BABY MOVEMENTS IN PREGNANCY FAQ
Most women are first aware of their baby moving when they are 18–20 weeks pregnant. However, if this is your first pregnancy, you may not become aware of movements until you are more than 20 weeks pregnant. If you have been pregnant before, you may feel movements as early as 16 weeks. Pregnant women feel their baby’s movements as a kick, flutter, swish or roll.
As your baby grows, both the number and type of movements will change with your baby’s activity pattern. Usually, afternoon and evening periods are times of peak activity for your baby. During both day and night, your baby has sleep periods that mostly last between 20 and 40 minutes, and is rarely longer than 90 minutes. Your baby will usually not move during these sleep periods.
The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date. Often, if you are busy, you may not notice all of these movements.
During your pregnancy, feeling your baby move gives you reassurance of his or her wellbeing. If you notice your baby is moving less than usual or if you have noticed a change in the pattern of movements, it may sometimes be a sign that your baby is unwell and therefore it is essential that you contact your doctor.
There is no specific number of movements that is considered normal. During your pregnancy, you need to be aware of your baby’s individual pattern of movements. A reduction or a change in your baby’s movements is what is important.
You are less likely to be aware of your baby’s movements when you are active or busy.
If your placenta (afterbirth) is at the front of your uterus (womb), it may not be so easy for you to feel your baby’s movements.
If your baby’s back is lying at the front of your uterus, you may feel fewer movements than if his or her back is lying alongside your own back.
Certain drugs such as strong pain relief or sedatives can get into your baby’s circulation and make your baby move less. Alcohol and smoking may also affect your baby’s movements. In some cases, a baby may move less because he or she is unwell. Rarely, a condition affecting the muscles or nerves may cause your baby to move very little or not at all.
There is not enough evidence to recommend the routine use of a movement chart. It is more important for you to be aware of your baby’s individual pattern of movements throughout your pregnancy and you should seek immediate help if you feel that the movements are reduced or changed.
Always seek professional help immediately. Never go to sleep ignoring a reduction or change in your baby’s movements. Do not rely on any home kits you may have for listening to your baby’s heartbeat.
The care you will be given when you report a reduction or change in your baby’s movements depends on the stage of your pregnancy:
- Less than 24 weeks pregnant: Most women first become aware of their baby moving when they are 18–20 weeks pregnant. If by 24 weeks you have never felt your baby move, you should contact your doctor, who will check your baby’s heartbeat. An ultrasound scan may be arranged.
- Between 24 weeks and 28 weeks pregnant: You should contact your doctor, who will check your baby’s heartbeat. You will have a full antenatal check-up that includes checking the size of your uterus, measuring your blood pressure and testing your urine for protein. If your uterus measures smaller than expected, an ultrasound scan may be arranged to check on your baby’s growth and development.
- Over 28 weeks pregnant: You must contact your doctor immediately. You must not wait until the next day to seek help. You will:
- be asked about your baby’s movements
- have a full antenatal check-up, including checking your baby’s heartbeat.
Your baby’s heart rate will be monitored, usually for at least 20 minutes. This should give you reassurance about your baby’s wellbeing. You should be able to see your baby’s heart rate increase as he or she moves. You will usually be able to go home once you are reassured.
An ultrasound scan, to check on the growth of your baby as well as the amount of amniotic fluid around your baby, may be arranged if:
- your uterus measures smaller than expected
- your pregnancy has risk factors associated with stillbirth
- the heart-rate monitoring is normal but you still feel that your baby’s movements are less than usual.
The ultrasound scan is normally performed within 24 hours of being requested.
These investigations usually provide reassurance that all is well. Most women who experience one episode of reduction in their baby’s movements have a straightforward pregnancy and go on to have a healthy baby.
If there are any concerns for your baby, your healthcare team will discuss this with you. Follow-up scans may be arranged. In some circumstances, you may be advised that it would be safer for your baby to be born as soon as possible.
RECURRENT MISCARRIAGE FAQ
If you lose a baby before 24 weeks of pregnancy, it is called a miscarriage. If this happens in the first 3 months of pregnancy, it is known as an early miscarriage. Unfortunately, early miscarriages are common, with 10–20 in 100 (10–20%) pregnancies ending this way.
Late miscarriages, after 3 months of pregnancy but before 24 weeks, are less common: 1–2 in 100 (1–2%) pregnancies end in a late miscarriage.
When a miscarriage happens two or more times in a row, it is called recurrent miscarriage. Recurrent miscarriage affects 1 in 100 (1%) couples trying to have a baby.
Sometimes there is a reason found for recurrent and late miscarriage. In other cases, no underlying problem can be found. Most couples are likely to have a successful pregnancy in the future, particularly if test results are normal.
There are a number of factors that may play a part in causing recurrent and late miscarriage:
Age: The older you are, the greater your risk of having a miscarriage. If the woman is aged over 40, more than 1 in 2 pregnancies end in a miscarriage. Miscarriages may also be more common if the father is older.
Antiphospholipid syndrome (APS): APS (a syndrome that makes your blood more likely to clot) is uncommon but is a cause of recurrent miscarriage and late miscarriage.
Thrombophilia: Thrombophilia (an inherited condition that means that your blood may be more likely to clot) may cause recurrent miscarriage and in particular late miscarriages.
Genetic factors: In about 2–5 in 100 couples (2–5%) with recurrent miscarriage, one partner will have an abnormality on one of their chromosomes (the genetic structures within our cells that contain our DNA and the features we inherit from our parents). Although this may not affect the parent, it can sometimes cause a miscarriage.
Weak cervix: Weakness of the cervix is known to be a cause of miscarriage from 14 to 23 weeks of pregnancy. This can be difficult to diagnose when you are not pregnant. It may be suspected if in a previous pregnancy your waters broke early, or if the neck of the womb opened without any pain.
