Does Kick Counting Work? What the Trials Found
If your baby's movements reduce or change, contact your care team now, whether or not you count kicks. No randomized trial we read has shown that kick counting works to prevent stillbirth, and none has shown that it does not, because the trials of counting were too small or too weak to settle it. The NHS says you do not need to count, and ACOG says no routine measure, formal kick counts included, has shown benefit for preventing stillbirth.
Written by the Bumpi Kicks team at Speed AI Labs LLP. Last updated . General information, not reviewed by a clinician, and not medical advice. How we write and check these pages.
If your baby's movements change, contact your care team now
Call your midwife, doctor or maternity unit immediately if your baby moves less than usual, you cannot feel movement, or the usual pattern changes. The NHS says not to wait until the next day. A count, a chart or an app does not replace that call, and this page does not tell you whether to count.
If you cannot reach them, or you are worried about your own health, call your local emergency number.
How to read these studies
Most large trials tested a package, not counting
AFFIRM tested a care package that raised women's awareness of the need to report reduced movement promptly and standardized how clinicians managed it. My Baby's Movements tested a multifaceted awareness package. Neither tested counting on its own, so neither can say that counting fails.
The largest test of counting itself that we read is from 1989
About 68,000 women were allocated by cluster to a policy of routine counting or to standard care, and death rates were similar. The authors said at best about 1,250 women would need to count to prevent one unexplained late death, that the study does not rule out a benefit, and that an adverse effect was just as likely.
Interventions rose in one trial, and a review found no clear rise
In AFFIRM, inductions of labor (40.7% against 35.8%) and caesarean births (28.3% against 25.5%) were more common in the intervention period, and ACOG notes an increase in interventions such as inductions. The authors also reported fewer small babies delivered at 40 weeks or later (1.5% against 2.0%), a surrogate for stillbirth, and said that potential benefit has to be set against the higher rates of intervention. A 2023 meta-analysis found awareness interventions may not be associated with more inductions or caesareans; we read its abstract only and could not check whether AFFIRM was in that analysis.
One before-and-after study found fewer stillbirths
A 2009 study in 14 Norwegian hospitals found stillbirths fell by about a third, from about 3 to 2 per 1000 births after a 2010 correction, after women received written information, including an invitation to monitor movements, and hospitals adopted a management guideline. It was not randomized, and counting was one part of the package.
A change in movement is still the signal
These studies test programs across whole populations. They do not test what to do about a change in your own baby's usual movements. The NHS and the RCOG say to contact your care team immediately about reduced or changed movement.
The evidence is dated or still moving
The Cochrane review is from 2015, and a 2021 Cochrane protocol calls it out of date. The RCOG's 2026 guideline reviews seven studies and finds insufficient evidence to recommend formal counting using specified numbers. The newest trial in the table is from 2022 and the newest review from 2023.
The main studies
| Study | What was tested | What it found | Limits |
|---|---|---|---|
| Grant and colleagues, The Lancet, 1989 | Cluster-randomized trial of about 68,000 women: a policy of routine daily counting against standard care. | Death rates in normally formed single babies were similar in the two groups. At best about 1,250 women would need to count to prevent one unexplained late death. | The authors said it does not rule out a benefit and that an adverse effect was just as likely. Standard care could include selective counting or informal noting of movements. |
| Saastad and colleagues, PLoS One, 2011 | Randomized trial in nine Norwegian hospitals: 1,076 women, counting from 28 weeks against standard care. | The compound main outcome, a mix of fetal pathology and adverse outcomes, was the same in both groups. Growth-restricted babies, a secondary outcome, were identified before birth more often with counting (20 of 23 against 12 of 20). There were no perinatal deaths in either group. | Underpowered to detect a difference in perinatal mortality. The authors wrote that the compound main outcome is not amenable to meaningful interpretation. |
| Cochrane review, Mangesi and colleagues, 2015 | Five studies and 71,458 women, 68,654 of them in one cluster trial. Two compared routine counting with standard care or mixed or undefined counting; three compared counting methods, or counting with hormone tests. | No difference in stillbirth rates per cluster between routine and mixed or undefined counting. The authors wrote that the review does not provide sufficient evidence to influence practice. | The review's authors wrote that no trials compared counting with no counting. A 2021 Cochrane protocol says this review is out of date. |
