RCOG Reduced Fetal Movements Guideline (2026)

If your baby is moving less, contact your maternity unit now. The RCOG published the second edition of its reduced fetal movements guideline on 27 April 2026. It tells clinicians to advise women to report any decrease or stopping of movements, finds insufficient evidence for counting to set numbers, and sets out the checks: a heartbeat check, a CTG from 26 weeks, and a scan after 28 weeks in some cases. It drops the 2011 step of counting 10 movements in 2 hours.

Written by the Bumpi Kicks team at Speed AI Labs LLP. Last updated October 17, 2026. General information, not reviewed by a clinician, and not medical advice. How we write and check these pages.

If your baby is moving less, contact your maternity unit now

Call your midwife or maternity unit immediately if your baby is moving less than usual, you cannot feel movement, or the usual pattern changes, even in the middle of the night. The NHS says not to wait until the next day. This page summarises a guideline written for clinicians, and no clinician has reviewed this summary.

If you cannot reach them, or you are worried about your own health, call your local emergency number.

What the guideline says, in plain words

Know your baby's own pattern

The guideline finds insufficient evidence to recommend counting movements to a set number (grade A), and says women should be aware of their own baby's pattern of movements (grade C).

Movements do not normally fall late in pregnancy

Movements are likely to plateau after 32 weeks but do not normally reduce in the third trimester, though kicks tend to give way to rolling, stretching and pushing. Women should be aware of movements up to and including the start of labour.

Afternoon and evening are often busiest

Afternoon and evening are a baby's peak times of activity, and sleep cycles usually last 20 to 40 minutes, rarely more than 90 in a healthy baby. There is some evidence women feel most movement lying down, though not flat on the back.

Do not explain a change away

Reduced movements should not be put down to an anterior placenta if a change occurs, or to a raised body mass index. The guideline lists the effect of glucose and caffeine on what women notice as unclear.

A sudden burst of movement

A single spell of exaggerated or excessive movement after 28 weeks has been linked with stillbirth in case-control studies, though three prospective studies of increased movement found no link with poor outcomes for the baby. The guideline says to report any decrease or stopping of movements, especially after such a spell, and to check a woman who is concerned with a CTG.

Monitoring and anxiety

Most evidence indicates that asking women to monitor movements is not associated with more anxiety and increases attachment to the baby (grade B). The 2011 edition had cautioned that it might raise anxiety.

No device can check for you

There is currently no objective way for a woman to reliably assess her baby's activity, the guideline says, and devices that sense movement are largely still in early studies.

What happens when you report reduced movements

1
A heartbeat check comes first
A midwife or doctor listens for the baby's heartbeat with a handheld Doppler and compares it with your pulse. If you call and cannot be checked this way, the guideline says you should be asked to come in.
2
Questions and an examination
They ask how long movements have been reduced and about risk factors such as smoking, diabetes, high blood pressure, or an earlier small baby or stillbirth. They measure your bump, check your blood pressure and test your urine.
3
A CTG from 26 weeks
From 26+0 weeks you should have a computerised CTG, which records the baby's heart rate, initially for at least 20 minutes.
4
A scan in some cases
After 28+0 weeks a scan of the baby's size, the fluid and umbilical blood flow should be part of the first checks if reduced movement continues despite a normal CTG or you have other risk factors, unless you had a scan in the previous 2 weeks.
5
If the checks are normal
One episode with normal checks is unlikely to mean a poor outcome, and there is no reason to bring the birth forward. Contact your unit again if movements reduce again.
6
If it keeps happening
A woman who reports reduced movements more than once should have her case reviewed and a scan, because her risk of a poor outcome is higher.

