Decreased Fetal Movement: When to Worry & What to Do

What Is Decreased Fetal Movement?

Decreased fetal movement (also called reduced fetal movement or RFM) refers to a reduction in a baby's activity in the womb as perceived by the pregnant mother. It is defined subjectively by the mother's perception that her baby is moving less frequently, less strongly, or differently than usual.

Feeling your baby move is an important way to monitor your baby's wellbeing during pregnancy. These movements, often described as kicks, rolls, jabs, or stretches, indicate that your baby is active and healthy. When a pregnant woman notices that these movements have decreased or changed, it's known as decreased fetal movement.

The significance of fetal movement was recognized as early as the 1970s when researchers first established a link between reduced movements and adverse pregnancy outcomes. Since then, awareness of fetal movement monitoring has become a cornerstone of prenatal care worldwide. Major medical organizations including the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the World Health Organization (WHO) all emphasize the importance of maternal awareness of fetal movements.

It's important to understand that decreased fetal movement is not a diagnosis in itself, but rather a symptom or observation that warrants investigation. In the majority of cases, evaluation reveals a healthy baby. However, reduced movements can sometimes be an early warning sign of fetal distress, growth restriction, or other complications that benefit from early detection and intervention.

How Movement Develops During Pregnancy

Fetal movement begins very early in pregnancy – around 7-8 weeks of gestation – but these early movements are too small to be felt. Most first-time mothers begin to feel fetal movements between 18-24 weeks of pregnancy, while women who have been pregnant before may recognize movements earlier, sometimes as early as 16 weeks. This early perception by multiparous women is likely due to their familiarity with the sensation rather than earlier onset of fetal activity.

By around 24-28 weeks, most babies develop a more predictable pattern of activity. Research has shown that healthy fetuses tend to be most active in the evening hours, particularly between 9 PM and 1 AM. This increased nighttime activity is thought to relate to the mother's decreased movement and lower blood glucose levels during rest. Understanding these patterns helps mothers establish what is "normal" for their individual baby.

Why Fetal Movement Matters

Fetal movement is a sign of fetal wellbeing and adequate oxygenation. When a baby receives sufficient oxygen and nutrients through the placenta, they have the energy to move actively. Conversely, when there are issues with placental function or blood flow, one of the early signs may be a decrease in fetal activity as the baby conserves energy.

Studies have consistently shown that maternal perception of decreased fetal movement is associated with increased risks of adverse outcomes including intrauterine growth restriction, preterm birth, and stillbirth. This is why healthcare providers take reports of reduced movement seriously and typically recommend immediate assessment.

When Should You Start Feeling Your Baby Move?

Most pregnant women begin to feel fetal movements between 18-24 weeks if it's their first pregnancy, or as early as 16 weeks in subsequent pregnancies. By 28 weeks, you should be feeling movements regularly and be familiar with your baby's pattern of activity.

The timing of when you first feel your baby move varies considerably between women and pregnancies. This first perception of fetal movement is called "quickening," a term that dates back centuries. Initially, these sensations may be subtle – often described as fluttering, bubbles, or a gentle tapping. As your pregnancy progresses, movements become more pronounced and unmistakable.

Several factors influence when you'll first perceive fetal movements. The position of your placenta plays a significant role – if you have an anterior placenta (located at the front of the uterus), it can act as a cushion that dampens the sensation of movements, potentially delaying when you first feel your baby move. Your body mass index, the amount of amniotic fluid, and your level of activity can also affect movement perception.

The Importance of the Third Trimester

From around 28 weeks onwards, monitoring fetal movements becomes particularly important. By this stage of pregnancy, your baby has developed a regular pattern of activity and rest cycles. These cycles typically last 20-40 minutes but can occasionally extend up to 90 minutes. Recognizing these patterns is crucial for identifying any changes that might warrant attention.

Contrary to a common misconception, babies do NOT move less as pregnancy progresses. While the type of movement may change – with fewer somersaults and more stretches and smaller movements as space becomes limited – the frequency of movements should remain consistent or may even become more noticeable. If you perceive a decrease in movements in late pregnancy, this should never be dismissed as "normal" and should always be evaluated.

Establishing Your Baby's Pattern

Between 24-28 weeks, make a conscious effort to learn your baby's movement pattern. Notice when your baby is most active – this is often after meals, in the evening, or when you're lying down. Pay attention to the type of movements your baby typically makes. Some babies are vigorous kickers, while others have a more rolling or stretching movement style.

Understanding your baby's individual pattern is more valuable than counting to a specific number. While some healthcare providers have historically recommended counting 10 movements in a certain time period, current evidence suggests that focusing on pattern recognition is more effective. You are the expert on YOUR baby's movements.

What Causes Decreased Fetal Movement?

Decreased fetal movement can have many causes ranging from completely benign (baby sleeping, mother busy and not noticing) to concerning (fetal distress, placental problems). Common harmless causes include the baby's sleep cycles, anterior placenta position, and maternal activity levels. Concerning causes include reduced placental function, fetal anemia, or infection.

When a pregnant woman perceives decreased fetal movement, there are numerous possible explanations. Understanding these various causes can help provide context, though it's important to emphasize that the cause cannot be determined without proper medical evaluation. Here we'll explore both the common benign causes and the more concerning possibilities.

Benign Causes of Reduced Movement Perception

In the majority of cases where women report decreased fetal movement, the baby is found to be healthy upon evaluation. Several factors can reduce your perception of movements without indicating any problem with your baby.

Fetal sleep cycles are one of the most common explanations. Healthy fetuses have regular cycles of activity and rest, typically lasting 20-40 minutes but occasionally extending up to 90 minutes. If you happen to be checking for movements during a sleep cycle, you may perceive less activity.

Maternal distraction plays a significant role. When you're busy, active, or distracted by work or daily activities, you're less likely to notice fetal movements. Many women report that they only become aware of reduced movements when they sit down to rest in the evening, at which point they realize they haven't felt the baby move as much during the day.

Placental position affects movement perception throughout pregnancy. An anterior placenta (positioned at the front of the uterus, between the baby and your abdominal wall) can significantly dampen the sensation of movements. Women with anterior placentas often feel movements later in pregnancy and may consistently perceive them as less strong than women with posterior placentas.

Maternal obesity can make it more difficult to perceive fetal movements due to increased abdominal tissue between the baby and the skin surface. This doesn't mean movements are reduced, only that they're harder to feel.

Amniotic fluid levels also influence movement perception. Higher fluid levels can cushion movements, while lower levels may make them more pronounced.

Concerning Causes of Decreased Fetal Movement

While less common, reduced fetal movement can sometimes indicate problems that require medical intervention. This is why prompt evaluation is always recommended.

Placental insufficiency occurs when the placenta is not functioning optimally and may not be delivering adequate oxygen and nutrients to the baby. When this happens, the baby may reduce activity to conserve energy. Placental insufficiency is associated with intrauterine growth restriction and other adverse outcomes.

Fetal hypoxia (reduced oxygen supply) can result from placental problems, umbilical cord issues, or maternal conditions affecting oxygen delivery. A baby experiencing hypoxia may move less as a compensatory mechanism.

Fetal anemia, often caused by infections like parvovirus B19 (fifth disease), can lead to reduced fetal activity. When the baby has fewer red blood cells to carry oxygen, energy levels decrease.

Intrauterine growth restriction (IUGR) means the baby is not growing as expected. Babies with IUGR often demonstrate decreased movement as one of the early signs.

Infection, whether maternal or fetal, can affect fetal activity levels. Certain infections can cross the placenta and directly impact the baby.

Medications and substances can also affect fetal movement. Sedative medications, alcohol, and certain other substances can temporarily reduce fetal activity.

When Should You Contact Your Healthcare Provider?