| Tveit and colleagues, BMC Pregnancy and Childbirth, 2009 | Before-and-after study in 14 Norwegian hospitals: 19,407 births before and 46,143 during written information and a management guideline. | Stillbirths fell from about 3 to 2 per 1000 births (odds ratio 0.69, 95% interval 0.50 to 0.96 after a 2010 correction). | Not randomized. The information invited women to monitor movements, so counting was only part of the change. A 2010 correction removed two duplicate stillbirth reports, and the authors then put their estimates at an odds ratio of 0.7 to 0.8, mostly of borderline significance. |
| AFFIRM, The Lancet, 2018 | Stepped-wedge cluster-randomized trial in 33 hospitals in the UK and Ireland, 409,175 pregnancies: a care package for reduced movements. | Stillbirth was 4.40 per 1000 births in the control period and 4.06 in the intervention period (adjusted odds ratio 0.90, 0.75 to 1.07). Inductions and caesarean births were more common in the intervention period, and small babies delivered at 40 weeks or later were less common (1.5% against 2.0%). | Tested a package, not counting. The authors wrote that the package did not reduce stillbirths and, in its present form, cannot be recommended. |
| My Baby's Movements, BJOG, 2022 | Stepped-wedge cluster-randomized trial in 27 hospitals in Australia and New Zealand, 290,105 births at 28 weeks or more: an awareness package. | Stillbirth was 2.2 per 1000 births with the package and 2.4 before it, a difference that was not statistically significant (adjusted odds ratio 1.18, 0.93 to 1.50). The authors concluded it did not reduce stillbirths beyond the downward trend over time. | Tested a package, not counting. The authors cite low uptake and say awareness of movements may already have reached women and clinicians before the trial. |
| Hayes and colleagues, AJOG MFM, 2023 | Systematic review and meta-analysis of 18 studies, 16 of them randomized trials, of awareness, counting and management of reduced movements. | The effect on stillbirth is uncertain. Awareness interventions may be associated with fewer NICU admissions and fewer low Apgar scores, and may not be associated with more caesarean births or inductions. | We read the abstract only. The authors say studies were frequently underpowered for rare outcomes and that none came from high-burden settings. |
Common questions
Does kick counting prevent stillbirth?
No trial we read has shown that it does. The 1989 trial of about 68,000 women found similar late death rates in normally formed single babies with and without a counting policy, and later trials of awareness packages did not show a reduction in stillbirths. The Cochrane review authors wrote that their review does not provide sufficient evidence to influence practice. That is different from showing that counting does not work.
Is kick counting recommended?
It depends on who you ask. The NHS says you do not need to count. The RCOG's 2026 guideline finds insufficient evidence to recommend formal counting using specified numbers. ACOG's patient page says that if you have felt movement less often than you think is normal, your health care professional may ask you to keep track and will tell you how. The WHO recommends daily counting only within research. The guide to advice by country sets each one out.
Could counting do harm?
The RCOG's 2026 guideline says most evidence indicates monitoring movements is not associated with increased anxiety, replacing a 2011 recommendation that cautioned about instructing women to monitor, though it still tells clinicians to take account of possible stress and anxiety. In the Cochrane review, one study found more antenatal admissions after women reported decreased movements (relative risk 2.72, 95% interval 1.34 to 5.52; 123 women). AFFIRM, which tested a care package and not counting, found more inductions and caesarean births. The guide on counting and anxiety sets out the studies of anxiety.
Should I stop counting if my midwife or doctor asked me to?
Follow the method your midwife or doctor gave you, and tell them if counting worries you. These studies are about whole populations, not about your pregnancy.
Why is the evidence so hard to read?
Stillbirth is uncommon: the RCOG's 2026 guideline says a trial would need more than 370,000 women in each group to show a 10% reduction. Most large trials also tested packages that changed more than counting. The Australian guideline says the largest trial in the Cochrane review was subject to some methodological bias, and that some women in its control group counted as part of standard care. It adds that the 1989 authors speculated that their definition of decreased movements, fewer than 10 a day for two consecutive days, may have been too strict.
Sources
These are the sources behind the statements on this page. We opened each one and checked it on the date shown.
- Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. The Lancet, 12 August 1989
A 1989 cluster trial of 68,000 women found similar late antepartum death rates with and without a routine counting policy; it did not rule out a benefit.
Limits: The authors wrote that at best about 1,250 women would need to count to prevent one unexplained late death, and that an adverse effect is just as likely. Standard care could include selective counting or informal noting of movements.
Checked . Read directly from the source.
- Saastad E, Winje BA, Stray Pedersen B, Frøen JF. Fetal movement counting improved identification of fetal growth restriction and perinatal outcomes: a multi-centre, randomized, controlled trial. PLoS One, December 2011
A 2011 trial of 1,076 women in nine Norwegian hospitals found the same rate of its compound main outcome with and without counting, and more growth-restricted babies identified before birth with counting.
