Whether your baby’s movements feel like delicate flutters or karate chops, they're a part of pregnancy you won’t forget. But what do you do if they change — or stop — during the third trimester?
In most cases, everything turns out to be OK. And if you’re worried, you can visit a designated place in the hospital for pregnant women called “OB triage” that will help you figure out what’s going on.
If you notice decreased movement, Dr. Meredith Mitchell, an obstetrician-gynecologist at Novant Health Riverside Women’s Care in Beaufort, South Carolina suggests you ask yourself the following questions:
1. Has my pregnancy been (relatively) smooth sailing so far? Or had complications?
If you have already been dealing with preeclampsia, low amniotic fluid, or intrauterine growth restriction and your baby hasn’t moved in a few hours, stop reading and go to OB triage at your local hospital.
2. Is the change in movements dramatic?
If you’re familiar with how regularly your baby moves and notice a big change, “Make that a ‘now’ problem,” Mitchell said. “If you feel like, ‘This kid is not moving and this doesn’t feel right,’ come right to the OB triage at your local hospital.”
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3. Am I sure there has been a change?
If you’ve had a healthy pregnancy so far, have had a busy day, and know it’s possible you just haven’t paid close attention to baby’s movements that day, it’s fine to get more information before seeking help. Mitchell suggests the following:
- Eat a snack or meal, especially if you haven’t eaten anything recently.
- Lie down on your left side and wait to feel movement. Most likely, you will feel movement soon.
- If you don’t feel movement within 20 to 30 minutes, head into OB triage at your local hospital.
4. Is movement still happening?
Know your baby’s movements
You may have read about “kick counts.” If you are having an average-risk pregnancy, Mitchell doesn’t necessarily recommend this. Here’s what she suggests instead.
Starting in the third trimester, start paying attention to your baby’s movement patterns including the time of day they’re most active, the position you feel them most, and about how long it takes them to do 10 movements. This can help you identify a baseline for what is “normal” for your baby that you can come back to if you ever have concerns.
Baby’s movements start out subtle, then start happening more often and more intensely as you get further along in the pregnancy. By week 32 of pregnancy, they usually level off.
Your baby should keep moving about as often as before — but the drama level might go down. “By 36 weeks, most babies are head down and they’re much less likely to do a big flip,” Mitchell said. "The movements are less big rolls and somersaults, and more kicks, jabs and punches.”
If they’re still taking about as long to do 10 movements as they were in previous weeks, don’t worry. And if you don’t know how long it takes them to do 10 movements, get into the positions that usually get them moving and see if baby moves. If you still notice changes that worry you, contact your OB-GYN or other provider.
Reasons your baby might not be moving in the third trimester
Here are a few non-scary possibilities:
Sleeping
Babies go through sleep cycles on the inside just like they do on the outside. "There may be brief periods of time when babies are literally taking a nap,” Mitchell said. However, if this is the case, they will wake up (seemingly, always around the time you try to head to bed yourself).
Energy depletion
If you haven’t eaten in a while, your baby might not move as much. However, they should start moving again shortly after you eat.
Time of day
Most women say that their babies are most active at night. “Whether we’ve had more time to pay attention to it, or whether that’s because they truly are more active at night is up for debate,” Mitchell said. Regardless, if it’s daytime, it might be normal to feel a little less movement.
Positioning: Yours and baby’s
You can feel more baby movement when you’re lying down, compared to when you are standing up and moving. Your baby’s position can also impact how much movement you feel. In the earlier part of the third trimester, the baby is still changing position frequently. If a baby’s spine is facing your belly inward, you’ll feel less movement than if your baby’s feet and arms are facing out on your belly.
Here are the possible reasons that your OB-GYN team is here to help you with:
If you notice a sudden change in movement in the third trimester:
Low amniotic fluid or placental compromise can make your baby stop moving or reduce their movements. If you notice less movement from your baby and are also leaking amniotic fluid or experiencing cramps, vaginal bleeding, abdominal or back pain, or uterine contractions, head to OB triage at your hospital right away.
If your baby hasn’t moved much throughout the pregnancy, including the third trimester:
Babies who are growth restricted, have congenital anomalies or have neurological, chromosomal, or neuromuscular disorders may not move as much throughout the entirety of the pregnancy. Your OB-GYN and/or maternal fetal medicine team may already be helping you with these concerns, but if not, bring them up.
What happens in OB triage
Generally, the team will ask for a urine sample and take your vital signs, including your blood pressure. You’ll be put on an external fetal monitor to find your baby’s heartbeat. They’ll do a non-stress test (also called a NST) which looks at the pattern of the baby’s heartbeat. You may also receive an ultrasound and additional testing.
“A lot of the times, you put that monitor on that baby and they start moving. You can hear it, you can see it, you can see a reassuring pattern on that NST,” Mitchell said. “The vast majority of the time, everything’s going to look OK, and that’s a happy day for all involved.”
Occasionally, the team will find something that indicates that baby and mom will need additional monitoring. Sometimes, they’ll find out that the baby needs to join the world sooner than expected — maybe much sooner — or that baby has passed away. “But the vast majority of the time, we find ourselves saying, ‘Everything looks great,’” Mitchell said.
Insurance coverage and wait times for OB triage
If you’re concerned about your baby’s movements, don’t let fears about insurance or time be a barrier, Mitchell said.
If you have Medicaid or are privately insured, “Any assessment that we do medically for someone with decreased fetal movement is covered,” Mitchell said. If you haven't met your deductible, it will apply toward your deductible. (But let’s face it: You will meet your deductible soon anyway, and that baby will be totally worth it.)
If you don’t have insurance, but are concerned about your baby’s movements, come in anyway, Mitchell said. There are options to help.
As far as timing goes, OB triage usually moves pretty quickly compared to an emergency room, Mitchell said. However, properly assessing your baby will take some time, so don’t plan on an immediate exit.
How to know if you should go to OB triage or wait until your next appointment
By the third trimester, you’re making frequent visits to your OB-GYN team. If you’re worried, it might be tempting to just wait a few days until your next appointment.
But if your baby’s movements have changed significantly, Mitchell said and especially if questions 1 through 3 earlier in this article apply to you, don’t wait until your next appointment.
“If patients are worried about their babies, they should let us check them out,” Mitchell said. “You’re never bothering us. We like to look at babies, and we like to help you.”