What changed from the 2011 edition

The RCOG's 2011 and 2026 guidelines on reduced fetal movements compared, topic by topic
Topic	2011 first edition	2026 second edition
Counting	Insufficient evidence to recommend formal counting using specified alarm limits.	Insufficient evidence to recommend formal counting using specified numbers (grade A). Be aware of your own baby's pattern.
If you are unsure	After 28+0 weeks, if unsure: lie on your left side and focus on movements for 2 hours. Contact your midwife or maternity unit immediately if you feel fewer than 10 discrete movements.	No counting step. Women who experience reduced movements should be seen by their maternity service.
Anxiety	Clinicians should be aware that instructing women to monitor movements is potentially associated with increased anxiety (grade B).	Most evidence indicates monitoring is not associated with increased anxiety, and it increases maternal-fetal attachment (grade B).
CTG	A CTG over 28+0 weeks, once the heartbeat is confirmed.	A computerised CTG from 26+0 weeks, initially for at least 20 minutes.
Scan	If reduced movement persists despite a normal CTG or there are risk factors, preferably within 24 hours.	The same triggers, unless scanned in the previous 2 weeks, at the earliest available opportunity. Not for every woman.
Anterior placenta	Before 28+0 weeks it may decrease how much movement a woman feels.	The same, and do not attribute reduced movements to an anterior placenta if a change occurs (grade C).
Twins and multiples	Excluded from the guideline.	A section of its own: CTG, growth, fluid and umbilical artery Doppler checks, and the type of twin pregnancy.
Excessive movement	No section.	A section of its own: a single spell after 28 weeks has been linked with stillbirth; check a concerned woman with a CTG.
What to tell women	After 28+0 weeks, report a reduction in or cessation of movements; the RCOG's patient information (2019) says reduced or changed.	Report any decrease or stopping of movements, especially after a spell of sudden excessive movement; section 10 also says to report any sudden change, including an increase. Tommy's, working with the NHS, Sands, Kicks Count and others, updated its patient information to reflect the 2026 guideline: it asks women to report movements that are less, weaker or stopped, and drops the words changed and increased, except for a baby who suddenly moves a lot and then stops.

Common questions

Does the RCOG's 2026 guideline say to count kicks?

No. It finds insufficient evidence to recommend formal counting using specified numbers, and says women should be aware of their own baby's pattern. It drops the 2011 step of counting 10 movements in 2 hours when unsure. If your midwife or doctor has asked you to count, follow their method.

Is the guideline written for pregnant women?

No. It is written for clinicians in the UK. The RCOG's patient information on movements dates from February 2019 and is based on the 2011 edition. It says to contact your midwife or maternity unit immediately, and over 28 weeks not to wait until the next day. The NHS gives the same advice.

Will I have a scan if I report reduced movements?

Not always. After 28 weeks the guideline says a scan should be part of the first checks if reduced movement continues despite a normal CTG or you have other risk factors, unless you were scanned in the past 2 weeks, and whenever reduced movements recur. It does not recommend a scan for every woman, citing the AFFIRM trial.

Should my baby be delivered early because movements were reduced?

Not on that basis alone. Where the checks show no sign of compromise, the guideline says there is no indication to bring the birth forward (grade A). It says any decision to bring the birth forward is made individually with you, and that after 39 weeks doing so does not appear to add risk for you or your baby.

Does it cover twins?

Yes, unlike the 2011 edition. A woman with reduced movements in a twin pregnancy should have a CTG, checks of growth and fluid, and umbilical artery Doppler. It gives no counting method for twins. The guide to counting with twins sets out other sources.

How common is a serious problem after reduced movements?

About 70% of women who notice reduced movements have a good outcome, the guideline says, and stillbirth occurred in 0.3% to 1% of women with reduced movements in the studies it cites. The commonest finding was a baby smaller than expected. That is why each episode needs checking.

Does Bumpi Kicks follow this guideline?

Bumpi Kicks records the movements you tap and how long they took. It does not judge whether a count is normal and cannot check on your baby. If movements reduce or change, call your maternity unit.

Sources

These are the sources behind the statements on this page. We opened each one and checked it on the date shown.

