When I was a young midwife it was considered best practice to give all women a fetal kick chart at the 28 week antenatal visit. I have to tell you that I hated doing it. Invariably the woman would come to the next visit and express confusion about what to count, or say that she couldn’t really find a good consistent time to sit down and count, or the chart was not filled in, or the chart was filled in with dots and marks all over the place, rendering it useless. Then in 1989, Grant published their large randomised control trial which suggested that there was minimal benefit in “formal” kick counting (counting to 10) and pretty much across the globe maternity care providers heaved a sigh of relief and threw out the kick charts.
In the past few years there has been something of a resurgence of the use of kick charts but these are not now coming from care provides but from organisations (ie Kicks count, Project alive and kicking, Count the kicks) usually set up by families of stillborn babies whose baby changed behaviour  in the days before their death.  Don’t get me wrong I think these organisations are absolutely right in raising awareness of the importance of fetal movements but they have a problem because either the maternity care provider is like me and knows about the many practical problems with kick charts AND knows about the Grant study findings OR their maternity care provider is younger than me (which is not hard :)) and they haven’t received consistent information in their training about fetal  movements because of the Grant study findings.
To illustrate this, as part of  a recently reported study  I gave a group of 109 trained midwives a brief scenario asking them what they would do if a woman rang them complaining of reduced fetal movement and the responses varied wildly from :

• “don’t worry its normal” to “sit down and have a cold sugary drink and ring me back if you are still concerned” to “Come straight in”

  AND  what to count and for how long also varied from:

• “10 movements  in 30 mins” to “10 movements in 24 hours”!

What care providers seem to know and advise women about fetal movement appears to have become something of a Chinese whisper with 10 movements being a pretty consistent number but all else is wildly inconsistent.  This is In spite of the fact that we have good guidance for care providers such as the Australian and New Zealand stillbirth alliance guidelines and UK  Royal College of Obstetricians and Gynaecologist  ‘green top’ guidelines but these don’t seem to be well known or widely used.
Instead care providers will often reassure a mother that a decrease in fetal movement is normal. Or, more even dangerously advocate that the mother sit down and drink a cold/sugary drink. This is known not to do anything (see above guidelines) but is pretty much routine advice across the globe. I often wonder what would happen to the care provider who reassured a mother of a toddler who rang concerned by his lack of activity and was told “sit down, watch to see how much he is moving, give him a sugary cold drink and ring me back if you are still concerned” !!!!!
So what needs to be done?
I think a two pronged approach is needed. Both pregnant women and their care provider need to know what to do.
What can the mother do?
It is my opinion that women should pay enough attention to fetal movements to know who the baby is, how the baby is and if there is a change. What I mean by that is that all babies arrive into this world with a personality. Some babies are slugs, others are footballers. Some are morning people who will always wake their mum with a happy hello, others are evening people who will be a bit sluggish in the morning but keep their mum up with vigorous kicks at night. Some are social people who will kick if they hear their siblings voice, others will be shy and stop moving the minute a family member or friend puts their hand on the mothers tummy. Getting to know who the baby is will help the mum know how the baby is and enable her to know there has been a change and confidently report that change to advocate for her unborn baby.
The problem with counting to a specific number is that the ailing footballer may well not be recognised and there will be lots of potential anxiety for the mother of the slug. For example if the mother of the footballer normally counts to ten in 5 minutes and one particular morning it takes 10 minutes to count to ten that mum would have every reason to feel concerned BUT if she rang her care provider and told him or her that it took 10 mins for her baby to move 10 times most care providers would discount it. BUT if she said, “my baby has reduced movements  and I need to get it checked out” that mother would most likely at the very least get a CTG (NST).
Is kick counting completely useless then? No, I think it has a place but needs to be used as a means to know who the baby is. So if you are going to count then it needs to be done consistently in the same position, at the same time of day, counting the same thing. I would suggest that you don’t count to ten but instead count the number of movements in a set period of time. Some suggest that you sit down, others that you lie down on your left side. Again it really doesn’t matter, the key thing is that you do the same thing each time. Count everything apart from hiccups. Count consistently so if you always count a flurry of activity which incorporates a kick, punch and wiggle as one movement then always count it as one and don’t suddenly count this as 3!. Every baby is different so if you count what your baby is doing this will help you get to know your baby. Women who count in the morning should be aware that unless the baby changes behaviour at the time that the counting occurs then a deterioration over the course of the day could be missed.
What can the care provider do?
I would like to suggest a very simple, easy to remember and consistent approach………….“I’m concerned that you are concerned”!!!!! followed by an invitation to be seen.