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Welcome back to the pod. I'm so excited to have our new guest here for the first time. We have Sarah Coleman. Sarah with an H. We've already predetermined that we are spelling Sarah the correct way. Sarah Coleman is here from Count the Kicks. And I am so excited to have a conversation about fetal kick counts. I feel like in my practice, it's always been something that I've taught prenatally in like a child birth class and something that you you do to assess fetal well-being. And yet I also know that at the bedside I have also heard particularly I will say I think probably more from doctors than anything that well it doesn't matter. It's not a thing like it skip it. And so we're going to get into all of that. But before we do that I'm going to have Sarah introduce herself and tell us a little bit about Count the Kicks. I'd love to do that. Thanks for having me. I really appreciate being here. Um I started out so I uh um started out in nursing school um in the late 90s and actually my familiarity with uh kick counting was the golden rule was 10 movements in two hours. Um and I know some people still really really hold on to that and I'm sure we're going to get into that. Um but I was drawn to maternal health right away. Um, I had an experience that allowed me to um, be present in a nursery at a very young age before I graduated high school and it kind of pusher in um, you know, a mother baby and I knew from that moment that that's where I wanted to be. Um, that nurse, the compassion, the things that were happening there just really kind of lit a fire under my butt. And then in nursing school, I had the opportunity to do um a clinical in um labor and delivery. I can still remember my very first birth. I ended up on the outside of the door almost about to pass off, you know. Um so fun there, but it didn't deter me. And I did a special project learning about doulas. So this would have been in the late 90s when doulas were kind of getting around um and we were starting to learn how important they were to birth. that just kind of continued a fire for me. I actually um stopped and took some time off to have a family and um that kind of I never wanted to let go of the maternal health stuff. I was on the Kappa board of directors. Um I worked with them in an education space and really just had a lot of fun opportunities. I ended up in the education sector. I taught high school health for a while. I worked in Denver as the health education administrator for the school district there and during the pandemic I did an MPH which again was so maternal health laden and that opportunity after I graduated in 2023 put me here at healthy birthday and so it's a little bit kind of about a background for me the work that I do at healthy birthday really allows me to focus on kind of that education skill which I love I love to be in this seat talking about things with folks um and helping them understand and just hear a different perspective. So that's the work that I do at Healthy Birthday. And that's just a little bit about me. Oh, I'm in Montana. You should know that. I'm in Montana. So everyone be jealous. Yeah. I live in such a wonderful state. I mean Montana I have family in Montana and Montana is a beautiful state. I can attest. Yeah. Especially coming from Los Angeles where I'm like dealing with traffic and concrete and desert. When we get rain, we're like, "Oh, it's green." Yeah. So [laughter] nice. Let me tell you a little bit about Count the Kicks and how we got started. Is that okay? I would love that. So Count the Kicks is a program that started out of Silver um experience that five moms here in Iowa. Well, I guess in Iowa, I'm in in Montana, but yeah, these five moms in Iowa um all connected through social circles after losing their daughters um to still birth and early infant loss in one case. And they as they got to know each other, spent time with their families, one thing that they determined was that this shouldn't happen. Um there were too many similarities in their stories and they really felt like they wanted to do something to prevent other families from experiencing what they had. And so they kind of got down the rabbit hole of research. They started looking like there's no education out there about this uh fetal movement, which was kind of a a thread for them that they noticed that in particular Tiffen, one of our founders, I share her story in every webinar I do. One of the things that she pointed out is that she was experiencing um no no movement and she went in she was seen and triaged and um they didn't talk about movement with her and she felt like the next morning they went in and there was no heartbeat for her daughter Meline and she was just overcome like why didn't anybody tell me you know anything about movement I should have been tracking movement and that was kind of the the undercurrent that she was picking up on and that that these movements didn't weren't existing for Meline and and why didn't she know and h how how did she go into triage and you know all of a sudden her baby is not here the next morning and so this was kind of um the same story for the other four moms in this experience they started to set out look for education they weren't finding anything and they also felt like no one was talking about this so they came across something that we refer to as the Norway study um this is a clinical uh study that was