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Posted Feb 11, 2022, 7:25 am
While pregnant with her second child 12 years ago, Shawn Soumilas
began having contractions and thought she was in labor. But the pain was
excruciating, and she knew something wasn’t right.
“I called my doctor, and she said, ‘Let’s go ahead and head over to the OB-GYN triage unit.’”
It was the day before the Fourth of July, and the hospital in
Scottsdale was busy. Then a shift change occurred. A new nurse was
supposed to perform a biophysical profile on the baby, checking for
heart rate, breathing and movement, but, Soumilas said, she neglected to
do so.
“I was a pebble under her shoe,” Soumilas recalled. “She just kept
barking at me that I was dehydrated because it’s July in Scottsdale.”
Things quickly went downhill. Hospital personnel sent Soumilas for an
ultrasound, but then the tech told her they needed her back in triage –
without saying why. While waiting to be transported, Soumilas was
overcome with nausea.
“My husband told me later, that’s when he felt like I was starting to die.”
Back in triage, Soumilas was met by a wall of doctors yelling, “Is that her? Is that her?”
They rushed her into an operating room and inserted an IV. Before she
went completely dark, Soumilas remembers screaming, “Please, take care
of my baby.”
When she awoke the next day, she asked her nurse, “Where’s my baby?”
But she didn’t need to wait for a response to realize the worst had
happened.
“I could tell by her eyes that he was gone.”
Counting kicks, helping moms
Soumilas later learned she had experienced a rare complication called a placental abruption,
in which the placenta separates from the uterine wall before birth –
sometimes depriving oxygen to an unborn child and causing internal
bleeding in the mother.
“I lost three times my blood volume,” she recalled, “and I needed
blood, plasma and platelet transfusions. They told my husband I had
about a 30% chance of getting through the surgery.”
By the time doctors got to the baby, he had been without oxygen for too long. Soumilas lost her son, Zachary, at 38 weeks.
As she recovered, Soumilas began researching everything she could
about stillbirth, and one thing struck her. A symptom of placental
abruption is decreased fetal movement, and two days before losing her
baby, she’d reported to doctors that she hadn’t felt much movement.
“I was told lay on my side, drink some juice, see if he perks up. So I
did that,” she said. “I was told, ‘His due date’s almost here; he’s
probably settling down for birth.’ And that doesn’t happen. They don’t
stop moving.
“If I would have been … tracking his patterns, then I would have
known something had changed. If I would have gone in two days before, he
would have been alive.”
Soumilas eventually discovered a campaign called Count the Kicks,
dedicated to teaching expectant mothers about fetal movement and
tracking the health of their unborn children. The effort grew out of the
nonprofit Healthy Birth Day, started in 2008 in Iowa by five mothers
who all lost daughters to stillbirth or infant death.
Working with state health agencies, the organization provides a free
app or paper chart to help expectant mothers track their babies’
movements during the third trimester so that if they detect any
unexpected changes, they can seek help immediately.
The campaign, already in 14 states, is expanding this month to Arizona. The Arizona Department of Health Services is partnering with
Count the Kicks to get educational materials in multiple languages to
health providers, birthing centers and others who are part of an
expectant mom’s journey.
“Too many people think that stillbirth can’t be prevented. We
strongly disagree,” said Emily Price, executive director of Count the
Kicks. In 2010, Price noticed her baby’s movements had slowed, but
because she had been tracking them, she alerted her doctor and her son,
Hayden, was born healthy.
Stillbirth is the death of a fetus at 20 or more weeks during
pregnancy. Causes may include infections, birth defects, lifestyle, or
problems with the umbilical cord or placenta, as Soumilas experienced.
Stillbirths have decreased in the U.S. over the past 15 years. Nevertheless, nearly 22,000 were recorded in 2019, according to data from the Centers for Disease Control and Prevention.
Mothers most at risk include Black women, those 35 and older, women
who smoke during pregnancy and those with such medical conditions as
diabetes and obesity. But they aren’t alone.
