Top 10 Prenatal Care Checklist

The Importance of Counting Kicks

Fetal Hiccups

Pregnancy Institute Protocol

**Important Prenatal Care Information:
A woman should ALWAYS trust her instincts and NEVER doubt herself. If she thinks something is not as it should be and has thoughts or a realization that her baby's behavior in utero has changed from it's typical patterns, she should seek medical care immediately and not delay. She should request to receive a Biophysical profile for her baby. This is a noninvasive stress test used medically to determine baby's wellbeing. The Biophysical combines the scores of both an ultrasound observation of baby movement, and an NST which is a Non Stress Test used to monitor baby's heart rate and mother's contractions. Contractions can exacerbate cord compression issues if one is present and may cause fetal stress. Some women may not realize they are contracting as they only feel mild low back pressure, leg cramping, and/ or tightening of the stomach area and due to the mildness may not realize they are having active contractions. Contractions can also lead to premature labor and cause a premature birth. If a woman's concerns for her baby's welfare are dismissed or put off to address at a later date or appointment she should seek another opinion as soon as possible. Signs of fetal stress can include: decreased movement, uncharacteristically hyperactive movement, quivering or shaking from the baby in utero, and ongoing/regular episodes of hiccups.

"Protect Your Pregnancy Checklist: A Moms Proactive Prenatal Care Top 10 Checklist"

The following top 10 is provided for use as a checklist to help women identify areas of concern with their pregnancy, which could ultimately lead to a possible stillbirth. This list is not intended for self-treatment use or diagnosis. It is to be utilized as a tool to help women know the specific areas to observe and then to use their findings in conjunction with their medical providers care to help ensure the well being of their baby.

1) Notify your Physician of bleeding, fluid loss, or fever (>101)

2) Be aware of intrauterine movements of the baby; frequent hiccups, hyperactivity, and or no activity - all can be serious and need evaluation. It is important to document and chart baby's daily kick counts. This helps to provide a record of the increase or decrease of the various movements.

3) Learn your baby's sleep/wake patterns and report any change. Usually their patterns are obvious by 28 weeks. Get to know the "personality" of your baby!

4) Go to Labor and Delivery if your baby does not move at bedtime (9pm-10pm and later especially) and request monitoring. Research has shown that the majority of stillborn babies die at night while a mother is sleeping and she is at a resting heart rate, which means there is less blood flow to the baby. If there are any cord compression issues, then they become most vulnerable during the night while the mother sleeps.

5) Be aware of uterine tightness, back- pressure, or pelvic pressure. Go to Labor and Delivery if persistent.

6) Be aware of your blood pressure and know if it is below 100/60 or above 140/80. Low blood pressure can be just as serious as high blood pressure!

7) Inform your physician of unusual fetal symptoms such as "quivering", "very strong kicking" or "localized pain".

8) Be aware of your fluid intake especially in the summer, and keep your urine clear (diluted) not yellow (concentrated).

9) Obvious uterine contractions less than 10 minutes apart for one hour, you need to be monitored. Continual Braxton-Hicks, or false labor, can be hard on the baby and can cause fetal stress.

10) Obvious labor, loss of your mucous plug, and frequent contractions (< 3min apart) need to be monitored at the hospital.

Copyright Jason H. Collins, MD, OB/GYN President of the Pregnancy Institute and Candy McVicar, Founder and Executive Director of Missing GRACE Foundation.

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The Importance of Counting Kicks

Kicking is how your baby tells you it's "OK". Uncomfortable at times for you but reassuring. It means your baby is active and growing.

In a survey conducted among stillbirth mothers we discovered 67% weren't ever told by their OB about the importance of monitoring kick counts. If you've not been told, or if it's not been properly explained, raise the question at your next checkup. It's your body and your baby so don't ever hesitate to voice your concerns. Counting kicks is a simple test to determine your baby's health that costs you nothing.

You can track your baby's activity by using a written log of its kick counts. If you detect a change, either a decrease in movement, or an unusual increase in your baby's level of activity, it may mean your baby is in distress. Should either occur, call your doctor at once. If you can't reach your doctor, head to the hospital to have your baby checked. A "false alarm", if it is one, is better than having a stillborn baby.

Before starting your activity log be aware there's no single "standard" for the number of kicks to expect, but on average you should detect at least 5 definite movements per hour. Babies sleep, and there may be times in the day when you feel little or no movement. That's why it's important to be aware of any changes in your baby's daily pattern. In time you'll get used to your baby's particular patterns.

Measuring Kick Counts:

Every day at the same time, preferably just after you've eaten, take time to be aware of your baby's movements. You needn't stop what you are doing, just be aware and count each movement as you detect it. If you haven't felt at least 4 or 5 movements by the end of an hour, you'll want to redo the count, this time lying down on your side and focusing on just counting movements. We call them "kicks" but punches, rolls and swooshes count, if it is a definite movement. You will hear that babies slow down as they get closer to full term. Whether that's true is debatable, but if your baby slows down, the change should not be sudden. A sudden change is trouble.

If, after redoing the kick count, you don't detect 10 movements within 2 hours its time to call your doctor. From a practical standpoint it's always easier to be seen and have your baby checked during office hours, but don't let the time of day stop you. If you detect a decline in movement, call, no matter what the time. We've all been taught to be considerate of others but this is a different situation. Doctors, like firemen, have chosen a 24-hour occupation. You've chosen to become a mother. As a mother your job is to protect your baby. Pick up the phone and call at once. The next morning could be too late.

Used with author's permission.
Copyright Richard K Olsen, President of the National Stillbirth Society

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Fetal Hiccups

Between 18-26 weeks fetal hiccups start. They are the result of the fetal lungs developing.

Between 28-30 weeks fetal hiccups start to slow down and typically should not occur everyday.

Between 30-40 weeks fetal hiccups should occur occasionally or seldom.

Fetal hiccups that occur more than 3 or 4 times a day with more than 10-minute episodes warrants further immediate concern, and especially after 28 weeks. What can occur is cord compression resulting in the baby hiccuping. Dr Jason Collins, MD of the Pregnancy Institute recommends getting an ultrasound to check for cord entanglement or cord compression. What can tragically happen down the road is the cord being compressed can cause the baby to experience distress possibly leading to stillbirth. Excessive hiccups should be cause for the baby to be checked as a precautionary method.

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