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.

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.

Mama, Can You Feel Me? Movement Counting Directions: 

Beginning at Week 28, it’s time to feel, count and track your baby’s daily movement patterns! Find a comfy position and…

• FEEL your baby’s movements! Every kick, nudge, jab, flip, punch, roll, or twirl (not hiccups) counts.
• COUNT your baby’s movements! Once daily, time how long it takes for 10 movements in 1 hour (max 2 hours).
• TRACK your baby’s movements! Use our FREE app, ME Preg, or our paper tracking chart.

If you notice any changes in your baby’s movement patterns, such as a decrease, increase, or absence in fetal movement, CALL your health care team immediately to make sure that your baby is well. If you are unable to reach or visit your health care team, go to Labor and Delivery or the Emergency Room. Do not wait until the next day or next appointment!

You know your baby best, so always trust your instincts.