Nora Nicholson still remembers the joy she experienced after learning she was expecting a son in the summer of 2011. She and her husband Dana, who already had a young daughter, were thrilled at the prospect of having a second child. They settled on the name Bryce for their son.

Yet at 37 weeks, the Lafayette, Calif., couple’s happiness was crushed when Nora gave birth. Bryce had a knot in the umbilical cord and was stillborn.

Now Nicholson is focused on preventing other parents from facing similar tragedies. In her new role as the California ambassador for Count the Kicks, Nicholson’s job is to encourage expectant mothers throughout the state to count their baby’s kicks in the third trimester of their pregnancy. A decrease in kicks may indicate in-utero distress.

“A sudden lack of activity in the third trimester can indicate complications,” Nicholson said, adding that while many doctors recommend kick counting, not all of them do. “Sudden Infant Death Syndrome (SIDS) is talked about far more than stillbirth, yet stillbirth is 10 times more likely to occur than SIDS.”

According to the Centers for Disease Control and Prevention (CDC), California loses 2,465 babies a year to stillbirth.

The CDC adds that the death of a baby before or during delivery can be caused by umbilical cord accidents, abdominal trauma, bacterial and viral infections, and maternal medical problems such as clotting disorders.

“When a baby isn’t kicking or moving often enough in the third trimester, it can be an early sign that the baby is in distress,” Nicholson said. “I had a healthy pregnancy and quality prenatal care, but no one ever suggested monitoring my baby’s health by counting kicks.”

Count the Kicks is a national stillbirth prevention public health campaign launched by Healthy Birth Day, a nonprofit started by a group of mothers in Iowa who had experienced stillbirths. The program is now in 21 states.

Based on a Norwegian program that teaches expectant moms how to systemically track fetal movement, Healthy Birth Day introduced Count the Kicks in 2005. In it’s first five years, Iowa’s stillbirth rate decreased by 29 percent, giving it the 3^rd best stillbirth rate in the country.

A 2018 study found that although 1 in every 160 pregnancies in the United States ends in stillbirth, nearly 25 percent of all stillbirths are fully preventable. Women of color are disproportionately affected. In California in 2015, the infant mortality rate among African-American infants was 9.3 for 1,000 births, compared to 4.5 per 1,000 for Latinas and 3.5 for white infants.

Count the Kicks ambassadors works with maternity care providers, birth centers, OB/GYN clinics and social service providers to promote the importance of paying attention to in-utero movement in the third trimester.

Addressing Racial Disparities in Stillbirth

This year, Count the Kicks formed a partnership with the Black Women’s Health Imperative, a Washington DC-based nonprofit dedicated to improving the health of Black women and girls.

“We know racial disparities still exist in stillbirth,” Nicholson said. “African American women experience stillbirth at twice the rate of the general pregnant population and Hispanic, Native American and Asian women also have a higher risk of having a stillbirth.”

Nicholson said the goal of the California program is to follow the success of Iowa and reduce stillbirths by 26 percent, which would save the lives of 712 babies each year in California.

To help accomplish this goal, Nicholson encourages pregnant women to download the free Count the Kicks smartphone app (available in 10 languages on Google Play and in the iTunes online stores).

Nicholson recommends picking a time each day and using the app to count the baby’s movements.

“Studies show that expectant moms in their third trimester should learn how long it takes their baby to get to 10 movements each day and record the amount of time daily,” Nicholson said. “When the amount of time it takes to get to 10 movements changes, this could be the sign of potential problems and warrants a call to the doctor.”

While some health care professionals encourage expectant moms to count their baby’s kicks in the third trimester, Nicholson said the guidelines aren’t universal.

“When I told my nurse practitioner that I had been feeling my son moving less, she just shrugged it off,” Nicholson said. “That conversation still haunts me because of how powerless I felt.”

Even in Nicholson’s subsequent pregnancy with her daughter, Lila, in 2012, no medical professionals suggested that she count kicks even though she was considered a high-risk pregnancy.

“Through my work with Count the Kicks, I hope to see the stillbirth rates change in California,” Nicholson said. “I don’t want any other family to suffer the pain my family went through.”