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Fetal movement in late pregnancy – a content analysis of women's experiences of how their unborn baby moved less or differently
BMC Pregnancy and Childbirth volume 16, Article number:127 (2016) Cite this commodity
Abstract
Background
Meaning women sometimes worry about their unborn baby'south health, often due to decreased fetal movements. The aim of this report was to examine how women, who consulted health care due to decreased fetal movements, depict how the baby had moved less or differently.
Methods
Women were recruited from all vii delivery wards in Stockholm, Sweden, during one/1 – 31/12 2014. The women completed a questionnaire after information technology was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women's responses to, "Endeavour to describe how your baby has moved less or had changes in movement".
Results
Iv categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (changed pattern of movements, slower movements) and "Duration". In add-on to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed blueprint of fetal movements.
Decision
Women reported changes in fetal move apropos frequency, intensity, character and elapsing. The challenge from a clinical perspective is to inform pregnant women nearly fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital filibuster if the fetus is at risk of fetal compromise.
Trial registration
Non applicable.
Peer Review reports
Background
It is widely acknowledged that a pattern of regular movements is associated with fetal wellbeing [1]. Fetal movements tin can be defined every bit whatsoever discrete kick, flutter, swish or gyre and are ordinarily first perceived past the mother between 18 and 20 weeks of gestation [2]. The frequency of fetal movements reaches a plateau in gestational calendar week 32 and stays at that level until birth [3]. There is ordinarily a variation in fetal movements with a broad range in the number of movements per 60 minutes [4]. The movements are normally absent during sleep and occur regularly throughout the 24-hour interval and nighttime, ordinarily lasting for twenty–xl min. The slumber cycles rarely exceed ninety min in the normal and good for you fetus [5]. Although the motion pattern of the private fetus is unique, it is general knowledge that decreased fetal movement is associated with adverse outcome, including stillbirth [6].
The character of the movements changes when the pregnancy approaches delivery due to limited space in the uterus, but the frequency and intensity will not commonly decrease [3]. In an interview study, twoscore term pregnant women with an outcome of a healthy baby described fetal movements during the past calendar week. Almost all experienced fetal movements as "strong and powerful". One-half of the women also described the movements equally "large" (involving the whole trunk of the fetus). Another common description was "tedious" as in "wearisome motion" and "stretching" or "turning". Some of the women stated that they were surprised how powerfully the fetus moved [7].
Several maternal factors may impair the power to recognize fetal movement [8]. Amniotic fluid book [9], fetal position [10], having an inductive placenta [10, xi], smoking, existence overweight [6] and nulliparity [half dozen, 12] take been reported as such factors. Maternal factors which may heighten the ability to recognize motility are the opportunity to focus on the fetus and the absence of distracting noises [xiii]. About l % of the pregnant women in a written report from Kingdom of norway were sometimes worried about decreased fetal movements [14]. In a review commodity, it was found that betwixt four and fifteen pct of pregnant women consult health care because of a decrease in fetal motility in the tertiary trimester [1]. The aim of the present report was to examine how women, who consulted health care due to decreased fetal movements later gestational week 28, describe how the baby had moved less or differently.
Methods
Settings and participants
Women were recruited from all seven commitment wards in Stockholm, Sweden from 1st Jan to 31st December 2014, and were asked to complete a questionnaire. The inclusion criteria were women in gestational week 28 or more who consulted health care due to concerns over decreased fetal movements, with the ability to understand Swedish or English and a normal cardiotocography (CTG). Non responders, inadequate answers, multiple pregnancies, undefined gestational calendar week and unknown personal identity number were exclusion criteria (Fig. ane). In total, 3555 questionnaires were completed during the data collection period. Data collection was in progress while the first m questionnaires were analysed. Twenty-eight women completed two questionnaires and three women filled in iii questionnaires; they consulted health intendance more once during the data collection period due to concerns over decreased fetal movements. Of the women, 672 (76.7 %) were aged twenty–35 years, 582 (66.4 %) had a college or university level of education and 650 (74.ii %) of the women were born in Sweden (Table 1). All women gave nascence to a live kid.
