Kick Chart

It is important to count the number of movements that a baby makes during pregnancy. And a kick chart is a form of graph that is used by pregnant woman, more in the later stages of pregnancy to record the activity of the fetus. Baby's movements could be kicks, rolls, punches or jabs. Kick counting is quite an easy and reliable way to monitor a baby's wellbeing in addition to your regular prenatal visits. Many medical practitioners do recommend kick chart as a way to monitor baby's health in the third trimester.

Why kick chart ?

Scientific studies reveal that kick counts during the third trimester, is an easy and reliable way to monitor a baby's well being in addition to regular prenatal visits. The aim of the kick chart is to provide a guideline for how active a baby should be. However, there is no standard criteria used to define what sufficient or insufficient movement is, and therefore it's use is quite controversial. While ultrasound studies of baby's movement patterns show that they can sleep for up to 90% of the time, they do have active periods of up to 40 minutes at a time and a kick chart is aimed at recording these movements.

The chart becomes important especially when only too few kicks are felt within a specified period of time, usually twelve hours that could indicate a problem in the fetus. The chart helps doctors and midwives to ascertain how many times a baby kicked in the last twelve hours. The chart, if used correctly, can help reduce stillbirth.

Kick chart basics

First and foremost, download the free count the kicks app available in Google play. Count the kicks daily, preferably at the same time, according to your choice, more so, when the baby is active. The pregnant mother needs to sit on her feet or lie on her side and count the baby's movements, as one kick and tap the foot on her app until it reaches ten movements. She will begin to see a pattern emerging after a few days, as to how long does it take for the baby to reach ten. While most of the time it would take less than half hour, there could be times when it could take as long as two hours.

Save the kick counting sessions to record the baby's movement history. It is important to know the normal movement pattern of the baby. When the normal pattern changes, it could be a sign of potential problems and an indication to consult the medical practitioner. The kick count history should help the doctor, as the app will record the amount of time it took to get ten movements. Alternatively, you can log the time into a kick chart. There is absolutely no magic number of movements that should be felt by the mother. Also, it is a fact that babies do not slow down at the end of pregnancy. While they may not be able to do somersaults, babies do move all the way up and during labor.

How to perform kick fetal counts ?

Fetal kick means any movement that the unborn baby makes - this includes jabs, punches, rolls, twists and turns. This does not include hiccups. If the fetal kick count is not normal, then it is a sign of fetal distress. In case the baby's kicks decrease, that does not necessarily mean the baby is unhealthy. Kick count helps understand the baby's sleeping and waking cycles and is an excellent way for the mother to bond with the baby, even before she/he is born.

Doctors recommend for kick chart around 28 weeks of pregnancy. The baby becomes noticeably active between eighteen and twenty five weeks into the pregnancy. Whereas, in the case of high risk pregnancies, doctors recommend kick count from twenty six weeks.

Though it is difficult to distinguish between gas, stomach discomfort and fetal kicks at the beginning; gradually a mother should be able to recognize her baby's pattern of movements. The baby becomes active at some parts of the day and rests during others. In the third trimester, the baby begins to demonstrate waking and sleeping cycles and should kick frequently, at least ten times in two hours. Once she is able to identify the kick patterns, it should be monitored closely. A fetal kick count should be performed at least once a day after twenty eight weeks of pregnancy as a way to monitor the baby's health.

It is better to consult a doctor if the discernible pattern does not begin between the twenty eighth and twenty ninth week of pregnancy. It is also better to seek medical help if the pattern ceases or changes drastically as this could be due to any of the following reasons:

• The baby may not be getting sufficient oxygen,
  
  
• The baby could have shifted to an awkward position
  
  
• Worst thing, the baby could have dies in the womb.
  

Stillbirth

A baby who is born without any signs of life at or after 24 weeks of pregnancy is defined as still birth. It could have been during late pregnancy, called intrauterine death or could have died during labor or birth, called intrapartum death. Though stillbirth is uncommon, it cannot be said as rare.