done and the primary researcher is Dr. Ruth Rretz. Um Dr. Fretz sits on our medical advisory board today and what the you know I'm going to break this down really quickly for you, but what the study looked at was can we reduce still birth by educating these parents, these expectant parents on how to monitor movement every single day. We're paying attention to what's normal for that baby. And then if we notice something they were taught, right? You know, you're writing it down, you're journaling it, you're tracking it, and if you get outside of this normal that's been established for you in the third trimester, get with that provider right away. So, what they saw was a reduction of the silver rate that is 30% in this cohort, which is significant. So, our founders saw this research um and got in contact with Dr. Frz and then set forward with a plan to provide education in Iowa. So that became the count the kicks campaign. They um filed for a nonprofit status in 2009 and the campaign was born. Um and so one of the benefits that they had in Iowa is a strong relationship with the University of Iowa and the Iowa Department of Public Health which caught on to this campaign and that led to kind of an adoption within the state. And what they saw was a reduction in the still birth rate across um this this time period, a specific time period. They've seen a 30% reduction in the still birth rate. Can we attribute that completely to Calic? Absolutely not. But we like to say that this is a large large factor in what's happening. Um and that's really important and that's kind of how our campaign got started. And as other states were seeing what was happening and information was being shared by providers, it caught on into other states. And so what we have today, we have 34 states that are participating in Count the Kicks information and providing it to all expectant families. Um providers are able to order materials for completely free in these states and we provide education to them and just work with communities. we try and work across providers and you know um really look at uh the cultural adaptation of the work as well as we look at different populations that we're serving because disparities exist. Um the reality is is that still birth does not impact all populations in the same way. And so we're really cognizant of that and we're really making sure that we listen to communities about how they feel about this education and and how how this fits into what they do. So, you said that there are 34 states involved with the Count the Kicks campaign. What does it take for a state to be involved and what does like the roll out look like? Because I'm also imagining that some of this feels like an undercurrent of a cultural change in maternity care. adding this in into like the norms because if it's not a part of the norms, there has to be almost like a workflow change or like it's not a full workflow change but at least an educational shift um in a large quantity of I'm thinking providers is probably where they're getting this from, right? Like in the clinics and so how have you guys gone about that and what does it look like? Yeah. To roll it out. Yeah. And this is the work that I'm involved in. So these states typically what's needed is a funer to make the materials free to ship them for free to provide the education. So something like a webinar that I do. Um so we contract with a state sometimes we contract with an MCO um to make those materials free and to provide information about the campaign. um we go about uh we have a community impact manager and she works to kind of what are the links that we have in the community but then we also lean into the providers because you're absolutely right if we don't have provider buyin and when I say provider we're talking OB's we're talking midwives we're talking nurses though if we don't have that buy in it's really difficult right to to have this change one of the big pieces that we've had happen for us in the last 18 months is the A1 algorithm. So we have the opportunity to have this CE module um changes in fetal movement patterns. Um and that has been really beneficial for us because that A1 is saying yes, we believe in fetal movement monitoring. We believe in the research behind this. they've put their stamp of approval on it and then we're able to turn around and on provide that to providers in these states as a part of the education that we do. Uh we make these course codes available uh to folks to take that and to learn from that. And it's not just nurses that can take it. I know we're here for nurses and I'm pro nurse. Um but everybody should really be educated about fetal movement, right? like this conversation needs to be happening in every space that uh a pregnant patient is entering in. It really really does matter. It absolutely we need that provider buyin and we work really hard on that. Um misconceptions, they're rampant. You know, we have to kind of work on that and we have to work in spaces where people hold on to kind of older ideology and they're not quite ready to give up on it or they're concerned about the impact. if we have, you know, all these people concerned about the this movement, are they going to come in at, you know, and and overwhelm our systems that are already very much impacted? And we understand that. So, our, you know, our our mission is really to get the right mom in at the right time. And the only way that that we how we