Menses chart
Information collection
The questionnaire used in the study was developed from a spider web survey, an interview report [7, 15] and clinical feel. The questionnaire was face-to-face validated with ten women who consulted health care due to reduced fetal movements, not included in the report. The final version of the questionnaire included a total of 22 questions with multiple-selection or open-concluded response alternatives (Additional file 1). This written report comprises the women'due south responses to the request: "Try to depict how your baby has moved less or had changes in move". The women were asked to describe their experiences in the space provided but could too, if necessary, continue on the back of the questionnaire.
Assay
The women's descriptions (n = 876) of how their unborn babe had moved less or differently were analysed using a modified content analysis [16]. The cloth consisted of concise descriptions of movements, which were used without editing. The assay was performed in 3 steps. Firstly, all the answers were read and re-read three times to gain a sense of content in the data. Codes were then revealed in accord with Malterud. Every quotation was read and sorted into codes. In the second phase of the analysis the material was organized. Units, the quotations, with the same code were divided into defined main categories and categories. When appropriate the categories were divided into subcategories [17] The quotations could exist placed in more than 1 category. However, each statement was only placed in 1 subcategory. During the whole process the findings were continually discussed in the research group in club to reach agreement. To validate the results, a sample of l quotations was randomly selected and re-analysed from the first of the analysis process. Afterwards consensus had been reached some of the quotations were transferred to other subcategories and iii quotations were accounted irrelevant and removed. Those conveying out the analysis did not know the gestational week.
Results
Four principal categories and 6 subcategories were identified: "Frequency" (decreased frequency, absence of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Grapheme" (inverse design of movements, slower movements) and "Duration". The number in each category and subcategory as well as an presentation of the figures for women seeking health care in gestational week 28–32, gestational week 33–36 and during gestational week 37+, are shown in Table 2.
Frequency
The most ordinarily experienced deviation of fetal movements concerned frequency, which was described in 746 (85 %) of the questionnaires. This category was divided into two subcategories; "Decreased frequency" and "Absence of kicks and movement".
Decreased frequency of fetal movement
This subcategory comprises 609 (69 %) statements. These statements referred to movements condign less frequent and indicating to the women a more often than not decreased liveliness in the fetus. The movements were described with words like, "a few", "seldom", "less frequent", "not every bit many" and "decreased activity".
"Less frequent during the day"
"From being very active and kicking a lot to very few movements during some days"
Absenteeism of kicks and move
Among the answers about the frequency of fetal movements, 137 (16 %) statements were about not feeling any move at all.
"I haven't felt any kicking for well-nigh 12 hours"
"Have non felt any movement during the whole day"
Intensity
A total of 343 (39 %) responses were perceptions that the movements had altered in intensity. Two subcategories were formed: "Weaker movements" and "Indistinct movements".
Weaker fetal movements
This subcategory comprised 277 (32 %) statements. Words frequently used were: "Weaker", "Softer", "Less sharp" and "With less power".
"From obvious, strong movements and nudging to feathery tickling a few times a day"
"… The movements of the infant felt weaker the few times I have felt my baby"
Indistinct fetal movements
Sixty-vi (viii %) statements fell into this subcategory. Some women were uncertain as to whether they felt anything at all only thought they could imagine movements.
"…The simply thing I felt was non-specific movements deep inside my tum…"
"Have previously felt apparent kicks which can be both felt and seen distinctly. Since yesterday evening simply pocket-sized occasionally twisting movements"
Character
This category comprised 252 (29 %) statements describing experiences of the fetal movements changing in character. The category revealed two subcategories: "Changed pattern of movements" and "Slower movements".
Changed pattern of movements
This subcategory comprised 141 (xvi %) statements. The women described the fetal movements as having inverse in pattern and decreased in activity.
"Not the aforementioned pattern of movements as before and non active at the same time"
"The babe has not moved at the times that she had moved earlier, following the pattern that she had previously. This has been going on for most 2 days. When she has moved, the movements felt weaker the by two days compared to earlier."
Slower movements
This subcategory included 111 (13 %) statements. When talking nearly the movements women used words such every bit: "sluggish", "indolent", "slow and sweeping".
"Calmer more tired movements equally if it were tired…"
"Slow and smoother movements"
Duration
Thirty-eight (iv %) were included in this category. Women reported that the periods of movement had become shorter and had been reduced from several kicks in a row to occasional ones. Nonetheless, the frequency of how often the baby had moved had non decreased.
"… the periods when it has moved have been shorter"
"No more than lively periods."