Limits: The main outcome was a compound of fetal pathology and adverse outcomes. Growth restriction was a secondary outcome: 20 of 23 babies identified before birth with counting against 12 of 20 (95% interval 1.0 to 2.1). The authors reported no difference in consultations or obstetric interventions, and wrote that the study was underpowered to detect any difference in perinatal mortality rates.
Checked . Read directly from the source.
- Mangesi L, Hofmeyr GJ, Smith V, Smyth RMD. Fetal movement counting for assessment of fetal wellbeing. Cochrane Database of Systematic Reviews, 15 October 2015
A 2015 Cochrane review of five studies (71,458 women), too few and too weak to be sure, found no difference in stillbirth between routine and mixed or undefined counting.
Limits: Two of the five studies compared routine counting with standard care or mixed or undefined counting; the other three compared counting methods, or counting with hormone tests, so most results come from single studies. One study of 1,013 women found less anxiety with counting. In another, antenatal admissions after women reported decreased movements rose with counting (relative risk 2.72, 95% interval 1.34 to 5.52; 123 women). The review is about ten years old, calls for more research, and notes that counting tests can cause considerable anxiety for some women.
Checked . Read directly from the source.
- Cochrane protocol, Interventions relating to fetal movements for improving pregnancy outcomes, Cochrane Database of Systematic Reviews, 2021 (CD014714)
A 2021 Cochrane protocol says the 2015 review of fetal movement counting and an earlier one are now out of date, and that its own review will supersede them.
Limits: We looked for a replacement review in PubMed and Crossref on 13 October 2026 and found none.
Checked . Read directly from the source.
- Tveit JVH, Saastad E, Stray-Pedersen B, et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines: a clinical quality improvement. BMC Pregnancy and Childbirth, 22 July 2009 (erratum 2010)
A 2009 Norwegian before-and-after study in 14 hospitals found stillbirths fell by about a third (odds ratio 0.69 after a 2010 correction) after written information and a management guideline.
Limits: Not a randomized trial: it compared 19,407 births before the changes with 46,143 during them. The written information invited women to monitor movements, so counting was one part of a package. A 2010 correction removed two duplicate stillbirth reports (odds ratio 0.69, 95% interval 0.50 to 0.96), and the authors then put their estimates at 0.7 to 0.8, mostly of borderline significance. We read the abstract and the correction.
Checked . Abstract read at the source.
- 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. The Lancet, 3 November 2018
The AFFIRM trial (409,175 UK and Irish pregnancies) found that a care package for reduced fetal movements did not reduce stillbirth: 4.40 per 1000 births in the control period, 4.06 in the intervention period.
Limits: The package raised women's awareness of the need to report reduced movement promptly and standardised management, including timely delivery. It did not test counting on its own. Adjusted odds ratio 0.90 (95% CI 0.75 to 1.07).
Checked . Read directly from the source.
- Norman JE, Heazell AEP, Rodriguez A, et al. AFFIRM trial, The Lancet, 3 November 2018 (results and discussion)
In the AFFIRM trial, caesarean sections (28.3% of births against 25.5%) and inductions of labour (40.7% against 35.8%) were more frequent in the intervention period, and the authors said the package cannot be recommended in its present form.
Limits: These were secondary outcomes taken from routine data. The paper's text and table differ by 0.1 point on some percentages. The authors also reported a surrogate of stillbirth, babies at or below the 10th centile delivered at 40 weeks or later, as lower in the intervention period (1.5% against 2.0%), and said this potential benefit has to be set against the higher frequency of caesarean section and induction.
Checked . Read directly from the source.
- Flenady V, Gardener G, Ellwood D, et al. My Baby's Movements: a stepped-wedge cluster-randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths. BJOG, 2022
The 2022 My Baby's Movements trial found an awareness program did not reduce stillbirth beyond the downward trend over time: 2.2 per 1000 against 2.4 before, in 290,105 births.
Limits: Births in Australia and New Zealand. The difference was not statistically significant (adjusted odds ratio 1.18, 95% CI 0.93 to 1.50). The authors cite low uptake, and say an awareness of fetal movements may have reached women and clinicians before the trial began.
Checked . Read directly from the source.
- 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. American Journal of Obstetrics and Gynecology MFM, March 2023
A 2023 systematic review of 18 studies found the effect of encouraging awareness of reduced movement, or of counting movements, on stillbirth uncertain, and said no studies came from high-burden settings.
