Decreased Fetal Movements: What Every Mother Should Know

In short: A mother begins to feel the baby move between weeks 18 and 20 in a first pregnancy, and as early as 16 weeks in later ones. If you feel fewer movements, lie on your left side in a quiet place for two hours; you should feel at least ten movements. If not, see the doctor for a heart trace of the baby (after week 28) or an ultrasound. Most women with a single episode have no complications, but repeated episodes need closer follow-up.

Feeling your baby move is one of the most reassuring parts of pregnancy — and one of the most important indicators of your baby’s wellbeing in the womb.

Regular, healthy fetal movements reflect a good, healthy interaction between your baby’s nervous system and muscles. Any noticeable change in how often or how strongly your baby moves may be a sign that something needs to be checked, so it’s always worth paying attention.

When does a mother begin to feel fetal movement?

Most mothers start noticing movements between week 18 and week 20 of pregnancy. If you’ve been pregnant before, you may feel the first flutters a little earlier, from around week 16.

Movements tend to increase gradually until about the 32nd week of pregnancy, after which they stabilize.

What can make it harder to feel your baby move?

• Your position — movements are usually easier to feel while lying down, and less noticeable while standing.
• Time of day — many mothers feel movements more in the evening, partly because daytime activities can make it harder to focus on counting them.
• Placental position — an anterior placenta (at the front of the womb) can make movements feel less noticeable, especially before 28 weeks.
• Use of certain substances, such as alcohol or opiates.
• Smoking — carbon monoxide from cigarette smoke reduces the oxygen reaching your baby and can reduce fetal movements.
• Steroid injections given for fetal lung maturity, which can temporarily reduce movements for about 48 hours.
• Congenital abnormalities in the baby.
• Neuromuscular conditions affecting the baby.

What is the best way to keep track of your baby’s movements?

Your own awareness and observation of your baby’s movements is the most reliable and important method.

Are there other ways doctors can check fetal movements?

Yes — for example, an ultrasound examination can be used to count the movements visible during the scan.

How should you count fetal movements properly?

There is no set number of movements that is ‘normal’ for every baby. What matters is your own baby’s usual pattern. If you think the movements have slowed down, become weaker or changed, lie on your left side and concentrate for a short while; if you are still not sure, contact your doctor or go to the hospital straight away — do not wait until the next day, and do not use a home heartbeat monitor to reassure yourself.

What happens if you notice fewer movements than usual?

• Your doctor will review your medical history to check for risk factors that could affect your baby’s health, such as diabetes, high blood pressure, smoking, or a previous pregnancy loss.
• Your doctor will talk with you carefully to confirm whether the movements are truly reduced — many mothers who describe a change turn out to have perfectly normal movement patterns once discussed in detail.
• Your doctor will ask whether this is the first time you’ve noticed reduced movement or whether it has happened before, since repeated episodes can sometimes be an early warning sign that needs closer attention.
• A urine test may be done to check for protein, since high blood pressure in pregnancy (preeclampsia) can sometimes be linked to reduced movements.

What happens next if the movements are confirmed to be reduced?

If you are more than 28 weeks pregnant, your doctor will usually recommend a cardiotocography (CTG) to monitor your baby’s heartbeat.

When is an ultrasound used to assess reduced fetal movements?

Usually in one of these situations:

• If your medical history includes risk factors linked to a higher chance of complications.
• If the CTG results are normal, but you still feel your baby is moving less than usual.

What does the ultrasound check for?

• The circumference of your baby’s abdomen
• An estimate of your baby’s weight
• The amount of amniotic fluid around your baby
• Blood flow through the umbilical cord
• A detailed anomaly scan to check for any congenital abnormalities

How are reduced movements assessed before 24 weeks or between 24–28 weeks?

• Your doctor will listen to your baby’s heartbeat directly (external auscultation) to confirm it is present and steady.
• Your medical history will be reviewed for any risk factors that may affect your baby’s growth or wellbeing.

It’s reassuring to know that around 70 percent of mothers who experience a single episode of reduced fetal movements go on to have no further complications. If you experience more than one episode, your doctor will want to look more closely, as repeated episodes deserve careful, thorough evaluation.

If you’re ever concerned about your baby’s movements, don’t hesitate to reach out to your obstetrician for reassurance and guidance — early evaluation is always the safest approach.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist