The American College of Obstetrics and Gynecology offers a step-by-step guide for mothers to start and maintaining a kick chart. Monitoring should begin in the 28th week of pregnancy or the 26th week for high-risk mothers or mothers who are pregnant with multiple children:
• Count the kicks every day, preferably at the same time of day.
• Pick a time based on when your baby is usually active, such as after a meal or snack.
• Make sure your baby is awake before counting by pushing on your stomach or having a cold drink first.
• Sit with your feet up or lie on your side, count each movement -- kicks, rolls or pokes -- as one "kick" and stop when you reach 10.
• The time it takes to reach this benchmark varies but could be between 30 minutes and two hours.
n Log your recorded time on a chart or use the one automatically generated through the Count the Kicks app.
• If your baby doesn't reach 10 kicks in two hours, try to wake him or her up and start a new session.
• Notify your health provider immediately if you notice significant changes in your baby's movements.
Source: Count the Kicks
The Count the Kicks smartphone app is available for free on Apple's App Store or Google's Google Play marketplaces. Mothers touch a large onscreen icon to register each of their baby's kicks. They also can set an automatic reminder to ensure each session occurs at the same time of day. Each session is recorded and stored in a history that can be reviewed or shown to a practitioner to document changes in activity level.
Two years ago, Meghan Hughes Petty suffered through an expectant mother's worst nightmare.
The day before she was scheduled for a regular checkup with her obstetrician, she felt like something wasn't right. Her son, Miles, wasn't moving as much. She could feel him shifting in the womb when she walked, but otherwise, he seemed uncharacteristically lethargic.
Her Google queries were mildly reassuring. She was late-term and many online commenters quoted a common adage that babies naturally become less active toward the end of a pregnancy.
Petty's husband, Jamie, suggested a wait-and-see approach. The checkup, which corresponded with Miles' due date, was only a few hours away, and her doctor would have an answer, he said.
So they waited, but the news they received the next day was devastating.
"The doctor listened [with a stethoscope] and said, 'Let me get the Doppler,'" Petty recalls. "She said, 'I'm not hearing anything.' A mom knows what a heartbeat sounds like. You go there enough and hear it enough when you're pregnant that, when it's absent, it's pretty clear what happened."
Miles had died two days earlier.
The National Stillbirth Society estimates that 1 in 160 pregnancies ends in a stillbirth, compared to about 1 in 2,000 babies nationwide who die due to sudden infant death syndrome. As is commonly the case in stillbirths, Miles had entangled himself in the umbilical cord while shifting about within the womb.
In the months following her son's death, Petty experienced insomnia fueled by a constant quest to eliminate the question marks surrounding her son's death.
"You don't sleep after you lose a child," she says.
She spent her evenings combing the Internet for some explanation on how her family's tragedy could have been avoided. An Iowa-based nonprofit called Count the Kicks provided the answer.
Count the Kicks was founded in 2003 by five grieving mothers -- Kerri Biondi-Morlan, Jan Caruthers, Kate Safris, Tiffan Yamen and Janet Petersen -- who had suffered stillbirth or infant deaths. Originally just a support group, the organization's mission changed when its founders discovered a Norwegian study showing a reduction in that country's rate of stillborn children after educating expectant mothers on the importance of keeping a daily chart of their baby's movements.
The American College of Obstetrics encourages mothers in the 28th week of pregnancy to keep a "kick chart" by timing the frequency of movement in the womb. A healthy baby should have 10 movements, or "kicks," during a two-hour period. Significant increases or decreases in activity that persist between timing sessions should immediately be brought to the attention of a physician, according to the organization.
On April 10, Count the Kicks released a free smartphone app to the Android Google Play store and Apple's App Store. The app offers automatic counting reminders and records every session to make kick counting even more convenient. But Petty says digital outreach isn't good enough. Mothers and care providers also need to see boots on the ground.
"I think you need both," says Petty, who last month was named Tennessee's Count the Kicks ambassador. "The handheld tool is definitely the best way to get people to use it, but there's nothing more powerful your doctor asking you if you're using it. If they're asking you how your baby is moving and you can show them, that's really powerful."
Despite the American medical community' familiarity with the importance of kick counting, expectant moms aren't always encouraged to monitor their baby's movement.
But Count the Kicks' crusade is making inroads. Its founders' efforts created a nationwide parent-to-parent grieving network for families of stillborn children and helped pass the Iowa Stillbirth Surveillance Project, which compiles data on stillbirth occurrence rates, research into what causes them and how to prevent them.
On Sunday, Count the Kicks will begin a national campaign coinciding with Mother's Day to spread awareness of kick counting beyond Iowa's borders.
As the organization's spokesperson in Tennessee, Petty has been spreading awareness of kick counting across the Volunteer State in preparation for the national push. She started in Hamilton County, where she initiated an early partnership with the Chattanooga-Hamilton County Health Department through Lisa Vincent, the department's infant mortality review coordinator.
Vincent says the Health Department receives reports of three to five stillbirths or fetal deaths from local hospitals every month. The emotional trauma left in the wake of a stillbirth causes some women to withdraw, and Vincent says she's inspired by Petty's willingness to face her grief and use it as a springboard for educating the public.
"Meghan is a very courageous person to be willing to openly share her story ... in order to help prevent other mothers from going through the loss she experienced," she says. "We are proud to partner with her to get the Count the Kicks message out to the public.
"We share the same goal: healthy pregnancies and healthy babies."
She and Petty evaluated the cost of putting Count the Kicks materials in the hands of healthcare providers throughout the county for a year. By soliciting donations from her friends and family, Petty raised the $1,200 necessary to print information pamphlets, posters and kick-count trackers and placed them with local obstetric providers and labor and delivery units throughout the county.
"I started here, in Hamilton County, obviously, for convenience and because it was important to me that it start here, since it's where my loss occurred," Petty says.
In the future, she says she hopes to encourage local hospitals to place Count the Kicks materials in pre-admission packets. She also has reached out to the Tennessee Department of Health and to representatives of the Fetal Infant Mortality Review in each of the state's larger cities.
Like many expectant mothers, Petty says, her doctor never probed deeper during checkups than asking, "Is the baby moving?" If the answer was "yes," regardless of the frequency of those movements, that was the end of the discussion, she says.
Had she been encouraged to pay more attention, Petty says, it might have saved Miles' life.
"I didn't know how much was too much or wasn't right. I didn't have any baseline," Petty says. "If we, as a community, decided that was not a sufficient question ... then moms would have a deeper discussion about it."
Petty says she easily could feel jealous or envious at other mothers avoiding her grief, but instead, she's encouraged by them.
"It's wonderful. It makes your whole day, sometimes your whole week, just to know that someone heard it," she says. "It doesn't take away any of my grief, but it enables me to feel like I'm doing something so someone else won't have to experience what I did."
And she's planning to take her own advice. On Sept. 22, two years and two days after Miles' due date, Petty is scheduled to give birth to a daughter, Misa Rene Petty.
She says she can already feel her moving.
Contact Casey Phillips at firstname.lastname@example.org or 423-757-6205. Follow him on Twitter at @PhillipsCTFP.