Your baby’s health
by Dr. Derrick Thompson (Obstetrician & Gynaecologist)
You should give birth to a healthy baby if your baby’s growth is normal as should on the SPH growth chart, and you feel its movements (kicks) after 18 to 20 weeks gestation and dialy kicks after about 26 weeks gestation. If you develop any complications such as high blood pressure or vaginal bleeding, this guideline may change.
Fetal movements (kicks)
1. Before 26 weeks gestation
You will usually start to feel fetal movements at 18-20 weeks gestation, although not necessarily on a daily basis. Many women describe them as flutters or butterflies felt below the navel. You will notice movements at this stage because by now the fetus has grown large enough for its movements to be sufficiently strong to be transmitted through the wall of the uterus to your anterior abdominal wall. At this stage of pregnancy, the wall of the uterus comes in direct contact with your anterior abdominal wall.
The wall of the uterus (myometrium) does not contain nerve fibres sensitive to movement. Thus, it is the fetus moving directly against your anterior abdominal wall which give you the sensation of movement.
2. After 26-28 weeks gestation
It is most important for you to be aware of your baby’s movements each day, either as a kick or rolling sensation. As your EDD approaches, you will experience your baby’s movements as a stretching sensation. Your baby is growing, and the amount of liqour (fluid) around your baby is diminishing. Therefore, there is less room for your baby to kick.
If you are concerned about your baby’s well being, your doctor may suggest you create a kick chart where you record and count your baby’s movements. You should feel at least 10 kicks between 9 am and 9 pm. You should not rely on kick charts alone to monitor the well being of your baby in utero.
If you are not aware of any fetal movements during the day, I recommend you either have your evening meal or a glass of fluid, and lie down. Normally, you should feel your baby move within the next 2 hours. Loud music music may stimulate fetal movements. If you do not feel any fetal movements within 2 hours, you should contact your doctor who normally would arrange for fetal monitoring to be performed on your baby.
you should contact your doctor or midwife if you perceive a daily reduction in fetal movements. Delays of greater than 24 hours between the perception of decreased movements and presentation to your carer have been associated with increased morbidity and mortality, for example stillborth.
Should the above circumstances arise, a cardiotocography (CTG) and an ultrasound examination – at least for liquor volume – should be performed.
At each antenatal visit, your doctor or midwife will listen to your baby’s heart. It is very reassuring if your carer can listen to your baby’s heart with a fetal dopler machine. This will enable you to hear your baby’s heart beating. I also recommend your partner listen to the fetal heart.
To do this at home after 30 weeks gestation, use the following method. Most of the time the fetus lies head first (cephalic). Your partner can therefore best hear the baby’s heart by placing his ear on your abdomen between the navel and the iliac crest (hip-bone) on the opposite side to where you feel the baby’s kicks.
The baby’s heart rate in utero is normally about double the mother’s heart rate, that is, 120 – 160 bpm (beats per minute) compared with 60 – 80 bpm of the mother. If your partner finds it difficult to discern the baby’s heart form yours, he should feel your pulse at the same time as listening for the fetal heart beat, and he will be able to tell the difference.
Many women require an ultrasound examination to further check the well-being of their baby.
If your baby is assessed as small for gestational age, that is, its size is measured as less than the 5th percentile, your doctor may recommend a chromosomal analysis. It has been found that up to 19% of fetuses of a size less than the 5th percentile have achromosomal abnormality, especially if there is:
- a structural abnormality such as a cardiac defect
- normal liquor volume
- normal uterine or umbilical artery blood flow measured by a Doppler flow ultrasound
In these circumstances a fetal chromosome analysis may be an option. The ultrasonologist will obtain a fetal blood sample form the umbilical cord of the baby. This is performed under local anaesthetic and ultrasound control by inserting a fine needle through he mother’s abdominal wall into the uterine cavity.