Counting Baby Kicks in Your Pink Book: Why Doctors Ask You to Record Them, and What to Do First When Movements Slow

Once you reach the third trimester, the nurse at the antenatal clinic will usually say, “Start counting baby kicks and write them down.” But in real life, some days you remember and some days you forget. Some days your baby moves so much there is no need to count, and some days it is so quiet your heart sinks, and you are torn between waiting a bit longer and going to the hospital right away.

Let’s look at why counting kicks matters, how hospitals in Thailand do it, and what newer international guidance has added. If we had to sum it up in one sentence: if you are unsure, do not wait.

Why do doctors ask you to count kicks?

Quick Answer: Because reduced movement may be one of the first signs that your baby is not getting enough oxygen or is unwell. Knowing early gives the doctor time to check and help.

Sriphat Medical Center at Chiang Mai University’s Faculty of Medicine explains that counting kicks helps to “detect warning signs in the baby before a life-threatening event occurs.” The NHS says plainly that reporting reduced movement quickly could save your baby’s life.

Babies move in many ways: kicking, pushing, twisting, stretching or squirming. All of these count as movements.

How to count kicks the way Thai hospitals recommend

Quick Answer: Start around 28 weeks, choose one time of day, count every movement until you reach 10, and write down the time you reached 10. If there are fewer than 10 movements in 4 hours, go to the hospital immediately.

Here is the method from Sriphat Medical Center at Chiang Mai University as an example:

1. Start counting from around 28 weeks of pregnancy, and do it every day until birth.
2. Choose the morning half of the day, for example starting at 8 a.m. You can count while working or going about your routine.
3. Count every time you feel your baby move, until you reach 10. Most babies reach 10 within 1 hour.
4. Once you reach 10, write down the time and carry on with your day as normal.
5. If there are fewer than 10 movements within 4 hours, go to the hospital right away.

Some hospitals have you count after meals or use a different chart. Just follow what your hospital recommends. You can record in the pink book (สมุดสีชมพู, the Thai Mother and Child Health Handbook), the chart you were given, or an app on your phone. What matters is that you record every day at around the same time, so you learn what is normal for your baby.

Does new guidance really say “don’t count”? Does it contradict the pink book?

Quick Answer: Not entirely. International guidance such as the NHS and RCOG no longer focuses on the number 10, and instead focuses on moms knowing their baby’s normal pattern and going to the hospital right away if it changes. Recording in the pink book is still useful if you use it to catch changes, not to wait for a number.

The NHS recommends not counting the number of movements, and instead getting to know your baby’s pattern of movements each day. The RCOG says there is not enough evidence to recommend routine kick charts, because every baby moves differently. Some babies normally move 10 times in 10 minutes. If one day it takes 3 hours to reach 10, even though that is still under the 4-hour threshold, that counts as a change, and you should get checked.

We think using both together, like this, works best:

What to use	What it is for
Recording movements in the pink book every day	To see how quickly your baby normally reaches 10 and when they are active
The 10 movements in 4 hours threshold	The “bottom line” at which you definitely go to the hospital
The feeling that “today is not like other days”	Reason enough to get checked, even before reaching the threshold

What to do first on a day your baby moves less

Quick Answer: If you feel your baby is moving less or differently, call the labor ward at the hospital where you have your antenatal care, or go to the hospital right away, even in the middle of the night. Do not wait until tomorrow or your next appointment.

Do this:

• Call or go to the labor ward immediately. The NHS stresses: “Call immediately, even if it’s the middle of the night.”
• Bring your pink book so the nurse can see your history.
• Say clearly “since when your baby has been moving less, and how they usually move.”

What not to do:

• Do not try to stimulate your baby first, such as drinking cold water, eating something sweet or jiggling your belly, and then keep waiting to see.
• Do not use a fetal heart monitor you bought for home use. The NHS warns that it is not reliable, and you may hear your own pulse and feel falsely reassured.
• Do not go to sleep while you are still worried. The RCOG says not to go to sleep ignoring reduced movement.

At the hospital, the nurse will usually attach a fetal heart monitor (NST), and the doctor may also do an ultrasound. Most of the time the results are normal and you go home. If your baby moves less again after that, you can always go back. There is no need to feel shy about it (เกรงใจ, kreng jai).

Common beliefs: true or not?

Quick Answer: “Babies move less near the due date because there is no room” is not true. “They’ll move soon, just wait” is not what you should do.

• “Near the due date the baby has no room, so moving less is normal.” The RCOG states your baby should keep moving until labor. The movements may change to rolling or squirming, but they should not decrease.
• “The baby is asleep, they’ll wake up soon.” Babies do sleep in stretches, but if they are quiet for longer than is normal for them, you need to get checked.
• “The elders say they never had to count in the old days.” They truly mean well. But the evidence is now clear that watching your baby’s movements helps doctors find problems in time. A gentle “The doctor asked me to record them” is all you need to say.

Go to the hospital right away if…

Quick Answer: Your baby is moving less, moving differently than usual, or not moving at all. Go immediately, whatever the time.

• Fewer than 10 movements in 4 hours, or fewer than the threshold your hospital gave you
• You feel the movements are fewer, weaker, or the pattern has changed, even if you have not reached the threshold
• You cannot feel your baby move at all
• Your baby is moving less together with bleeding, your waters breaking, frequent tightening of the belly (read False labor vs. real labor), or a headache with blurred vision (read Preeclampsia warning signs)

If you are not sure which sleeping position is comfortable for your baby, continue to Sleeping positions in pregnancy.

Counting kicks is not meant to make you worry every day. You can think of it as a small moment to talk with your baby through the hand resting on your belly. If one day it feels different, trust yourself and go see the doctor, because no one knows this baby as well as you do.