are concerned with fetal movement monitoring to do that is for someone to understand what's their normal, you know, what is their normal when it comes to their baby's movement pattern. And guess who knows that? Mom, right? Mom's the one who knows. So, we have to lean into that. So, that's kind of where I sit. Obviously, [laughter] that's my opinion around kind of making that change. But, that's a huge moment for us. um a that that algorithm that seeks to re-educate and re-emphasize the importance of a structured guidance around how are we responding if somebody comes in here to triage but I think the component that I really want to make sure that um as we're talking today it's not just triage nurses that need to know it's not just that bedside nurse that needs to know it's those clinic nurses that are going to have contact and we hope we hope that people are getting pren prenatal care, right? Who is having that contact prenatally um with those patients because that's where it that's where we really need people to initiate those conversations. We need them to have buy in so that as right away as someone is presenting and they're pregnant, like even in that first trimester, hey, down the road, you're going to want to pay attention to these movements. And there's these great opportunities to track movement and there's some tools that can help you do that. But like just having those conversations early and often is really important because you you know those bedside nurses, triage nurses, you're critical and and yes, if somebody's not tracking, we want you to teach that, but we got to have it prenatally. Yep. Totally. Totally. So, let's say I'm a patient and I am you're my you're my triage nurse. Let's go with triage nurse. And I come in at 32 weeks because I have a headache and blurry vision. They're ruling out preeacclampsia and I don't have preeclampsia by the way. I'm actually healthy and I just was a little dehydrated. I got a bololis in triage and I'm feeling better. And you're doing your discharge education but you are a expert in count the kicks information. And so what would be your form of discharge sort of training for me at 32 weeks? Um, and like what would you say to a patient? Yeah. Well, I'm going to need to know, are they counting before? Do they even know about I don't even know anything about what the heck you're talking about actually. Yeah. So, a really great way for you to get to know your baby and for you to kind of keep tabs on your baby is to understand how they are moving every single day. What is that normal pattern for you? So, there's an opportunity for you to track those movements. And you may have heard about kick counting in other spaces before. We really want you to pay attention to all movements because we want you to get to know what feels normal for your baby, what time of day that's occurring. Um, and so one of the best ways that you can do that is to pay attention. Pick a time when you know baby is usually active. And the way it's usually when you're you're you know getting ready for bed sometimes that obviously you know when you need sleep your baby's really active. So just laying down and paying attention to your baby. Take a look at the clock. See how much time it takes for your baby to get to those 10 movements. And then repeat that every single night until you deliver. We want you to pay attention every single day. So you may find that you're at 15 minutes. You may find that you're at 22 minutes. But what's your baby's normal? But where are they falling? There's, you know, a great tool. You can use the Countakes app completely free to track those movements. You can write it down in a journal. But we want you to understand what's normal for your baby. And then if you notice one day that you haven't felt baby move in the same way or baby is moving really fast and it's different than what you normally experience, we want you to come back right away. We want you to let us assess you. We want to understand that you and your baby are okay. So try that one out and think of it as a bonding activity for you and baby. And if you have a partner at home that wants to get involved, have them be the timer. You know, this is an activity you can do to not only bond with your baby, but to bond with the people who are going to help you birth and be a parent. So I heard this nurse tell me that if I didn't feel my baby move for a little bit that I heard this thing about like juice or ice water. Is that something I should also do before I come in? No, we want you to just come right away. We want to see baby without you doing anything. We want to not delay care and we also want to see what's going on with baby before we introduce something. We we introduce a change that could affect that pattern because baby may perk up for a little while, but that's not what that's kind of going to mask what may really be going on. So, come see us right away. Don't do any of that. Don't go get a candy bar. Don't go drink Dr. Pepper. Just come in and see us right away. So, let's say I've been doing this for like a week and I know and I kind of know already because I know my baby and my baby is definitely most active at night between like 8 and 900 p.m. And I've been doing this, but I feel like I it took me it took me like an hour to get to the 10 kicks, but normally it would take about 15 minutes. Is that a reason to come in? That is definitely a reason to come in. That's not your