Limits: The review reports that counting may increase maternal-fetal attachment and decrease anxiety, and that awareness may be associated with fewer adverse neonatal outcomes and may not be associated with more interventions in labour. It says studies were frequently underpowered. We read the abstract only and could not check whether AFFIRM was in the pooled analysis of interventions.
Checked . Abstract read at the source.
- Perinatal Society of Australia and New Zealand and Centre of Research Excellence in Stillbirth, Clinical practice guideline for the care of women with decreased fetal movements with a singleton pregnancy from 28 weeks' gestation, version 2.4, March 2023 (section 6)
The Australian and New Zealand guideline on decreased fetal movements says the Cochrane review found not enough evidence to recommend or not recommend formal counting, and that its largest trial was subject to some methodological bias.
Limits: The guideline gives two reasons for the bias: clusters within hospitals, and counting by some women in the control group as part of standard care. It adds that the authors of the 1989 trial speculated that their definition of decreased movements, fewer than 10 a day for two consecutive days, may have been too strict. It says its recommendations are consensus-based because of the lack of high-quality evidence. It was due for review by October 2025, and we found no newer version.
Checked . Read directly from the source.
- NICE, Antenatal care (NG201), recommendation 1.2.35, published 19 August 2021
NICE (2021) says structured fetal movement awareness packages, such as the one in the AFFIRM trial, have not been shown to reduce stillbirth rates.
Limits: The recommendation is for services in England. The recommendation before it asks services to ask about movements at each antenatal contact after 24+0 weeks, to advise contact at any time of day or night about concerns, and to assess the woman and baby if there are any concerns.
Checked . Read directly from the source.
- American College of Obstetricians and Gynecologists, Obstetric Care Consensus No. 10, Management of Stillbirth, March 2020
ACOG's 2020 obstetric care consensus on stillbirth says evidence of kick counting's effectiveness in preventing stillbirth remains uncertain, although it is an inexpensive test of fetal well-being.
Limits: The passage sits in a section on women with a history of unexplained stillbirth. It cites the AFFIRM trial.
Checked . Read directly from the source.
- American College of Obstetricians and Gynecologists, Clinical Consensus No. 8, Tailored Prenatal Care Delivery for Pregnant Individuals, Obstetrics & Gynecology 2025;145(5):565-577, May 2025
ACOG's 2025 consensus says no routine antenatal measure of fetal well-being, formal kick counts included, has shown benefit for stillbirth prevention.
Limits: The sentence is about the content of routine prenatal visits.
Checked . Read directly from the source.
- Royal College of Obstetricians and Gynaecologists, Reduced Fetal Movements, Green-top Guideline No. 57, first edition, February 2011
The RCOG's 2011 guideline said there is insufficient evidence to recommend formal movement counting with specified alarm limits, and advised women to know their baby's usual pattern.
Limits: The same section advised women who were unsure after 28+0 weeks to lie on their left side, focus on movements for 2 hours and contact their unit if they felt fewer than 10 discrete movements. The 2026 second edition keeps the finding on counting (worded as specified numbers, graded A) and does not include the 2-hour step.
Checked . Read directly from the source.
- Whitworth M, Fisher M, Heazell A, Royal College of Obstetricians and Gynaecologists. Reduced Fetal Movements, Green-top Guideline No. 57, second edition. BJOG 2026;133(8):e70-e92, first published 27 April 2026 (section 7)
The RCOG's 2026 guideline says there is insufficient evidence to recommend formal counting of fetal movements using specified numbers, and that women should know their baby's own pattern.
Limits: Graded A for counting and C for the pattern. It notes that the most widely used alarm limit was developed in women at high risk counting in hospital, so may not apply to a general population. The same section says women who experience reduced movements should be seen by their maternity service. The 2011 edition's step for women who were unsure (lie on the left side, focus for 2 hours, and call if fewer than 10 discrete movements) does not appear in the 2026 text.
Checked . Read directly from the source.
- Whitworth M, Fisher M, Heazell A, Royal College of Obstetricians and Gynaecologists. Reduced Fetal Movements, Green-top Guideline No. 57, second edition. BJOG 2026;133(8):e70-e92, first published 27 April 2026 (section 7, table 2)
The RCOG's 2026 guideline reviews seven studies of counting or awareness methods and finds insufficient evidence that formal counting lowers perinatal deaths.
Limits: The methods it describes: count-to-ten charts with attendance if fewer than 10 movements in 12 hours (Grant 1989); focusing for 2 hours three times a week and attending if fewer than 3 (Neldam 1983, a mostly high-risk group); 10 movements with attendance if not felt in 2 hours (Moore and Piacquadio 1989); count-to-ten charts in New Zealand (Westgate and Jamieson 1986); count-to-ten from 28 weeks (Saastad 2011); an information package (Tveit 2009); and Mindfetalness (Akselsson 2020).
