Health

Counting fetal kicks leads to fewer stillbirths

Successful Iowa campaign now spreading to other states

Emily Eekhoff talks to a TV station after her daughter, Ruby, was born. She said counting the fetal kicks led to a Caesarean section that saved Ruby’s life. Husband Jeremy holds their son, Liam. Today, a nonprofit group, Count the Kicks, promotes the method. (Photo courtesy Count the Kicks)
Emily Eekhoff talks to a TV station after her daughter, Ruby, was born. She said counting the fetal kicks led to a Caesarean section that saved Ruby’s life. Husband Jeremy holds their son, Liam. Today, a nonprofit group, Count the Kicks, promotes the method. (Photo courtesy Count the Kicks)

Emily Eekhoff was in the 33rd week of her second pregnancy when she made an unsettling discovery.

As she had with her first baby, Liam, Eekhoff was keeping track of the number of kicks her unborn baby delivered during the third trimester.

This baby had been consistent, kicking about 10 times in a 10-minute period. But that day, in 2017, “I noticed she was not moving like she normally did,” said Eekhoff of Ankeny. “That day, it was like three or four kicks in a couple hours.”

She alerted her doctor’s office and was told to immediately go to the hospital, where the staff detected a heartbeat, but couldn’t coax more movement. When an ultrasound revealed the baby was in distress, Eekhoff was quickly dispatched to an operating room for an emergency Caesarean section.

Out came baby Ruby, with her umbilical cord wrapped three times tightly around her neck.

“The on-call doctor who examined the ultrasound said that if they had waited even a day longer, she probably would have died,” Eekhoff recalled.

Ruby, now 15 months old and scooting around the house, was the beneficiary of the mothers-initiated campaign “Count the Kicks.” Started in 2008 in Iowa, it teaches pregnant women to track the movements of their unborn babies in the last trimester of pregnancy so they can quickly detect in utero distress. The campaign has corresponded to a nearly 28 percent drop in stillbirths in Iowa — and it is starting to spread.

Campaigns based on the Iowa model have been launched in Nebraska, Illinois, Kansas and Missouri, the last two this year and both with state financing. Emily Price, executive director of Count the Kicks, the nonprofit group behind the campaign, said there are plans for launches by the end of the year in Alabama and Ohio.

Many doctors have long urged pregnant women to pay attention to fetal kicks. But too many physicians still rely on what they glean from routine office visits, even though waiting for the next scheduled appointment may be too late, said Jason Collins, a Louisiana obstetrician.

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In 2003, Tiffan Yamen, a marketing and sales executive who lived in Waukee, went into labor 10 days before her scheduled C-section.

It was her second delivery, and she felt comfortable waiting until the end of her workday before heading to the hospital, where she was monitored. Several times, nurses said, “You have a very sleepy baby.”

She was given medication to slow down her labor in the hopes of delaying delivery until closer to her due date and sent home. The next day, she woke up not feeling well and noticed her baby was not moving. But because the previous day’s tests hadn’t alarmed caregivers, she wasn’t alarmed.

By coincidence, she had an appointment with her obstetrician that day. When she showed up with her 2-year-old, Isabela, he staff made a routine check for the baby’s heartbeat. Then Yamen remembers her doctor saying, “We need to get an ultrasound right away.”

Yamen said she was more focused on Isabela than the doctor’s frantic probing with the ultrasound. That is, until he abruptly pronounced the words she would not forget. “Tiffan,” he said, “I’m sorry. It’s too late.”

The next day, Yamen delivered the baby, posthumously named Madeline, stillborn.

The baby’s umbilical cord had formed a knot around her neck, a frequent cause of stillbirths.

Because of how distraught Yamen was in the aftermath, she said, her pastor put her in touch with another woman in his congregation who had just had a stillbirth. Together, they connected with three other women, two of whom had also had stillbirths. The third woman had lost her baby within days of delivery.

The five women started meeting regularly at a coffee shop. As they learned how little was said about stillbirths outside medical circles, they began sharing ideas about how to help others. They settled on the idea of asking the state to create a stillbirth registry review panel, which would record stillbirths and investigate them.

One member of their group was state Rep. Janet Peterson, a Democrat who is now a state senator. She introduced a bill to create the registry. It passed in 2004.

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The women then headed to Washington to seek funding for the registry, enlisting the help of then-U. S. Sen. Tom Harkin, D-Iowa, who secured startup funding from the Centers for Disease Control and Prevention.

The mothers’ group wasn’t done. Attending a 2009 summit in Washington on stillbirths, some wandered from sessions geared toward mothers to another area where childbirth researchers were presenting.

There, Yamen heard about a study from Norway that had demonstrated the rate of stillbirths among mothers who had received training in tracking fetal movement fell by half.

The mothers’ group created Count the Kicks and planned to launch the campaign in Iowa.

With a $15,000 March of Dimes donation, the group created brochures and contacted every provider of maternal health care in the state.

The results have been impressive. Within five years, the stillbirth rate in Iowa dropped from 6.13 to 4.36 per thousand births. While other factors might explain the drop, no one has identified any changes other than the campaign to explain it.

Stateline is an initiative of the Pew Charitable Trusts.

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