normal pattern. You did it for a week. We want you to keep doing it, but we do want to evaluate you. We want to make sure everything looks good. So, when you go from 15 minutes to 60 minutes, that's a big difference. Also, we want to think about as you're tracking those baby's movements, how hard are those movements? Like, how what's the strength of them? Is it normally like a fluttery feeling and then all of a sudden it's like real jabs and it's really furious kind of feeling? That may be something that uh may indicate something needs to be looked at with you and baby. So again, we just want you to come in and your intuition. We always want to respect your intuition. We always want to respect your voice. We want you to know, we will listen to you and your concern and we we will come, we will look at you with the tools that we have and we will make sure we're on the same page as far as your baby is concerned. We'll make sure that we can see your baby, hear your baby, and if if there's something to be looked at, we're going to make sure we take care of that, too. What I think is fascinating about this is sort of like I'm thinking about all the things that I have heard as a nurse on like how to train, how to how to talk about it. Decreased fetal movement. We know or at least I was taught in triage. If somebody comes in with decreased fetal movement, like I'm like, "Okay, hello. Let's sit you down and let's get you on the monitor immediately." Like there's no like chitchat, change in the bathroom, blah blah blah dlay, delay. It's you want to be taking those and seeing those clients right away. Um, you know, but I think as far as mis misconceptions, do you want to speak to some of the misconceptions that you hear in education in our training and some and like sort of set us straight on what's best practice for all of this? One of them I is why I brought it up is like the juice thing. I mean, I've said that, you know, but I think as I'm thinking about it, I'm like, you're right. It's sort of like we don't want to mask a fever in labor by, you know, cooling them off and throwing ice packs everywhere. If they have a fever and an infection, we want to treat the infection, you know, right? And that's the big one for me, like I I think we have talked about a couple misconceptions here, but let's go back and pick them up. But the big one for me with the juice or you're changing how you're masking like at the end of the day, you're masking. Like if you were to look at this from a research lens, you've changed a variable, right? And so you may fix the problem for a little bit, but in an hour or two, we're back to the same problem if that's the problem, right, with baby. So the other the the one that you know in the A1 pathway they talk about delay in care right and that's and what you spoke to the chitchat now you can do that while you get somebody on the monitor efficiently right of course right but but like you said let's not go down the hall and pick out our juice before we come back that you're going to have after the NSD that you know like all those things right so I think that that is something for me that I have leaned into is that change in that normal pattern and then you've gone and introduced another change, right? And so how do we how do we efficiently quickly diagnose and get to the root of the problem if you've changed a variable, right? So, but the delay in care is also one of those one of those things that's related to that. We've we've heard things like rubbing ice on the belly and I think like you were going there with that like we had somebody in a southeast state a nurse uh was you know said okay well let's get the ice bucket out and start rubbing your belly down and see if we can get baby to respond. Well you know baby may respond but is that truly a representation of what's really going on? Like absolutely not. Yeah. You know, other misconceptions we hear are 10 and two. And this is a big one that we kind of fight a little bit to get some ground on with some providers, not all, but with some providers, they really hold to that, right? So, what if someone's normal is normally six to eight minutes and then they go 10 and two? Sorry, I don't know what 10 movements in two hours. Oh, got it. Okay. 10 and two. Y So, what if someone's much quicker than two hours and they're, you know, six to eight minutes. I was at a baby shower and this woman came up and she was like, "I'm four minutes flat." She showed me the app and I was like, "Wow." You know, she really was quick. Um, you know, also depends on time of day, all those things. All those things, right? You're normal. So, if you're sitting there and you always count at 5:00 p.m. and at 5:00 p.m. you're done by 5:12 and now it's 5:55. Like, but okay, in my head I've got two hours to make these 10 movements happen. Well, what happens if it's too late? You know, that's that is the worst outcome that you can have as a nurse and a provider, right? Is someone who comes in and there is not a heartbeat. That that's what we do not want to have. So for us, our perspective leaning into the research is get to know what your baby's normal is instead. Right? knowing what your baby's normal is. If you have a deviation in that pattern, you get it checked out. That's the that's kind of where we hold some ground and we and we speak to the individuality of a pregnancy. Every baby's different. Every baby's impact on mom is different. And so why would we