Fetal movement in late pregnancy – a content analysis of women’s experiences of how their unborn baby moved less or differently
We are not aware of any studies that have categorized how women describe the changes they have perceived concerning fetal movements when they seek health care due to worry about their unborn baby.
Women who consulted health care due to decrease fetal movements described changes in frequency, intensity, character and duration of the movements. However, all women in this study were reassured after an examination of their unborn baby. In Norway, as many as 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy [14]. In different populations, between four and 15 % consulted health care facilities because of decreased fetal movements in the third trimester [1]. There are several factors which may impair the ability to recognize fetal movements [8]. However, we have no data concerning amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this study. These factors may explain some of the women’s perceptions of decreased fetal movements. Also, the plateau in gestational week 32 [3] may be perceived as a decrease. In a study by Sheikh and colleagues (2014), 729 women counted and registered fetal movements for one hour three times per day. Eight percent of the pregnant women in the third trimester, who in the end gave birth to a healthy child, experienced reduced fetal movements. Further, the researchers found that among women who consulted health care for reduced fetal movements but later gave birth to a healthy child, more of them were working than those who did not perceive reduced fetal movements [18]. We do not have data as to work status among the women participating in our study.
Placental dysfunction is one main reason for decreased fetal movements in late pregnancy [19]. It is thus important for the pregnant women to recognize the pattern of movement. A change may be a sign of asphyxia due to the redistribution of the circulation which gives priority to the brain over peripheral parts [20]. All fetuses in the present study were examined and no symptoms of asphyxia or placental dysfunction were identified at the time when the woman consulted health care. The women’s worry about their unborn baby’s health due to decreased fetal movements in this study did not result in a diagnosis or actions to induce the delivery.
Our results indicate that some women at term seek health care due only to a change in the character of the fetal movements. Although these women were asked to describe how their baby had moved less or differently, they did not mention a decrease in frequency in the fetal movements or a change in intensity. Slow, as in slow motion, stretching and turning, are descriptions of the character of fetal movements used by women in full term pregnancy, pregnancies that resulted in a healthy child [7]. The women in our study who consulted health care merely due to a change in the character of the movements and not because of altered frequency and intensity might not have been aware of normal changes in the fetal movement patterns in late pregnancy. The changes they reported as different can be physiological due to limited space in the uterus at term [3]. There is no routine in Swedish antenatal health care for giving information about fetal movements but women are recommended to consult health care if they experience decreased fetal movements [21]. However, pregnant women ask for information about fetal movements in general and for information about the number and type of fetal movements they can expect, as well as how the movements are supposed to change over time in pregnancy [22].
There were no stillbirths among the women in this study. Thus, we can only speculate that it is possible that women who consult health care due to decreased or changed patterns of fetal movement may be aware of the importance of detecting fetuses at risk as early as possible. Detection of decreased fetal movements can improve the outcome and reduce delay in consulting health care [23, 24]. Further, the fetuses in this study who could be at risk were examined and risk factors such as placental abruptions, growth retardation or malformations [25] may have been detected. The primary reason for consulting health care due to decreased fetal movements is worry about the health of the baby [14]. None of the women in our study consulted health care without cause, but their worry was obviously unfounded from a medical perspective in the short term.
Strengths and limitations
Women in this study had a normal CTG before they completed the questionnaire. However, aside from no stillbirths among the participating women, we have no data regarding the health status of the baby after birth. This is a major limitation of the study. There is also only sparse information about the women’s’ sociodemographic background.
One strength of the study is the large number of participants. Another strength is that all delivery wards in Stockholm participated in the study. However, all women came from the capital city in Sweden where women in generally are older and well educated compared with women outside the capital. Further, the number of those who declined to participate and their reasons for doing so are not known.
The wording of the request, “Try to describe how your baby has moved less or had changes in movement” might have influenced the responders to use the words “decreased” and “differently” in their descriptions of their experiences. The results may have yielded even more if the initial request had been broader or more open, for example, “Try to describe how your baby has moved”. However, the context in which the women completed the questionnaire was one of already perceived decreased fetal movements.
Clinical implications
Increased knowledge about the normal changes in the fetal movement patterns in late pregnancy can be one way to lessen the number of visits to obstetric clinics from women over concerns that turn out to be unnecessary from a medical perspective. The challenge from a clinical perspective is to inform and advise pregnant women about fetal movements with the goal of diminishing the length of pre-hospital delay if the fetus is at risk and at the same time reduce worry leading to unnecessary consultation. Reducing the pre-hospital delay when the intrauterine environment is a threat to the unborn baby’s life will provide a window of opportunity to save a greater number of children from death or compromised health. Further, fewer visits to obstetric clinics, over concern that turns out to be unnecessary from a medical perspective, will have health economic benefits. Before giving definitive advice that can reduce unnecessary controls at the end of the pregnancy, distinct differences must be identified regarding how women who lost their child intrauterine or have given birth to a hypoxic or anaemic child, report the changes in character of movements as only symptoms when they seek care for decreased fetal movements. Future studies are needed.