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 5)
The RCOG's 2026 guideline tells clinicians to advise women to report any decrease or stopping of their baby's movements to the maternity unit, especially after a spell of sudden, vigorous movement.
Limits: Graded B. The same section says to advise women to be aware of movements up to and including the start of labour. Section 10 says women should be encouraged to report any sudden change in their normal movements, whether an increase, a decrease or stopping. The RCOG's patient information (2019) and the NHS also ask you to call about a change in the usual pattern.
Checked October 17, 2026. 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 October 17, 2026. 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 4)
The RCOG's 2026 guideline says women are likely to feel movements from 20 weeks, and that movements are likely to plateau after 32 weeks but do not normally reduce in the third trimester.
Limits: Graded C and B. It says the nature of movement changes late in pregnancy, with kicks tending to give way to rolling, stretching and pushing, while the frequency does not fall at term.
Checked October 17, 2026. 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 (sections 4 and 5)
The RCOG's 2026 guideline says afternoon and evening are a baby's peak times of activity, and that sleep cycles usually last 20 to 40 minutes and rarely exceed 90 minutes in a healthy baby.
Limits: Evidence levels 2- and 2+. It adds that there is some evidence women feel most movements lying down (but not flat on the back), fewer sitting and fewest standing. It cites an average of 31 movements an hour at term (range 16 to 45), which describes a study, not a number to count to.
Checked October 17, 2026. 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 5)
The RCOG's 2026 guideline says not to put reduced movements down to an anterior placenta if a change in movement occurs, or to a raised body mass index.
Limits: Graded C and B. It says that before 28+0 weeks an anterior placenta may decrease how much movement a woman feels. After 28 weeks one study found no reduction and another found more women with an anterior placenta presented with reduced movements.
Checked October 17, 2026. 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 5, table 1)
The RCOG's 2026 guideline lists focused attention, exercise, anxiety and mealtimes as raising how much movement women notice, and the effect of glucose and caffeine as unclear.
Limits: The same table lists an anterior placenta, some drugs (alcohol, benzodiazepines, methadone), fetal anomalies and distraction as lowering perception, and corticosteroids and a raised body mass index as unclear. The table is about what women notice, not about how to check a baby.
Checked October 17, 2026. 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 15)
The RCOG's 2026 guideline says a single spell of excessive fetal movement after 28 weeks was linked with stillbirth in case-control studies, and a concerned woman should be checked with a CTG.
Limits: Graded B and C. The link comes from case-control studies; three prospective studies found no link between increased movements and poor outcomes. It says there is no indication for intervention unless the CTG shows compromise.
Checked October 17, 2026. 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 October 17, 2026. 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 6)
The RCOG's 2026 guideline says there is currently no objective way for a woman to reliably assess her baby's activity, so movements are judged by what she feels.
Limits: Graded D. Devices using accelerometers, microphones or the fetal ECG are in early studies (appendix B), and no study has tested whether long-term monitoring with them finds babies at risk.
Checked October 17, 2026. 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 8.2)
The RCOG's 2026 guideline says that when a woman reports reduced movements, a clinician should first listen for the baby's heartbeat with a handheld Doppler to exclude fetal death.
Limits: Graded C. It says the clinician must compare the baby's heart rate with the mother's pulse to tell them apart, and that a woman advised by phone or video, without this check, should be told to attend her maternity unit. The examination also includes measuring the bump, blood pressure and a urine test.
Checked October 17, 2026. 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 (sections 8.3 and key recommendations)
The RCOG's 2026 guideline says that from 26+0 weeks, once the heartbeat is confirmed, a woman with reduced movements should have a computerised CTG, initially for at least 20 minutes.
Limits: Graded B. A CTG records the baby's heart rate, which the guideline says rises with 92% to 97% of the large movements a mother feels. In one cohort it cites, 95% of 524 women had a normal CTG at presentation or after an initially non-reassuring one.
Checked October 17, 2026. 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 8.4)
The RCOG's 2026 guideline says that, unless a scan was done in the past 2 weeks, a scan should be among the first checks after 28+0 weeks if reduced movement persists despite a normal CTG or there are risk factors.
Limits: Graded B. The recommendation adds the condition that no scan was done in the previous 2 weeks. The scan measures the baby's size, the fluid around the baby and umbilical artery blood flow. A scan for every woman with reduced movements is not recommended, the guideline says, citing the AFFIRM trial.
Checked October 17, 2026. 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 (sections 10 and 11)
The RCOG's 2026 guideline says a woman with one episode of reduced movements and normal checks is unlikely to have a poor outcome, and should contact her unit again if it happens again.
