Decreased fetal movements

It is 22:00 on the antenatal ward. A 30-year-old woman at 36 weeks has come in for the second time this week, frightened: "The baby just isn't moving like it usually does." Last time the CTG was reassuring and she was sent home. Tonight it is the same story — and the examiner wants to know what you do differently on the second presentation. DFM is a real warning sign: individual-participant meta-analysis shows reduced movements are associated with stillbirth, and remaining alert to recurrent presentations matters. This is the topic that asks whether you can hear the warning sign the second time.^[2]

Overview and definition

DFM is defined by what the mother tells you, not by a count. The internationally accepted working definition is the maternal subjective perception of a reduction in the frequency or strength of fetal movements.^[2][4]

The temptation — and the trap — is to reach for a number. Kick counting protocols exist (Cardiff count-to-ten, modified Cardiff, the "ten movements in two hours" rule), but there is no agreed numerical threshold that defines DFM, and routine counting in low-risk women has not been shown to reduce perinatal death.^[8] What matters is the woman's perception of a change from her baby's normal pattern. She is the sensor; you are the responder.

Two distinctions sharpen the definition:

• Frequency versus strength. Women report reduced frequency ("fewer movements"), reduced strength ("weaker"), or both. Both patterns carry risk; the IPD meta-analysis found reduced frequency in the last two weeks carried an adjusted odds ratio of 2.33 for late stillbirth.^[2]
• Change versus absolute number. A woman whose baby normally moves vigorously at 80 times a day and reports 40 is more concerning than one whose baby moves quietly throughout. The change from her normal is the data point, not the absolute count.

References14ShowHide

1. [1]Norman JE, Heazell AEP, Rodriguez A, et al. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial Lancet, 2018.PMID 30269876
2. [2]Thompson JMD, Wilson J, Bradford BF, et al. A better understanding of the association between maternal perception of foetal movements and late stillbirth: findings from an individual participant data meta-analysis BMC Med, 2021.PMID 34775977
3. [3]Lu Y, Palin V, Heazell A Risk factors for adverse pregnancy outcomes in reduced fetal movement: an IPD meta-analysis BJOG, 2025.PMID 40091517
4. [4]Hayes DJL, Dumville JC, Walsh T, et al. Effect of encouraging awareness of reduced fetal movement and subsequent clinical management on pregnancy outcome: a systematic review and meta-analysis Am J Obstet Gynecol MFM, 2023.PMID 36481411
5. [5]Dutton PJ, Warrander LK, Roberts SA, et al. Predictors of poor perinatal outcome following maternal perception of reduced fetal movements: a prospective cohort study PLoS One, 2012.PMID 22808059
6. [6]Skalecki S, Lawford H, Gardener G, et al. My Baby's Movements: an assessment of the effectiveness of the My Baby's Movements phone program in reducing late-gestation stillbirth rates Aust N Z J Obstet Gynaecol, 2023.PMID 36717966
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8. [8]Mangesi L, Hofmeyr GJ, Smith V, Smyth RM Fetal movement counting for assessment of fetal wellbeing Cochrane Database Syst Rev, 2015.PMID 26467769
9. [9]Andrews C, Boyle FM, Pade A, et al. Experiences of antenatal care practices to reduce stillbirth: surveys of women and healthcare professionals pre-post implementation of the Safer Baby Bundle BMC Pregnancy Childbirth, 2024.PMID 39090562
10. [10]Andrews CJ, Ellwood D, Middleton PF, et al. Implementation and evaluation of a quality improvement initiative to reduce late gestation stillbirths in Australia: Safer Baby Bundle study protocol BMC Pregnancy Childbirth, 2020.PMID 33187483
11. [11]Frøen JF, Friberg IK, Lawn JE, et al. Stillbirths: progress and unfinished business Lancet, 2016.PMID 26794077
12. [12]Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030 Lancet, 2016.PMID 26794078
13. [13]Butler E, Hugh O, Gardosi J Evaluating the Growth Assessment Protocol for stillbirth prevention: progress and challenges J Perinat Med, 2022.PMID 35618671
14. [14]Thompson JMD, Heazell AEP, Cronin RS, et al. Does fetal size affect maternal perception of fetal movements? Evidence from an individual participant data meta-analysis Acta Obstet Gynecol Scand, 2023.PMID 37553853