Differences according to gestational age
Women in gestational weeks 33–36 experienced changes more than oft than women at term regarding the category Frequency (92 % vs. 81 %), the subcategory Decreased frequency (75 % vs. 67 %), and the category Intensity (42 % vs. 35 %). Compared to women at term, those in gestational weeks 28–32 expressed changes to a bottom extent within the category Character and the subcategory Slower movements (v % vs. xv %) (Table ii).
Iv percent, 32/876, of the full number of women in this study only stated a change in the grapheme of the movements, not included in any other category. The distribution regarding length of pregnancy was; gestational week 28–32, ane/190 (0.v %), 33–36, one/263 (0.4 %) and gestational weeks 37+, xxx/423 (7 %). There were no statistically pregnant differences in the other categories (Not in table).
In addition to the responses categorised in accordance with the question, the women besides mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.
Stimulation due to less movement
We identified 146 (17 %) statements about trying to provoke movement by triggering the fetus. About of the women reported that they did this when not having felt movements for a while. When they did non succeed they consulted health care. The methods used to trigger movements were to pull, nudge or button on the tummy, stimulate with lite or noise, take a shower or bath or to beverage cold, sweet drinks. Others said that they had diverse positions they used to experience the baby more than distinctly. Some women described not feeling movements without stimulating the baby.
"No pushes" back when I am pulling on the breadbasket, no reaction when drinking a drinking glass of lemonade. Otherwise he has been quite active and y'all take been able to run into my tummy moving"
"Even if I bear on my tum, eat, drink, there is not much departure. He is moving considerably less"
Difficult to distinguish fetal movements from contractions
The women stated that the fetal movements ceased or inverse in relation to contractions or that it was difficult to distinguish movements from contractions. Some women also described that the movements decreased in relation to contractions, pain in the tummy or the dorsum. We identified forty statements (5 %) concerning difficulties in distinguishing fetal movements from contractions.
"Not felt whatsoever movements since the contractions became more intensive"
"It has been more than difficult to perceive movements. Difficult to distinguish movements from contractions… previously the movements accept been very distinct"
Worry due to incidents related to changed design of fetal movements
We identified 25 (3 %) statements well-nigh external factors, such as the adult female was sick and perceived less fetal movement. Half-dozen women stated that they consulted health intendance due to pain in relation to changed patterns of fetal movement. 2 statements referred to the adult female having taken a autumn and wanting to be reassured that the fetus had not been damaged. Other reasons related to increased worry were: postal service maturity, following an expelled fungus plug, an external cephalic version effort, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to move a lot during both mean solar day and dark. Have been ill with fever for three days and so there have been movements four–5 times every twenty-four hours"
"Not as oftentimes as before but I still experience him daily. We're extremely worried as we lost our first child in gestational week 33 in utero then it may be imagination"
Discussion
We are not aware of whatsoever studies that accept categorized how women draw the changes they have perceived concerning fetal movements when they seek wellness care due to worry about their unborn baby.
Women who consulted wellness care due to decrease fetal movements described changes in frequency, intensity, character and elapsing of the movements. Nevertheless, all women in this written report were reassured after an examination of their unborn baby. In Norway, as many equally 51 % of women reported that they were concerned near decreased fetal movements once or more than in pregnancy [14]. In different populations, betwixt iv and 15 % consulted health intendance facilities because of decreased fetal movements in the tertiary trimester [1]. There are several factors which may impair the power to recognize fetal movements [viii]. However, nosotros take no data concerning amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this written report. 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 1 hour iii times per day. Viii percent of the pregnant women in the third trimester, who in the stop gave birth to a salubrious child, experienced reduced fetal movements. Further, the researchers found that among women who consulted health care for reduced fetal movements but afterward gave birth to a healthy child, more of them were working than those who did not perceive reduced fetal movements [eighteen]. We do not have data equally to work condition among the women participating in our study.
Placental dysfunction is one primary reason for decreased fetal movements in late pregnancy [19]. It is thus important for the pregnant women to recognize the pattern of motility. A change may be a sign of asphyxia due to the redistribution of the apportionment which gives priority to the brain over peripheral parts [twenty]. All fetuses in the nowadays report were examined and no symptoms of asphyxia or placental dysfunction were identified at the fourth dimension when the woman consulted health intendance. The women'south worry about their unborn baby'south wellness due to decreased fetal movements in this study did not issue in a diagnosis or actions to induce the commitment.