hold to this standard of 10 and two if everybody's different, right? Why not just lean into what's my baby's normal? But but owning that, you have to establish what your baby's normal is by investigating, paying attention, and tracking. I think my biggest question is, and I I admit I've never been pregnant. I've been around a lot of pregnant people, but is it from the research like pregnancy to pregnancy that babies follow the exact same pattern all the time? I what I'm fearful of and I'm sure you've gotten this before is like I'm hearing the nurse in my brain going we're going to have 600 patients a day with decreased fetal movement and yet at the same time how do you balance the fact that we do want to catch them like I fully agree with you that like let's get them in let's get them checked out and if you catch one of every 50 that's great does every baby follow the exact same pattern every single day of movement. Yes, that's why we track every single day because the longer the more data that we have that shows us, oh, look at that. I'm within I'm in with 12 to 14 patterns. And that's kind of the beauty of the count that kicks up is when you are a registered user, you see a trend line like you get a graph representation when you're done. And so you get this trend line. And so that I think to answer your question is the research does show us the app that we have like the data that we have from all these moms is backing that up as well that they're get there begins to be an established normal after several days and that's what we want parents to lean into is knowing that normal for that baby. Does that make sense? Yeah. And then the app will also show you like hey alert this is abnormal for you. No, because that's a legal thing. Okay, that totally right. No, but but so that is on the onus of that that parent who's monitoring it to go, "Oh my gosh, you know, normally I'm 12, 14 minutes and here I'm sitting at 37 minutes." Like that seems like maybe it's a problem, right? Yeah. So, I hear what you're saying. I understand that. You know, the University of Iowa, tons and tons of births. That's where I was like tons and tons and tons of births and I recognize that that feels like a huge weight that we're going to get everybody on them, but the reality is we're not. So, we've worked with a hospital in Massachusetts. Um, and that hospital has been tracking patients as they've implemented this program at a very standard level across five facilities. And that program, the nurse midwife leader that that I work with, she has said they have not seen an increase. She's like, "We're running the same kind of standard. We are educating people." And the beauty of that is they can lean into what their normal is and they can worry a little bit less. And when they understand when a mom understands, okay, every day this is what I know to expect, there's a little less anxiety there, right? There's less anxiety if you know what to expect. And again, as I said in the beginning, we are focused on getting the right patient in at the right time. And and will there be aberrations? Absolutely. You know, there will be there will be the one clinic that sees an increase in that. But if we save the one out of 50, like you've said, we've saved a baby, right? We've saved a life. And I think that that and going back to our founders, if we're just saving one baby, we've saved one starfish. for our starfish viewers of our of our story around here. Yeah. Yeah. It's so true. I I think I understand the concern. I I absolutely understand that concern, especially where we're at. My daughter is in her nurse residency year. I understand where we are at as far as nurses are concerned and and the workforce. This is not meant to make your life harder. Um this is meant to get the right mom in at the right time, though. Mhm. How would you answer the naysayers out there? I'm thinking nurses ongoing, well, this will just cause more anxiety. You kind of touched on it, but I want to be really directive on that particular push back. Um that like, well, now you're just creating an issue and they're already anxious. Yeah. So, my my I would point to the evidence that we have. There are some research papers out there that the more we know, the less anxious that we are. If we understand a pattern, the less anxious we are. We can lean into what we know and we can be um what's the word I want to say affirmed. We can be affirmed in what we know and understand about our baby and our body. So for me, the research is clear out there. We have a post app survey when so people have the opportunity post pregnancy to say you know how was your experience with the app tell us a little bit about that and overwhelmingly the app users tell us this did not make me feel more anxious this actually helped me understand my baby and helped me understand how to come with a concern to my provider with evidence that I was concerned right because that's the other piece of this when somebody presents into obri like I think in my brain they present and we ask them as we're getting them on getting them strapped in. Tell me how your baby normally moves. Tell me when the last time your baby moves. Well, in their panic brain, if they have not been paying attention to movement, it either comes out, well, they move in time. No, or yeah, I don't know, which is why I'm here, right? And so talking them down like get it. Let's get you. Let's use our skills, our nurturing