Contact your healthcare provider or maternity unit immediately if you notice any significant change in your baby's movement pattern, if movements feel weaker than usual, if you haven't felt your baby move for 2 hours during their normally active time, or if you simply feel something is "not right." Never wait until the next day – reduced fetal movement should be evaluated on the same day.

The decision to seek care for reduced fetal movement should be based on your own perception of what is normal for YOUR baby. Guidelines from major medical organizations including ACOG and RCOG emphasize that maternal concern about fetal movements should always be taken seriously and evaluated promptly.

You should contact your maternity unit or healthcare provider if you experience any of the following:

• A noticeable decrease in the frequency of movements compared to your baby's normal pattern
• Movements that feel weaker or less vigorous than usual
• A change in the character of movements (for example, if your active baby suddenly feels sluggish)
• No movements felt for 2 hours during a time when your baby is usually active, even after resting and focusing
• An intuitive feeling that something is "off" or different, even if you can't pinpoint exactly why
• Complete absence of movements for an extended period

What NOT to Do

When concerned about fetal movements, there are certain things you should avoid. Do NOT use home doppler devices to check your baby's heartbeat as a substitute for medical evaluation. While hearing a heartbeat may provide temporary reassurance, it does not assess overall fetal wellbeing and can lead to false reassurance in situations where problems exist.

Do NOT wait until the next day to seek care. Studies have shown that delays in presentation for reduced fetal movement are associated with worse outcomes. Most maternity units have 24-hour access for concerns about fetal movements specifically because of this time-sensitive nature.

Do NOT assume that reduced movements are normal because you're near your due date. As emphasized earlier, the myth that babies "slow down" before birth is dangerous and unfounded. Your baby should maintain their movement pattern until delivery.

Trust Your Instincts

Perhaps the most important guidance is to trust your maternal instincts. You have been feeling your baby's movements for weeks or months and have developed an intimate awareness of their patterns. If something feels wrong – even if you can't articulate exactly what – that feeling deserves attention and investigation.

Healthcare providers would rather see a hundred women with concerns about fetal movement who turn out to have healthy babies than miss one baby in distress. You should never feel that you are "bothering" your healthcare team by seeking evaluation. This is exactly what they are there for, and most will explicitly encourage pregnant women to contact them with any concerns about movements.

How to Check Your Baby's Movements

To check your baby's movements, lie down on your left side in a quiet environment and focus on movements for up to 2 hours. You should feel several distinct movements during this time. A cold drink or a snack may stimulate activity. However, if movements remain reduced or you're worried, contact your healthcare provider regardless of how many movements you've counted.

While formal "kick counting" has evolved over the years, the principle of focused attention to your baby's movements remains valuable. If you're concerned about reduced movements, here's a systematic approach to checking on your baby before deciding whether to seek care.

Step-by-Step Movement Check

Step 1: Find a quiet space. Go to a calm, comfortable environment where you can focus without distractions. Turn off the television and put away your phone.

Step 2: Lie on your left side. This position optimizes blood flow to your uterus and baby, and places your baby in a good position to perceive movements. Use pillows for comfort and try to relax.

Step 3: Focus on movements for up to 2 hours. During a period when your baby is normally active (often after a meal or in the evening), pay close attention to any movements you feel. These might be kicks, rolls, jabs, stretches, or any other sensation of your baby moving.

Step 4: Consider trying to stimulate activity. A cold drink, a small snack (particularly something sweet), or gentle prodding of your belly may encourage your baby to move. Some babies respond to these stimuli, though not all do.

Step 5: Evaluate the result. If you feel several distinct movements and they seem normal in strength and character for your baby, you can be reasonably reassured. However, if movements remain reduced, feel weaker than usual, or you remain worried, contact your healthcare provider promptly.

Understanding Movement Patterns

Research has shown that healthy babies typically have periods of activity lasting 40-75 minutes, interspersed with quiet periods that usually last 20-40 minutes. The longest period of inactivity in a healthy term fetus is typically under 2 hours. Babies tend to be most active in the evening hours, particularly between 9 PM and 1 AM.