Our results indicate that some women at term seek health intendance due only to a change in the character of the fetal movements. Although these women were asked to draw 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. Dull, every bit in slow motion, stretching and turning, are descriptions of the grapheme of fetal movements used by women in full term pregnancy, pregnancies that resulted in a healthy child [7]. The women in our written report who consulted health care only due to a change in the graphic symbol of the movements and not considering 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 every bit different can be physiological due to express space in the uterus at term [3]. There is no routine in Swedish antenatal wellness care for giving data about fetal movements simply women are recommended to consult health care if they feel decreased fetal movements [21]. Still, pregnant women ask for data nearly fetal movements in general and for information well-nigh the number and blazon of fetal movements they tin can wait, likewise as how the movements are supposed to change over time in pregnancy [22].
At that place 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 motility may be aware of the importance of detecting fetuses at risk equally early on as possible. Detection of decreased fetal movements can better the upshot and reduce filibuster in consulting health care [23, 24]. Further, the fetuses in this study who could be at run a risk were examined and risk factors such as placental abruptions, growth retardation or malformations [25] may have been detected. The principal reason for consulting health care due to decreased fetal movements is worry most the wellness of the babe [xiv]. None of the women in our study consulted health intendance without cause, but their worry was apparently 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. Yet, aside from no stillbirths amid the participating women, we accept no data regarding the health condition of the babe afterwards birth. This is a major limitation of the study. There is also just sparse data about the women'due south' sociodemographic background.
One strength of the study is the large number of participants. Another force is that all delivery wards in Stockholm participated in the study. However, all women came from the capital urban center in Sweden where women in generally are older and well educated compared with women outside the capital. Farther, the number of those who declined to participate and their reasons for doing and then are not known.
The wording of the request, "Effort to describe how your baby has moved less or had changes in motility" might accept influenced the responders to apply the words "decreased" and "differently" in their descriptions of their experiences. The results may have yielded fifty-fifty more if the initial request had been broader or more than open, for case, "Attempt to describe how your baby has moved". Nevertheless, the context in which the women completed the questionnaire was 1 of already perceived decreased fetal movements.
Clinical implications
Increased cognition about the normal changes in the fetal move patterns in late pregnancy can be one way to lessen the number of visits to obstetric clinics from women over concerns that plow out to be unnecessary from a medical perspective. The challenge from a clinical perspective is to inform and advise meaning women about fetal movements with the goal of diminishing the length of pre-infirmary 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 babe'due south life will provide a window of opportunity to save a greater number of children from expiry or compromised health. Further, fewer visits to obstetric clinics, over business organization that turns out to be unnecessary from a medical perspective, will have health economic benefits. Before giving definitive communication that tin 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 nascency to a hypoxic or anaemic child, written report the changes in graphic symbol of movements as but symptoms when they seek care for decreased fetal movements. Future studies are needed.
Conclusions
Women reported changes in fetal movement apropos frequency, intensity, graphic symbol and elapsing; they described decreased, absenteeism, weaker, slower and changed pattern of the movements.
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Funding
The Little Kid's Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo'southward Research Foundation funded this study.
Availability of data and materials
The data will non be fabricated available in lodge to protect the participant'southward identity.
Authors' contributions
AL, KP and IR participated in the design of the report. AL, SG and IR performed the qualitative analyses. SH and EN carried out the offset and main part of the assay. KP contributed to the discussion of the analysis. AL, SG, KP and IR drafted all versions of the manuscript. AL, SG, KP, SH, EN and IR commented on the draft. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Non applicable.
Ethics approving and consent to participate
The women gave consent to participate and permission to access supporting data when receiving information about the study. The information volition not be made available in lodge to protect the participant's identity. The report was canonical by the Regional Ethical Review Board in Stockholm: DNR: 2013/1077-31/3.
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Linde, A., Georgsson, S., Pettersson, K. et al. Fetal movement in late pregnancy – a content analysis of women'due south experiences of how their unborn babe moved less or differently. BMC Pregnancy Childbirth sixteen, 127 (2016). https://doi.org/10.1186/s12884-016-0922-z
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DOI : https://doi.org/10.1186/s12884-016-0922-z
Keywords
- Pregnancy
- Fetal motion
- Decreased fetal movements
- Content analysis
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0922-z
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