Checked . Read directly from the source.
- Whitworth M, Fisher M, Heazell A, Royal College of Obstetricians and Gynaecologists. Reduced Fetal Movements, Green-top Guideline No. 57, second edition. BJOG 2026;133(8):e70-e92, first published 27 April 2026 (section 7)
The RCOG's 2026 guideline says most evidence indicates that asking women to monitor fetal movements is not associated with more maternal anxiety, and that it increases maternal-fetal attachment.
Limits: Graded B. This replaces the 2011 edition's caution that monitoring is potentially associated with increased anxiety, though the guideline still says clinicians must take account of potentially negative effects of maternal stress and anxiety. The section still notes a small cohort in which 23% of women reported anxiety, and says perceiving reduced movements is itself associated with anxiety.
Checked . Read directly from the source.
- Whitworth M, Fisher M, Heazell A, Royal College of Obstetricians and Gynaecologists. Reduced Fetal Movements, Green-top Guideline No. 57, second edition. BJOG 2026;133(8):e70-e92, first published 27 April 2026 (section 3.1)
The RCOG's 2026 guideline says stillbirth is uncommon enough that a trial would need more than 370,000 women in each group to show a 10% reduction, so many studies were underpowered.
Limits: It also says the studies define normal and reduced movements in different ways, that few randomized trials address the management of reduced movements, and that they compared different things, which makes pooling difficult.
Checked . Read directly from the source.
- World Health Organization, WHO recommendations on antenatal care for a positive pregnancy experience, 2016, recommendation B.2.1 (context-specific recommendation)
The WHO's 2016 antenatal care recommendations say daily fetal movement counting, such as with count-to-ten kick charts, is only recommended in the context of rigorous research.
Limits: The remarks on this recommendation in the 2016 guideline (page 54) say healthy pregnant women should be made aware of the importance of fetal movements in the third trimester and of reporting reduced movements, and that women who perceive reduced movements need further monitoring, for example daily counting, and investigation if indicated.
Checked . Read directly from the source.
- Royal College of Obstetricians and Gynaecologists, Your baby's movements in pregnancy (patient information based on Green-top Guideline No. 57, February 2011)
The RCOG says there is no specific number of movements that is considered normal, and that there is not enough evidence to recommend the routine use of a movement chart.
Limits: UK patient information published February 2019 and based on the 2011 guideline; the RCOG still had it online on 17 October 2026. The guideline's second edition (April 2026) says to report any decrease or stopping of movements and finds insufficient evidence for counting to set numbers. Advice elsewhere differs, and your own midwife or doctor comes first.
Checked . Read directly from the source.
- American College of Obstetricians and Gynecologists, Special Tests for Monitoring Fetal Well-Being (FAQ098), last reviewed January 2026
ACOG's patient page says your health care professional may ask you to track movements if you feel them less often than normal, that there are different ways to do kick counts, and that your professional will tell you how often to count and when to call.
Limits: This page gives no number of movements and no time limit. Other ACOG documents may describe specific methods.
Checked . Read directly from the source.
- Royal College of Obstetricians and Gynaecologists, Your baby's movements in pregnancy (patient information based on Green-top Guideline No. 57, February 2011)
The RCOG says that if your baby moves less than usual or the pattern changes, it is essential to contact your midwife or maternity unit immediately, and that over 28 weeks you must not wait until the next day.
Limits: UK patient information published February 2019 and based on the 2011 guideline; the RCOG still had it online on 17 October 2026. The guideline's second edition (April 2026) says to report any decrease or stopping of movements and finds insufficient evidence for counting to set numbers. Advice elsewhere differs, and your own midwife or doctor comes first.
Checked . Read directly from the source.
- NHS, Your baby's movements, page last reviewed 8 July 2024
The NHS says there is no set number of movements you should feel each day, that you do not need to count your baby's kicks, and that you should get to know your baby's usual pattern.
Limits: NHS advice is written for the UK. Advice elsewhere differs, and your own midwife or doctor comes first.
Checked . Read directly from the source.
- NHS, Your baby's movements, page last reviewed 8 July 2024
The NHS says to call your midwife or maternity unit immediately if your baby moves less than usual, you cannot feel movement, or the usual pattern changes, and not to wait until the next day.
Limits: NHS advice is written for the UK. Advice elsewhere differs, and your own midwife or doctor comes first.
Checked . Read directly from the source.
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