Your baby's movements may temporarily decrease after you eat (as blood flow is redirected to digestion), during periods when you're very active, or when your baby is in a sleep cycle. These normal variations are why it's important to focus on your baby's overall pattern rather than moment-to-moment activity.

What Happens When You Seek Care for Reduced Movement?

When you present with reduced fetal movement, your healthcare provider will typically perform a cardiotocography (CTG) to monitor your baby's heart rate pattern for 20-30 minutes or longer. An ultrasound may also be performed to check amniotic fluid, observe the baby, and assess growth. Most evaluations find reassuring results and healthy babies.

Understanding what to expect when you seek care for reduced fetal movement can help reduce anxiety and ensure you're prepared for the assessment process. Here's what typically happens during an evaluation.

Initial Assessment

When you contact your maternity unit about reduced fetal movement, you'll usually be asked to come in for assessment. Upon arrival, a midwife or doctor will take your history, asking about your baby's usual movement pattern, when you first noticed the decrease, and any other symptoms or concerns you may have.

They will also review your pregnancy history, check your blood pressure, and may perform a brief examination. This initial assessment helps the healthcare team understand your individual situation and plan appropriate investigations.

Cardiotocography (CTG)

The cornerstone of fetal wellbeing assessment is cardiotocography, also known as electronic fetal monitoring or a non-stress test. This involves placing two external monitors on your belly – one to record your baby's heart rate and one to detect any uterine contractions.

A normal CTG typically runs for 20-30 minutes, though it may be continued longer if initial results are not immediately reassuring. During this time, you'll lie comfortably while the machine records a continuous trace of your baby's heart rate. Healthcare providers look for specific patterns including:

• A baseline heart rate in the normal range (110-160 beats per minute)
• Good variability in the heart rate (fluctuations of 5-25 beats per minute)
• Accelerations – brief increases in heart rate that typically occur with movement
• Absence of concerning decelerations

A reassuring CTG suggests that your baby is currently coping well. However, it's important to understand that CTG is a snapshot in time and has limitations in predicting future problems, which is why additional assessments may be recommended.

Ultrasound Assessment

Depending on the clinical situation, an ultrasound may be performed. This can provide additional information including:

Amniotic fluid assessment: Low amniotic fluid (oligohydramnios) can be associated with placental insufficiency and poor fetal outcomes. Checking fluid levels helps assess placental function.

Fetal observation: The sonographer can observe your baby's movements, breathing movements, and general activity level during the scan.

Growth assessment: If there are concerns about fetal growth, measurements may be taken to estimate your baby's size and compare to expected norms.

Doppler studies: Blood flow through the umbilical cord and other vessels can be assessed using Doppler ultrasound, providing information about placental function.

What Happens After Assessment

In the majority of cases, assessment reveals a healthy baby with reassuring findings. In these situations, you'll typically be sent home with advice to continue monitoring your baby's movements and to return if concerns arise again.

If the assessment reveals any concerning findings, your healthcare team will discuss the options with you. This might include increased monitoring, additional tests, or in some cases, consideration of delivery if the baby would be safer outside the womb.

What Are the Possible Outcomes and Risks?

The vast majority of women who report decreased fetal movement have healthy babies after investigation. However, reduced movement can be associated with increased risks of intrauterine growth restriction (10-15% of RFM cases), placental insufficiency, preterm birth, and stillbirth. Early presentation and evaluation can identify problems when intervention may improve outcomes.

Understanding the potential outcomes associated with reduced fetal movement provides important context for why this symptom is taken seriously by healthcare providers, while also offering reassurance that most assessments yield positive results.

Reassuring Outcomes

Research consistently shows that the majority of women who present with reduced fetal movement are found to have healthy, normally developing babies. Studies suggest that 60-85% of evaluations for reduced fetal movement result in normal findings with no intervention required beyond reassurance and continued monitoring.