- Developmental problems of the baby: Some abnormalities of the baby may lead to a miscarriage but are unlikely to be the cause of recurrent miscarriage.
- Infection: Any infection that makes you very unwell can cause a miscarriage. Milder infections that affect the baby can also cause a miscarriage. The role of infections in recurrent miscarriage is unclear.
- Shape of the uterus: It is not clear how much an abnormally shaped uterus contributes to recurrent miscarriage or late miscarriages. However, minor variations do not appear to cause miscarriage.
- Diabetes and thyroid problems: Diabetes or thyroid disorders can be factors in miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept under control.
Immune factors: It has been suggested that some women miscarry because their immune system does not respond to the baby in the usual way. This is known as an alloimmune reaction. There is no clear evidence to support this theory at present. Further research is needed.
Being overweight increases the risk of miscarriage. Smoking and too much caffeine may also increase the risk. Excessive alcohol is known to be harmful to a developing baby
The chance of a further miscarriage increases slightly with each miscarriage. Women with three miscarriages in a row have a 4 in 10 chance of having another one. This means that 6 out of 10 women (60%) in this situation will go on to have a baby next time.
Finding out whether there is a cause for your recurrent miscarriage or late miscarriage is important as your doctor will be able to give you an idea about your likelihood of having a successful pregnancy. In a small number of cases there may be treatment available to help you.
- Blood tests:
For APS. APS is diagnosed if you test positive on two occasions 12 weeks apart, before you become pregnant again.
For thrombophilia. If you have had a late miscarriage you should be offered blood tests for certain inherited thrombophilias.
To check you and your partner’s chromosomes for abnormalities. You may be offered this test if your baby has been shown to have abnormal chromosomes.
- Tests for abnormalities in the baby
You should be offered tests to check for abnormalities in your baby’s chromosomes. This is not always possible but may help to determine your chance of miscarrying again.
If you have had a late miscarriage you may also be offered a postmortem examination of your baby. This will not happen without your consent and you will have the opportunity to discuss this with your health team beforehand.
- Tests for abnormalities in the shape of your uterus
You should be offered a pelvic ultrasound scan to check for any abnormalities in the shape of your uterus. If an abnormality is suspected, further investigations may include a hysteroscopy (a procedure to examine the uterus through a small telescope which is passed through the vagina and cervix) or a laparoscopy (a procedure in which a surgeon uses a fine telescope to look inside the abdomen and pelvis).
- Tests for infection
If you have had a late miscarriage, tests such as blood samples and vaginal swabs may be taken at the time to look for any source of infection.
- What are my treatment options?
- Treatment for APS
- If you have APS and have had recurrent miscarriage or a late miscarriage, treatment with low-dose aspirin tablets and heparin injections in pregnancy increases your chance of having a baby. Aspirin and heparin make your blood less likely to clot and are safe to take in pregnancy.
- Having APS means you are at increased risk of complications during pregnancy such as pre-eclampsia, problems with your baby’s growth and premature birth. You should be carefully monitored so that you can be offered treatment for any problems that arise.
- Treatment for thrombophilia
- If you have an inherited tendency to blood clotting (thrombophilia) and have had a miscarriage between 12 and 24 weeks of pregnancy, you should be offered treatment with heparin.
- At present there is not enough evidence to say whether heparin will reduce your chance of miscarriage if you have had early miscarriages (up to 12 weeks of pregnancy). However, you may be still offered the treatment to reduce the risk of a blood clot during pregnancy. Your doctor will discuss what would be recommended in your particular case.
- Referral for genetic counseling
- If either you or your partner has a chromosome abnormality, you should be offered the chance to see a specialist called a clinical geneticist. They will discuss with you what your chances are for future pregnancies and will explain what your choices are. This is known as genetic counseling.
- Monitoring and treatment for a weak cervix
If you have had a miscarriage between 14 and 24 weeks and have a diagnosis of a weak cervix, you may be offered an operation to put a stitch in your cervix. This is usually done through the vagina at 13 or 14 weeks of pregnancy under a general or spinal anaesthetic. Your doctor should discuss the surgery with you.
If it is unclear whether your late miscarriage was caused by a weak cervix, you may be offered vaginal ultrasound scans during your pregnancy to measure the length of your cervix. This may give information on how likely you are to miscarry. If your cervix is shorter than it should be before 24 weeks of pregnancy, you may be offered an operation to put a stitch in your cervix.
- Surgery to the uterus
- If an abnormality is found in your uterus, you may be offered an operation to correct this.
- Hormone treatment
- Taking progesterone or human chorionic gonadotrophin hormones early in pregnancy has been tried to prevent recurrent miscarriage. More evidence is needed to show whether this works.
Treatment to prevent or change the response of the immune system (known as immunotherapy) is not recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and may carry serious risks (including transfusion reaction, allergic shock and hepatitis).
Where there does not appear to be a cause for recurrent miscarriage or late miscarriage, there is currently no evidence that heparin and aspirin treatment reduces the chance of a further miscarriage. For that reason this treatment is not recommended in these circumstances.
You and your partner should be seen together by a specialist health professional. This may be within a clinic dedicated to recurrent and late miscarriage.
Your doctor will talk to you both about your particular situation and your likelihood of having a further miscarriage and a successful pregnancy. If a cause has been found, possible treatment options will be offered to you to improve your chance of a successful pregnancy.
Women who have supportive care from an early pregnancy assessment unit from the beginning of a pregnancy have a better chance of a successful birth. For couples where no cause for recurrent miscarriage has been found, 75 in 100 (75%) will have a successful pregnancy with this care.
It is worth remembering that the majority of couples will have a successful pregnancy the next time even after three miscarriages in a row.