Kicks Count

Suzanne Pullen
Sunday, March 25, 2007

Days before a scheduled Cesarean section of her 39- week old son, the movements inside Blair Blanks womb noticeable slowed. Thinking it was because it he was too big to have any room to move, she was blindsided when she went in for surgery and doctors found no heartbeat.
"The word stillbirth was never mentioned to me," said Blair, who lives in Baltimore, MD. "I was told all about the back-to-sleep method for preventing SIDS. Now I discover that the risk of having a stillbirth is about 10 times the risk of a SIDS death. I was never told anything about kick counting. I am outraged that no one ever told me what to look for."

In the 1970s and '80s, studies showed that use of kick counting charts -- a self-monitoring practice where a mother logs how often she feels movement over a specific period of time -- had greatly reduced stillbirth rates. But after a study of 68,000 women published in the Lancet in 1989 asserted that there was no benefit from kick counting, teaching it quickly fell out of practice.
But in the last few years, stillbirth advocates have been challenging the study's findings. The largest flaw, according to stillbirth researcher Dr. Frederick Froen, was that stillbirth rates in both the study group and the control group -- which was told that kick counting would be studied but told not to do it -- decreased significantly.

In 2005, Froen surveyed more than 5,000 women with a stillbirth. Fifty percent had noticed a decrease in their baby's movements several days prior to their loss. Fifty-six percent said it was the first reason they had to believe something was wrong.

Richard K. Olsen, founder of the National Stillbirth Society, said more than 67 percent of his members with a loss were never told about kick counting. Of the women who had been, only three percent said their doctors recommended it and explained how to do it.
Olsen believes the number of stillbirths occurring for unknown reasons could be cut in half if the medical community endorsed kick counting.

"We need to make mothers aware of how to monitor fetal activity," said Olsen, whose daughter, Camille, was stillborn at full-term. "Just like the 'Back to Sleep' campaign dramatically reduced the number of SIDS deaths, so can kick counting reduce stillbirths."
Dr. Ruth Fretts with Brigham and Women's Hospital at Harvard University believes it is possible that mothers also may be picking up on signs of fetal distress that are not noted during non-stress tests, an exam where the baby's movements, growth and heart rate are monitored. She pointed out that 10 percent of stillbirths in the Lancet study were correctly predicted by mothers who reported reduced fetal movements. But when formal fetal testing and non-stress tests came back reassuring, the information was not acted upon.
Fretts said she found similar missed opportunities to intervene in a study she published last year of more than 500 women who reported feeling decreased fetal movements. They were four times more likely to have a stillbirth. Forty-four percent of them had babies that were below average weight.

"(Doctors) were relieved because the testing was falsely reassuring," said Fretts. "Reduced fetal movements and a normal non-stress should still require additional testing. The baby might be fine when it is being monitored, but not later on."
Reduced fetal movements and below average weight are evidence that some stillbirths happen over time and can be avoided, said Dr. Diep Nguyen, founder of the BabyKick Alliance. She believes mothers may be picking up on something that formal testing is missing.
"The goal for kick counting is to encourage moms to be aware of their babies and to empower them to be a part of the medical team to ensure a safe and healthy pregnancy," said Nguyen, who witnessed a sibling being stillborn when she was 12-years-old. She said that kick counting later helped another sister avoid repeating the family tragedy.

While there are several different tracking methods, the American College of Obstetricians and Gynecologists recommends charting how long it takes for a baby to complete 10 movements and to alert a doctor if there is a change in the baby's pattern. "I think a lot of doctors don't trust pregnant women enough to give them any significant role in judging the well-being of their babies," said Blanks. "It's a very patronizing attitude. So women have no choice but to wait until each doctor visit to find out if their babies are OK, and in the meantime they are left feeling powerless and uncertain."
Nguyen, who tell her patients to begin counting at 24 weeks, while the standard is 28 weeks, said that some doctors don't teach kick counting because they think it will cause mothers to panic unnecessarily, but that studies show no increase in a mother's anxiety when she is given clear directions about how to count and about a baby's normal sleep cycles. "(Doctors) seem to be concerned that kick counting will cause women to worry and call them at 2 a.m. in the morning and say 'I'm having a stillbirth,'" Olsen said. "But we don't seem to be worried about alarming air travelers by practically stripping them to their shorts before they are allowed on a plane. Given a choice, I think women will choose knowing over not knowing."

Blanks will never know if counting her son James' kicks would have prevented his death, but she hopes her story will encourage others to make it common practice. "It's free and easy and could save your baby," she said.
For more information on kick counting methods, visit www.babykickalliance.org

This article appeared on page P - 12 of the San Francisco Chronicle