Common explanations for reduced movement perception in these cases include fetal sleep cycles, changes in maternal activity or awareness, anterior placenta position, and normal variations in movement patterns. These women can be reassured that their vigilance was appropriate and that seeking care was the right decision.

Identified Concerns

In a proportion of cases, evaluation for reduced fetal movement identifies problems that benefit from medical attention:

Intrauterine Growth Restriction (IUGR): Studies have found that 10-15% of women presenting with reduced fetal movement have babies with growth restriction. Early identification allows for increased monitoring and planning for the safest timing of delivery.

Oligohydramnios: Low amniotic fluid is found in a subset of RFM cases and may indicate placental insufficiency or other problems requiring closer surveillance.

Placental Insufficiency: Reduced placental function can be identified through Doppler studies and other assessments, allowing for appropriate management.

Fetal Distress: In some cases, abnormal CTG findings indicate that the baby is not coping well and may need to be delivered urgently.

Association with Stillbirth

The relationship between reduced fetal movement and stillbirth is the primary reason this symptom is taken so seriously. Research has shown that:

• Approximately 50% of women who experience stillbirth report reduced fetal movement in the days preceding the event
• Delayed presentation for evaluation is associated with worse outcomes
• Prompt assessment and appropriate intervention may prevent some stillbirths

It's important to emphasize that experiencing reduced fetal movement does NOT mean stillbirth is likely – the vast majority of assessments have reassuring outcomes. However, the potential seriousness of the underlying causes is why immediate evaluation is recommended.

How Can You Help Keep Your Baby Healthy?

To support your baby's health and monitor effectively: learn your baby's unique movement pattern by 28 weeks, check movements daily at a consistent time, avoid smoking and alcohol, attend all prenatal appointments, maintain a healthy diet, sleep on your side in the third trimester, and trust your instincts if something feels wrong.

While not all causes of reduced fetal movement can be prevented, there are many things you can do to support your baby's health during pregnancy and to optimize your ability to monitor their wellbeing effectively.

Lifestyle Factors

Avoid smoking and alcohol: Both smoking and alcohol consumption are associated with reduced fetal movement and adverse pregnancy outcomes including growth restriction and stillbirth. Smoking reduces blood flow to the placenta, while alcohol can directly affect fetal development and activity.

Maintain a healthy diet: Good nutrition supports placental function and fetal development. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins provides the nutrients your baby needs to thrive.

Stay hydrated: Adequate fluid intake supports amniotic fluid levels and overall pregnancy health. Aim for 8-10 glasses of water daily, more in hot weather or when exercising.

Sleep on your side: In the third trimester, sleeping on your side (particularly your left side) is recommended. Research has shown that back sleeping in late pregnancy is associated with increased stillbirth risk, possibly due to effects on blood flow to the uterus.

Monitoring Best Practices

Learn your baby's pattern: Make a conscious effort to get to know your baby's movement pattern from around 24-28 weeks. Notice when they're most active, what type of movements are typical, and how they respond to different stimuli.

Check movements daily: Take time each day to focus on your baby's movements. Many women find the evening (when babies are often most active) a good time for this daily check.

Avoid relying on apps or kick counting alone: While kick counting apps can be useful tools, they should not replace your overall awareness of your baby's movement pattern. The quality and character of movements matter as much as the quantity.

Never hesitate to seek care: If you're worried about your baby's movements, contact your healthcare provider. It's always better to be checked and reassured than to wait and worry.

Prenatal Care

Attend all appointments: Regular prenatal care allows your healthcare team to monitor your pregnancy, identify any developing problems, and intervene early if needed.

Report concerns promptly: Don't wait for your next scheduled appointment if you have concerns about fetal movements or anything else. Contact your maternity unit immediately.

Discuss risk factors: If you have risk factors for placental problems or fetal growth restriction (such as previous pregnancy complications, high blood pressure, or diabetes), discuss with your healthcare team whether additional monitoring is appropriate.