Dear Doctor,

I’m soon ending my second trimester of pregnancy and so far everything has been going well. However, I haven’t yet felt my baby kick.  I am due for a scan soon but I’m worried. Is this normal?

Kate

Dear Kate,

It seems you are pregnant for the first time. The baby’s body is formed during first three months of pregnancy. From 12 weeks onwards, the body grows and systems develop and mature gradually. It is this time that the baby starts to move in the womb.  A multiparous woman (who has had more than one child) is able to pick up the movement faster due to experiences compared to one who is having her first pregnancy. For a new soon-to-be mother, these movements may be confused with gas in the stomach and other sensations.  These are felt well when a woman is relaxed, that is, sitting comfortably or lying down on her side.

Usually around 12 weeks, a baby starts to move but the movements may be too small to be noticed. At 16 weeks or so, a woman may start to feel tiny butterfly like flutter sensations. This could be due to the baby moving or could be due to gas. As the baby grows further, with advancing pregnancy, these movements become more distinct and clear. The clarity and frequency grows. By 24 weeks, a pregnant woman can clearly feel kicks and jabs, which can become more crowded with time.  In 32 weeks or later, there may be 20 to 30 kicks within an hour or so.  A kick may be so intense so as to take the breath away.  Usually these kicks are intermittent coinciding with times of alertness and sleeping of the baby within the uterus.  Movements are at a maximum after a meal taken by the mother when blood glucose levels peak. They are also more from after midnight till early morning, when due to the body’s biological clock, the blood glucose levels are high. However, these are not hard and fixed timings for foetal movements. The baby may be active immediately with the beginning of second trimester. Some babies are naturally sluggish, starting movements a bit late and moving less frequently.  By experience an observant mother can know the time and frequency of the foetal movements. There is no fixed time or technique to monitor foetal movements. However, once they have started, they should be consistent. If there is a sudden change in movements of a baby, one should check with the doctor. If the movements become sluggish suddenly or there has not been even 10 movements within a two hour period, it is alarming.

With an ultrasound examination, all details regarding the state of the uterus, placenta, amniotic fluid, growth and movements of the baby will be known clearly.

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.