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Evidence Library · Staying well

Counting kicks does not do what you were told

Two large trials. Neither found what everyone expected.

Awareness of the baby's movements is universally taught, and formal kick-counting programmes are widely promoted as a way to prevent stillbirth. They have been tested.

The AFFIRM trial covered 409,175 pregnancies across 33 hospitals. Stillbirth was 4.40 per 1,000 births before the movement-awareness package and 4.06 per 1,000 after, an adjusted odds ratio of 0.90 that was not statistically significant. The authors' conclusion: the care package did not reduce the risk of stillbirth, and the benefits of promoting awareness remain unproven.

The Mindfetalness trial randomized 39,865 Swedish women. Its primary outcome, a low Apgar score, was identical at 1.1% in both groups. Women in the intervention group contacted healthcare about reduced movements far more often, 6.6% against 3.8%.

What has not changedA genuine, noticed reduction in your baby's movements is still a reason to be seen the same day, every time, without apology. That advice is unaffected by these trials. What the trials tested was whether formal counting programmes reduce stillbirth across a population, and they did not show that.
Where this comes from:
171. Norman JE, Heazell AEP, Rodriguez A, Weir CJ, Stock SJE, Calderwood CJ, et al. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. Lancet. 2018;392(10158):1629-1638.
172. Akselsson A, Lindgren H, Georgsson S, Pettersson K, Steineck G, Skokic V, et al. Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39,865 women. BJOG. 2020;127(7):829-837.

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