Posted October 24, 2018 in Articles
Author: Brie Zeltner, The Plain Dealer
CLEVELAND, Ohio-- In an effort to prevent stillbirths, Ohio is encouraging pregnant women to track fetal movement in the third trimester of pregnancy by counting and tracking kicks and other in utero activity using a free app.
With $50,000 and materials from Iowa-Based Count the Kicks, a non-profit started by mothers who lost babies to stillbirth, the Ohio Department of Health has started sending letters and emails about the program to more than 3,000 healthcare providers. (You can read the provider letter in the window below). It also will offer web-based and in-person training to up to 1,350 maternal-child healthcare workers across the state.
Ohio is the sixth state to provide free access to Count The Kicks promotional materials, joining Iowa, Illinois, Kansas, Missouri and Nebraska. The "Count the Kicks" program was created by five Iowa women who suffered stillbirth and infant loss. The program encourages women in the third trimester of pregnancy to measure how long it takes them to feel 10 kicks and to call a provider if there is a significant change. The program offers a free app, which can be downloaded to smartphones, to help mothers keep track of their results.
In Cuyahoga County, infant mortality initiative First Year Cleveland expressed its support for the program in August, introducing the free app at a meeting on effective strategies to reduce infant death.
Stillbirths, which happen when a baby dies in the womb after 20 weeks of pregnancy, are not counted in infant mortality statistics, which only record deaths of live-born babies in the first year of life. Still, First Year Cleveland hopes that increasing education about stillbirth will save lives.
"Count the Kicks is a safe and simple way to help monitor the well-being of a baby," said FYC Executive Director Bernadette Kerrigan. "Using their app every day during the third trimester of a pregnancy to track a baby's movement patterns helps to monitor fetal well-being and is therefore another tool that helps to ensure all our babies celebrate their first birthday."
Stillbirth is surprisingly common: About 24,000 pregnancies end in stillbirth each year in the United States, or about 1 percent of all pregnancies, according to the March of Dimes. That's about as many deaths as babies who are lost to infant mortality. It's also 10 times as many deaths as the number that occur from Sudden Infant Death Syndrome, or SIDS, according to the Centers for Disease Control and Prevention.
Kari Davis, the Ohio ambassador for Count The Kicks, lost her daughter Harper at 39 weeks of pregnancy in 2013 to stillbirth. She said she knew little about stillbirth at the time and assumed she was "safe" after her pregnancy progressed past the first trimester, when most miscarriages occur.
"Count The Kicks teaches moms... to speak up if they notice a change in what's normal for their babies," she said. "I know for me, it was my first pregnancy with my daughter and I was afraid to speak up.
"It's devastating," she said. "You go through a birth and you go through a death all at once."
There is evidence that stillbirth is often preceded by a period of reduced fetal movement such as kicks, rolls or jabs. Yet it's unclear if counting kicks, or otherwise tracking fetal movement, reduces the rate of stillbirth.
In Iowa, where Count The Kicks was first launched statewide in 2009, stillbirths have since decreased by 26 percent in the state, from 5.74 per 1,000 births in 2008 to 4.3 in 2015.
It's impossible to tell if the reduction is due to use of the kick-counting method or other factors, though.
It's unknown what causes all stillbirths, though common causes include infections, birth defects and pregnancy complications, such as preeclampsia, which is high blood pressure during pregnancy. Most stillbirths occur before labor and delivery begins.
Studies of the use of education about fetal movement and movement tracking have shown mixed results.
A 2009 quality improvement project in Norway found that stillbirth rates fell about 2 percent after participating hospitals provided written information to pregnant women about fetal movements and changes or reductions in movement as well as formalized guidelines for doctors on how to respond to reduced fetal movements. Healthcare providers at participating hospitals invited pregnant women to track fetal movements, but it was not a requirement. Stillbirth fell significantly, by nearly half, among women who experienced reduced fetal movements.
A subsequent similar program involving 37 hospitals in the United Kingdom and Ireland showed no significant effect on stillbirth from such an intervention, however. And during the study there was an increase in both the risk of birth by Cesarean section and in the risk of induced labor, or the use of medications to artificially begin contractions. Both are associated with potential risks to pregnant women and their babies.
A 2015 Cochrane review examined five studies comprising more than 71,000 women, and found that rates of stillbirth were similar between those who employed kick counts and those who did not.
"The data is extremely conflicting on whether it's beneficial or not," said Dr. Ellie Ragsdale, director of fetal intervention at University Hospitals Cleveland Medical Center. "I think the thing to take away from it is that it's not harmful to the mom. It's a very inexpensive, non-invasive way to give a snapshot into fetal well-being in the uterus."
One problem with kick counting, Ragsdale said, is that it can sometimes cause undue anxiety. Most women who detect a period of decreased fetal movement and undergo follow-up tests in a doctor's office find there is no problem.
Ragsdale tells her patients to pay attention to the movement of the baby but does not prescribe a certain number of kicks or movements to expect because all women and their pregnancies are different. The only evidence-based way to reduce stillbirth today is with good, regular prenatal care visits, Ragsdale said.
Count The Kicks doesn't provide a "normal" number of kicks over time, either, but instead instructs women to record the amount of time it takes, on a daily basis and at the same time of day, to reach 10 kicks or other movements. Women are encouraged to contact their doctors if the time changes significantly.
Ragsdale agrees that women should feel empowered to speak up if they think there is something amiss during pregnancy: "We're always happy to see and assess a mom when she feels like the baby is not moving as much as she's used to."
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