My Third Trimester

Both Drs. Kliman and Uma Reddy, MD, MPH, Medical Officer Pregnancy & Perinatology Branch, Eunice Shriver National Institute of Child and Human Development, concur that UCAs, including nuchal cords, true knots, twists, torsion, kinks and long or short cords, account for 16 percent of the 26,000 yearly deaths in utero in the USA. That is at least 71 untimely deaths each and every day in our country. Dr. Collins states a UCA is not a “rare condition or event” and should be watched for especially in the last trimester of pregnancy. He advocates an ultrasound be done if decreased fetal movements are noted for a day. 

After your ultrasound

If a problem is seen on your baby’s ultrasound with the umbilical cord or placenta, a plan of action needs to be decided upon with your health care team. Examples of close monitoring include repeat office visits, ultrasounds, Fetal Non-Stress Tests (NST), Biophysical Profiles (BPP), Cord (blood flow) Doppler tests, very diligent movement counting and daily home fetal heart rate monitoring offered by companies such as Genesis Obstetrical Home Health Care Services.

If you and your health care team determine your baby should have further monitoring following your 28 week ultrasound, or you are considered high risk, don’t panic! It is comforting and reassuring to know your baby is healthy and stable thanks to the frequent monitoring. The four main reasons for monitoring your baby are to ensure that your baby is comfortable in utero, to ensure that your baby’s heart rate is normal and steady with no significant decelerations (decels) present, the placenta is working efficiently and not appearing to be aged, and to ensure that there are no signs of preterm or premature labor present.

“Most women who notice a decrease in movement will still have a healthy outcome,” says Obstetrician-Gynecologist Ruth Fretts, M.D., MPH, Assistant Professor at Harvard Medical School and Chair of the Stillbirth Review Committee at the Brigham and Women’s Hospital in Boston. “The biggest concern is when it happens repeatedly.” Dr. Fretts reminds every mom that as her pregnancy advances and her expected baby has less space, the kicks (movements) won’t be as strong and obvious. But if it takes you more than two hours to count 10 kicks (movements), your health care team should be called. She says a Non Fetal Stress Test (NST) is necessary to confirm your baby’s heart rate, “This rules out a life-threatening emergency, but it doesn’t address the underlying reason for decreased movement.”

Dr. Fretts says an ultrasound may add additional clarification. Unfortunately in the United States ultrasounds will be performed only about 20% of the time in these situations, so mom will need to assert her proactive skillfulness requesting one is done. With a normal NST, movement counting should be completed and charted every day. Mom should never hesitate to be evaluated every time a problem is perceived.

If the thought of counting and charting your baby’s movements makes you nervous, remember that movement counting is the safest and easiest course of action that every mom can take to monitor her baby’s movements on a daily basis. This simple concept is also free and non-invasive. Studies inform us that being attentive to your baby’s movements and informing your health care team of any changes such as speeding up or slowing down, or changes in sleep-wake cycles will decrease the likelihood of having a stillbirth. Ask your health care team about the signs of a baby that is not well and their protocol for such signs.

Movement Counting Directions: 

You can count your movements at any point during the day. Ideally, we recommend first thing in the morning, once in the afternoon, and once in the evening before bed.

Use ME Preg’s Movement Tracker whenever you want to count your baby’s movements. If you don’t have a smartphone, use our Mom & Baby Tracking Chart available in both English and Spanish. Begin by lying on your left side if possible and count every kick, punch, roll, swish, jab and swoosh – but not hiccups. You should be able to get 10 movements in one hour or less. Track the number on your movement tracker or jot down the number in your tracking chart. This information will be important for you and your health care team, and may also become part of your medical record!

You may wonder, “How will I know if something isn’t right?” You are looking for anything different or out of the ordinary.  For example: Let’s say you always do your movement counts at 7am, immediately following breakfast, and it usually takes about 5 minutes to count your 10 movements. If one morning, at the same time, it suddenly took you 45 minutes to get 10 movements, that would be considered out of the ordinary. You might want to wait a little and do another movement counting session just to be sure. But if you are truly concerned, call your health care team.

Another example: You may count 4 or 5 movements in an hour instead of the usual 10 movements. Count your movements again. If, for any reason, you are still not able to obtain the usual 10 movements in your normal amount of time, you detect an unusual amount of activity level for your baby (an increase or decrease in fetal movement), or you notice any sudden changes in movement, call your health care team to make sure your baby is well. If you are unable to contact or visit your health care team, go to Labor and Delivery (L&D) as most L&D units will see you immediately for Decreased Fetal Movements (DFM), or go to the nearest Emergency Room (ER).

Never hesitate to call your health care team with any questions or concerns you may have or comments they have made that you don’t understand. With your new proactive mindset, working together will now empower your pregnancy journey. You know your baby best, so always trust your instincts!