Limits: Graded B. Section 10 also says there are no data to support kick charts after normal checks (grade C). Section 11 says that where checks show no sign of compromise there is no indication to bring the birth forward (grade A), that any decision to bring the birth forward is made individually with the woman, and that after 39 weeks doing so does not appear to be associated with increased risk.
Checked October 17, 2026. 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 12)
The RCOG's 2026 guideline says a woman who reports reduced movements more than once should have her case reviewed and an ultrasound scan, because her risk of a poor outcome is higher.
Limits: Graded C and B. In the studies it cites, stillbirth occurred in 1.4% of women who presented two or more times after 28 weeks, against 0.6% of women with one episode. There is no universal definition of recurrent; one UK region uses two or more episodes within 21 days after 26 weeks.
Checked October 17, 2026. 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 13)
The RCOG's 2026 guideline says a woman with reduced movements in a twin or multiple pregnancy should have a CTG, checks of growth and fluid, and umbilical artery Doppler.
Limits: Graded C. It also says to determine the chorionicity of the pregnancy, that very few studies report on reduced movements in multiple pregnancy, and that none studied care for it. The 2011 edition excluded multiple pregnancy. It gives no counting method for twins.
Checked October 17, 2026. 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 (sections 2, 8 and 10)
The RCOG's 2026 guideline says about 70% of women who notice reduced movements have a good outcome, and stillbirth occurred in 0.3% to 1% of women with reduced movements in the studies.
Limits: The commonest finding was a small-for-gestational-age baby (14.3% to 23%). Fetal death is found in under 1% of presentations. A systematic review of 39 studies it cites found higher odds of stillbirth with reduced movements (odds ratio 3.44), which is why a change needs checking.
Checked October 17, 2026. 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 October 13, 2026. Read directly from the source.
Royal College of Obstetricians and Gynaecologists, Reduced Fetal Movements, Green-top Guideline No. 57, first edition, February 2011 (section 7)
The RCOG's 2011 guideline said instructing women to monitor fetal movements is potentially associated with increased maternal anxiety, and that clinicians should be aware of this.
Limits: Graded B. The text cites a small 1986 retrospective cohort in which 23% of women reported anxiety. The same section said two studies, one of them randomized, reported no adverse effects. The 2026 second edition replaces it: most evidence indicates asking women to monitor movements is not associated with increased anxiety (grade B).
Checked October 13, 2026. Read directly from the source.
Royal College of Obstetricians and Gynaecologists, Reduced Fetal Movements, Green-top Guideline No. 57, first edition, February 2011 (sections 7, 8.3 and 8.4)
The RCOG's 2011 guideline said women over 28+0 weeks with reduced movements should have a CTG, and a scan, preferably within 24 hours, if reduced movement persisted or there were risk factors.
Limits: Graded B for the CTG and scan, and a good practice point for timing. The same edition said women concerned about reduced movements should not wait until the next day for assessment. The 2026 edition moves the CTG to 26+0 weeks, makes it computerised, and asks for the scan at the earliest available opportunity.
Checked October 17, 2026. Read directly from the source.
Royal College of Obstetricians and Gynaecologists, Reduced Fetal Movements, Green-top Guideline No. 57, first edition, February 2011 (section 5)
The RCOG's 2011 guideline said that before 28+0 weeks of gestation an anteriorly positioned placenta may decrease a woman's perception of fetal movements.
Limits: Evidence level 2-, the guideline's grade for case-control or cohort studies with a significant risk that the relationship is not causal. The 2026 second edition repeats it and adds: do not attribute reduced movements to an anterior placenta if a change in movement occurs (grade C).
Checked October 13, 2026. Read directly from the source.
Royal College of Obstetricians and Gynaecologists, Reduced Fetal Movements, Green-top Guideline No. 57, first edition, February 2011 (section 1)
The RCOG's 2011 guideline on reduced fetal movements said it excludes the management of reduced movements in multiple pregnancy.
Limits: A statement of scope in the first edition. The 2026 second edition adds a section on reduced movements in multiple pregnancy.
Checked October 13, 2026. 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 October 9, 2026. 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 October 9, 2026. Read directly from the source.
Tommy's, Talking about reduced fetal movements with women and birthing people (guidance for health professionals), no date shown on the page
Tommy's updated its patient advice for the RCOG's 2026 guideline: report movements that are less, weaker or stopped, or a sudden burst then none. It drops 'change' (vague) and 'increased' (no link found with poor outcomes).
Limits: Tommy's says the update was made with the NHS, Sands, Kicks Count and others. The message is to get checked if a baby moves less than normal, movements feel weaker or they have stopped, with one exception: a baby who suddenly moves a lot and then stops moving needs checking too. It says research found no link between increased movement and poor outcomes. The NHS page this site cites still lists a change in the usual pattern as a reason to call. Read in a browser, because the page answers scripts with 403.
Checked October 17, 2026. Read directly from the source.

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