skills, our, you know, our conversation. Let's try and find out what do you know about your baby's movement and lean into that. But guess what? If they are monitoring every day, they're so far ahead in that conversation. Whose job does it make easier? Years as a nurse, right? Like, you know, okay, she says she's 12 to 14 minutes and we're at 37, like let's let's go ahead and and and document that. We're going to get on the NST. We're going to take a look at that. Do we need to advance? Yeah. you know, um, or is this are we going to reassure and we're all going to walk away, okay, thank you for here's what we want to do. And we go back to that conversation you and I had in the role play. You know, here's what we're going to do from this point forward. So, you are informed and you know what to expect. Y, that's the way we decrease anxiety. We know what to expect. Mhm. Well, and I'm thinking about like patient satisfaction and so much of patient satisfaction is linked to control and there's so much that you can't control in pregnancy, labor, birth, but what one of the things you can would be this is something you give them tangible that they're like doing their homework. You know, they go they put together a birth plan. That's one of the examples I use when I talk about birth plans that like what else can they do other than make a birth plan where they feel like they've come in and said, "Look, here's my homework. This is what I did. that I did my child birth class, the bundle birth class. I did my birth plan, and I've been doing my fetal kick counts, and here's the data that I have. First of all, we love data. I want to see that. Actually, I'm thinking like if I were to have somebody pull up their app and be like, "This is how my baby trends for movement that's come in for fetal movement." I'm like, "Heck yeah, that's amazing." And remember, it's not just that time of movement, it's also the strength of movement, which is another important piece of the puzzle, right? like how is your baby moving and what does that tell us? Like what do those frantic movements tell us? Well, is there a cord problem? You know, is is hypoxia happening? Because we've had some frantic movements and normally that's not what's going on, you know, or is baby super super super like I said fluttery and normally it's like getting after it. So, I think that that's another piece. The more information we have that we know, the better we can feel about that. One of the other myths that I hear is around anterior placenta or a patient that is obese. And um this is actually talked about explicitly in the A1 algorithm. There's, you know, a slide dedicated to this information. The reality is is that that patient may need to work a little bit harder to understand what those movements feel like. It's not that they're going to be completely absent, but you know, I have run into folks in my own community here in Montana who have said, you know, I have an anterior placenta and my provider told me don't do kick counts because it won't be worth it. And I have a little bit of an issue with that. The other thing about that is is that that is a like let's call it a bonding time or mindful time, whatever you want space for you to pay attention to baby. And so I think telling people that just because they have an anterior placenta or are obese they're not going to feel anything. That's not right. And it and again like thinking about that respectful care like yes don't take that opportunity away from them. You have then you have then taken that decision- making out of their hands by telling them that. So again they may need to work just a little bit harder to feel those movements. then you need to pay attention in a different way, but no less rewarding at the end of the day, right? And and saving space for that. Totally. What else do you want nurses to know? I mean, we've touched on a lot of things here and I believe that we need to, you know, Rose Horton is on our board and I love her. I know she was on your podcast. Um, she's coming back long ago. Oh, good, good. She might actually come before you, actually. So, those listening are like, "Yeah, she was here." But she was here. She was here in the space. Yeah. Yeah. So, I think, you know, Rose talks a lot about the five tenants and I think these definitely apply. This respectful care model when somebody comes in and tells you, we've all seen the stories in the news, right, of these moms that tell you they're in labor and then there's a video and you know that's not good. But when we treat people with dignity and respect, you you're concerned about your baby, then so am I. I want to hear about that. Tell me about how your baby normally moves as we're getting on the monitor. Tell me why you're concerned. What What is different today? And oh, your intuition is telling you something's wrong. Well, let's find what we can find to help you feel better about that, right? Like treating people with dignity and respect. And if they want a fetal movement monitor and you don't believe in that, treat them with dignity and respect because that's a piece of data that you don't have and they do. I feel very strongly about that. I am coming from a camp. Now, I'll be honest with you. I haven't been on the floor, [laughter] but if we allow patients to track their blood pressure and call it in and we treat that as a piece of data that we honor and respect and we ask them to check their blood sugars and call it