Possible Causes

Genetic factors or

How the placenta works or

Age and lifestyle of the parent and

Infection.

Out of these, problem with the placenta or placental insufficiency is probably the most common cause of a baby dying in the womb. Though the exact reason for placenta not functioning properly is not understood, the blood vessels that connect a mother to her baby could become constricted. This may result in a drop in nutrients and oxygen to the baby, causing growth problems and hence death.

Reduced blood flow to the baby via the placenta could be due to pregnancy illness called Preeclampsia.

About 10 % of the babies are still born due to genetic or chromosomal defects. This happens when the placenta separates from the womb causing placental abruption.

Sometimes health condition of the mother such as diabetes, and rare infections such as flu, group B streptococcus, listeriosis or toxoplasmosis can cause the loss of baby in the womb.

The risk of stillbirth is more in older women. This risk appears to be highest at around 41 weeks. That is why in some hospitals, an older mother-to-be is sometimes recommended to have labor induced few weeks before due date. It is very rare that a baby may be stillborn at the very end of pregnancy. This could be due to problems with the placenta wearing out. If you are several weeks past the due date, the placenta may not work as well as it did earlier. Hence, induced labor is recommended by about 41 weeks. Lifestyle factors such as obesity, heavy drinking and smoking in pregnancy increase the risk of a baby being stillborn. Smoking again, can restrict a baby's growth as it reduces the supply of oxygen to the baby via the placenta.

Stillborn during labor or birth

It is quite rare for a baby to die unexpectedly during labor or birth. Most of the times, stillborn babies are lost when they are still in the womb. If the baby is large, in rare instances, his/her shoulders may get stuck as he/she leaves the birth canal, severely reducing the flow of oxygen to the baby. While most babies recover well, sometimes the shoulder dystocia can result in a baby being stillborn. Another cause is problems in the umbilical cord which could result in loss of oxygen to the baby. Either the cord can slip through the cervix or becomes wrapped around a baby's neck.

Diagnosis

Fetal behavior and changes in fetal movements or sleep-wake cycles can indicate if there is any fetal distress. Decreased or cessation of fetal activity is an indication of fetal distress or even death. Medical examination including a non-stress test is recommended. Obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetoscopy/doptone, ultrasound or electronic fetal monitoring aid in confirming fetal distress or death. In case the fetus is alive but inactive, extra attention is given to the placenta, and umbilical cord during ultrasound examination to ensure that there is no dearth of oxygen supply and nutrients to the baby.

What happens if the baby dies in the womb ?

The sad reality is that even after the baby dies, the mother has to go through with the birth, as it is better for her health and physical recovery. It is rare for a stillborn baby to be born by cesarean section. In most cases, the labor will have to be started artificially induced. While some parents would want to have the induction as soon as possible, some others would prefer to wait a day to two to see what happens if the labor starts by itself. In case the mother is infected, they will advise the labor induced straightway.

Whether induced or natural labor, the midwife or doctor will administer effective morphine-based pain relief. In case of twins or more, and the death of one baby occurs, the doctor normally advises not to have an induction of labor. Other issues such as whether or not the babies share a placenta, and at what stage the loss occurred should be viewed. The doctor would give the best shot for the live baby or babies to develop and mature a bit longer in the womb. The babies can then be born at the same time, when it is best for the mother's health.

A post mortem examination is done to:

1. Identify a cause or causes for death

2. Provide information about the baby's development

3. Information about health problems to combat future pregnancy.

4. Officially confirm the baby's gender.

Not all parents agree to get a post mortem done and it is only carried out with prior written consent of the parents. Post mortem could also be refused for personal, religious or cultural reasons or for any other personal reasons which the parents may not want to disclose.

Implications for next pregnancy

The decision to try for another baby can be difficult for some mothers, whereas, there is an overwhelming urge to get pregnant again as soon as possible in some others. Depending upon the cause of the stillbirth, the doctor should be able to work together to reduce the risk of it happening again.