerned?

If you have any concerns about your baby’s movements you should contact me AT THE TIME YOU ARE CONCERNED. Rule No 1 is that you do not go to bed worried about your baby’s movements, even if you are seeing me or having a scan the next morning. If you cannot get hold of me please contact the delivery suite at the hospital you are booked and they will check out your baby and call me to come and see you.

Of course in most instances perceived reduced movements are a false alarm and the baby “wakes up” either just before or just after you come to be checked. That doesn’t alter the fact that if you are concerned about your baby’s movements you should seek help immediately.

How do we check out whether my baby is sick or not?

When you come to the hospital with reduced movements the midwives will monitor your baby’s hear for twenty minutes or more. The tracing that is produced is called a cardiotocograph, or CTG. Certain patterns of your baby’ CTG tracing indicate whether your baby is healthy or not.

I will often examine your baby with ultrasound if we are concerned about your baby’s movements. This is called performing a biophysical profile (BPP) on your baby and includes looking at your baby’s body and breathing movements and the amniotic fluid volume.

What if my baby really is sick?

It is rare to discover that your baby is sick under these circumstances but if it is we usually deliver it if it is mature enough to survive outside your womb.


  • Remember that in most instances a reduction in your baby’s movements is NOT a sign that your baby is unwell.
  • However, we should check your baby out if you are concerned or there has been a reduction in your baby’s movements.
  • Don’t become paranoid or overanxious (like your obstetrician) – just make yourself aware of what is normal for your baby and contact me if there is a significant change or you are concerned.
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