in and monitor their insulin, why are we not going to believe them with fetal movement monitoring? Like that's a big one for me. I that's a big one that I struggle to understand because this is something that only mom can tell you is happening. And so why are we not believing them? So treating them with dignity and respect. Believing them when they tell us something is wrong. That goes into that intuition, right? I think then that shared decision making like this is what we're going to do. These are our options. this is what we can do following our algorithm that we have from Awan. Does that feel reasonable to you? Does that feel like this will help you feel better about your baby? You know, like sharing that decision- making and if they choose to do fetal movement monitoring like that's a decision. How do we support that? You know, like how can you make that possible for them if they express that they want to do that, normalize it, you know? And then I think the evidence, we've talked a little bit about the evidence. Of course, you know, we have links and all those things on our website to point to those articles. We're participating in research. We work with researchers. We're we we want to know more about it too as well, right? Like we want to be in we want to be curious about it. We want to learn from it so that we can forward the education, right? Like we want to be a part of the solution and improve these outcomes. you do that with evidence-based care. So, I think that's really important. And then efficac, you know, in my webinars, the call to action is, are you going to turn around and and teach your patients about this? Just what you did, that role play at the beginning and working with teams that are working alongside medical providers to really everybody's got to be saying the same message, right? Everybody's got to say, know what's normal for your baby. Everywhere you are as a pregnant person, you've got to hear that. I love it. Thank you so much. If nurses were looking to learn more, all this education you're talking about and the app and all that. So, how can nurses continue to learn and grow, continue to get better, continue to uplevel their care no matter what setting they're in, whether that be clinic hospital, you know, educator, child birth educator, doula even. What are the what are the opportunities that you guys provide? We have many things on our website and a lot of them are completely free. Um, we offer, you know, lots of links to the research. We offer talking points. We offer opportunities to learn. Every webinar that we do, we record. It's on our YouTube channel. So, somebody can go back and and sit with that. For nurses in particular, that A1 pathway, the algorithm is really great. So, we have that continuing ed education opportunity. In some states, this may be available to you. So, I'd encourage you to reach out to us if you see Count the Kicks materials are in your state. Reach out to us and ask. We may be able to hook you up with a code um depending on how those are being used. If not, they're very inexpensive and you get a CE off of that. So, I would just say, you know, that's another opportunity and that's our professional organization, right? Awan's the professional organization that we can lean into. So um where we get where we get our information is also really critical and if our professional organization is telling us hey this is what we need to lean into then I believe that we do our research so that we can be 100 100% behind them but like I said so many resources are on our website and I would say if there's something that you as a nurse are wondering like I wonder if they do this please just email us we have info@countthekicks.org or just go on our website and pick a person. We want to hear how this can be better for you, better utilized for you. We want to hear your experiences with it. Is there a way that we need to um adjust the messaging that we are doing or share things in a different way with different populations? How do we listen to them and make sure that that what they need is there? Like nurses are such an important key to that because we provide education, right? That's a big part of our job. Thank you so much for being here and offering all of us your wisdom and expertise in this. I feel like, you know, I I feel like kick counts maybe at like the at a at face value when you see that in the title or something, you're like, "Oh, okay." But I actually learned so much from you and I'm excited to continue to push into the resources that you offer. We will link everything down below, including the A1 algorithm that she's mentioned and any other links that you want to include, we will have in the show notes down below. Thank you so much for being here, Sarah. Thank you for having me. It's a pleasure and I am so thrilled to be a learner alongside everybody here. So, thank you. We're in it together. Thanks for spending your time with us during this episode of Happy Hour with Bundle Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to bundle nurses.com, subscribe to our email list, or follow us on Instagram. [music] Now, it's your turn to take what you learned today, apply it to your life, and go educate on fetal kick counts. Let's not miss this potentially lifesaving and controlgiving intervention in our education as we interact with patients and help them have the most positive healthy birth experience possible. We'll see you next time.