Concern about Fetal Movements
In a first pregnancy, fetal movements are rarely felt before 19 weeks and it may be closer to 24 weeks before a woman is certain of feeling fetal movements. For women who have had a previous pregnancy, the earliest movements may be felt is around 16 weeks. Initially fetal movements are very subtle like little taps and bubbles and then become more like kicks as baby becomes bigger. Early fetal movements can be intermittent depending on the position of baby’s legs and the placenta but after 24 weeks will become more consistent.
By third trimester, feeling good fetal movements can be reassuring of fetal wellbeing. It used to be accepted that fetal movements reduced close to term. In recent years it is thought that any decrease in fetal movements is concerning, as it may reflect a problem with placental function which may affect baby’s wellbeing.
It is very important to pay extra attention to fetal movements after 28 weeks and the habit should be developed of checking on baby’s movements throughout the day. If there is any change in the pattern of movements, or movements are fewer in number or less strong, then presentation to Pregnancy Assessment Centre for monitoring is required.
Prior to 23 weeks the fetal heart will be listened to. After 23 weeks a CTG (cardiotocograph) will be performed where the fetal heart rate is continuously recorded via a doppler strapped to the maternal abdomen while a pressure detector records any uterine activity. Certain patterns on the CTG are reassuring of fetal wellbeing and the monitor can also detect fetal movements. A blood test will be taken to look for fetal cells to exclude leakage of blood from the fetus to the maternal circulation, as this may result in fetal anaemia and decreased movements. If there has not been a recent ultrasound scan, one will be organised to assess fetal growth and wellbeing. The scan will measure blood flow through the placenta and fluid around baby as further reassurance of normal placental function.
Rupture of Membranes
In around ten percent of pregnancies the waters will break prior to contractions starting. This means that the membranes that form the sac around baby rupture or break and fluid from around baby will leak out. Rupture of membranes can occur pre-term or around term. If there are gushes or trickles of fluid like leaking urine, but it is not urine, then go to the hospital to be assessed. If there is a one-off leak of fluid, this could be due to watery mucus or discharge but if it is ongoing, it could be amniotic fluid. If there is uncertainty about the amount of fluid involved, then wearing a pad may help. If the pad becomes damp then proceed to the hospital to be checked for ruptured membranes.
Close to term it may be possible to have a show with mucus and a small amount of blood from the cervix. This could happen hours, days or weeks before labour and is associated with ripening (shortening and opening up) of the cervix. If there is more mucus than blood, then put on a pad and observe any other loss. If there is bleeding like a period, then go to the hospital for monitoring.
If a woman with a Rhesus negative blood group has any vaginal bleeding (or abdominal pain or minor trauma such as a motor vehicle accident or fall on to the abdomen), then presentation to Pregnancy Assessment Centre is essential, as an injection of ANTI D may be required. Preventative doses of ANTI D are given during pregnancy around 28 weeks and 34 weeks gestation to Rhesus negative women and this reduces sensitisation to Rhesus positive antigens on small numbers of fetal red cells that may leak into the maternal circulation. If there are symptoms of vaginal bleeding or pain, this may involve larger amounts of fetal cells and a blood test for fetal cells in maternal blood and an additional dose of ANTI D may be required.
Pain and Contractions
If there is severe or constant abdominal pain lasting more than a few minutes then presentation to the hospital to be assessed is urgent. There are rare conditions such as abruption, or bleeding behind the placenta, which can threaten baby’s wellbeing.
If there is no vaginal bleeding or fluid loss and no reduction in movements and there is pain that is coming and going, then it is possible to monitor the pains to see whether the contractions continue and become more regular and stronger. It may be possible to have a short run of contractions that fizzle out.
If contractions continue, it may be difficult to decide when to go to the hospital. If any contraction is so intense, that it is not possible to talk normally through it and deep breathing is needed, then it would be time to go to the hospital, even if contractions are not regular and not every contraction is that intense. If one contraction can be that intense then it is possible that all could become that intense.
For some women their contractions do not bother them until they are very close together. If contractions have been occurring every five minutes or closer for several hours, then it is worthwhile to go to the hospital to be assessed.
Travelling to Hospital
If there are symptoms and peak hour traffic is approaching, then a decision should be made on whether to move to the hospital before or after the peak hour traffic. It is best to avoid being stuck in the car in labour for a long time during peak hour. If hot water has been helping with discomfort and the hot water runs out at home, moving to the hospital will allow use of the hot water there.
One downside of labouring at home is then moving to the hospital when labour has established. It can be very uncomfortable travelling in a car and a lot of women cannot sit comfortably. When travelling to hospital in labour, there should be something on the seat underneath in case there is bleeding or the waters break and something to vomit into as vomiting is very common during labour.