“Hispanic women are at greater risk,” Price said. “Indigenous women
are at greater risk. And it is completely unacceptable that in 2022, we
are losing babies to stillbirth at the rate that we are.”
New research also shows that women sick with COVID-19 at the time of delivery face greater risk of stillbirth. One CDC study
found that among 1,249,634 deliveries in March 2020 through September
2021, stillbirths occurred in 0.65% of deliveries. But among those with
COVID-19 at the time of delivery, the stillbirth rate was 1.26%.
Arizona recorded nearly 500 stillbirths in 2019, the latest data available, with clear disparities among women of color.
“It’s a much larger problem in American Indian communities, as well
as African American communities,” said Angie Lorenzo, who heads the
office of women’s health at the state Department of Health Services.
“Those are the two largest hit by this.”
Experts examining such disparities note that in many cases,
a cause of death isn’t even documented, but they point to aggravating
factors that include access to good health care, institutional bias and
differences in health care before and during pregnancy.
“Racial disparities definitely persist,” said Stephaney Moody, health
equity coordinator at Count the Kicks. “We’re not having the
conversations. It’s not an easy one to have, but it’s one that I’m not
afraid of doing.”
Warning signs – and solutions
Although lack of fetal movement is one warning sign of potential
problems, experts disagree on whether counting kicks directly correlates
to any decrease in stillbirths.
A 2009 study
in the journal BMC Pregnancy Childbirth that reviewed previous research
on fetal movement monitoring found some evidence of impact on
stillbirths in high-risk pregnancies, but it recommended more study be
done to determine the effect of universal fetal movement monitoring.
Another review in 2021
agreed that more study is necessary to evaluate the effectiveness of
various methods of monitoring fetal movement, but it noted that “fetal
movement count monitoring is a low-cost and low-tech method that has the
potential to prevent worsening problems with unborn babies and merits
the attention of providers and pregnant women.”
Count the Kicks is undertaking its own research
as well. Researchers at Des Moines University and the Harkin Institute
for Public Policy & Citizen Engagement surveyed 809 women who used
the Count the Kicks app and determined that users increased their
knowledge of movement patterns and were more likely to be seen by a
doctor for decreased fetal movement.
The app that Count the Kicks developed works with expectant moms to
track how long it takes to feel 10 movements, including kicking and
rolling. Count the Kicks has also developed a paper form to track
movements and average them out.
“Every baby and every pregnancy is different,” Moody said. “Maybe it
would take my baby 10 minutes to get the 10 kicks … but it takes your
baby 45 minutes. The key is knowing what is ‘normal.’”
In Arizona, the health department and Count the Kicks are working to
specifically target underserved communities and women of color.
Materials are available in English and Spanish, and Moody and Lorenzo
said the goal is to provide brochures, posters and app reminder cards in
Navajo as well.
The Department of Health Services is partnering with Diné College on
the Navajo Nation and South Phoenix Healthy Start, a provider to women
of color, to help spread word of the effort.
Moody said she hopes to see a drop in stillbirths in the state by
introducing the program to “not only expecting parents, but also to the
maternal health workers and providers that are in the state.”
Honoring Zach
After volunteering with Count the Kicks, Soumilas now represents
Arizona as an ambassador for the organization – to share her story and
spread awareness of the campaign. She connects with groups and hospitals
that treat pregnant women, and is heartened that the partnership with
AZDHS will bring added attention.
Today, Soumilas, 48, lives in Prescott with her husband, Theo, and 13-year-old son, Ian. But Zach is always in her heart.
“It will always be hard to know that Zach is supposed to be right by
Ian’s side during all of our memorable family moments,” she said. “When I
was pregnant with Zach, I felt a sense of peace that they would always
have each other in life.”
And every day, she works to honor her son through her work with Count the Kicks.
“If you do see a change, you’ve got to speak up… Don’t wait until
tomorrow,” she said. “Having that conversation is extremely important
for women to know that you’re the one that’s empowered to do this for
you.”
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