30 Weeks Pregnant Baby Moving but Not Kicking
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Fetal move in late pregnancy – a content assay of women'southward 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
Pregnant women sometimes worry about their unborn baby'south wellness, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted wellness care due to decreased fetal movements, describe how the baby had moved less or differently.
Methods
Women were recruited from all seven commitment wards in Stockholm, Sweden, during 1/1 – 31/12 2014. The women completed a questionnaire after it 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 depict how your baby has moved less or had changes in movement".
Results
Four categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and motion), "Intensity" (weaker fetal movements, indistinct fetal movements), "Grapheme" (changed pattern of movements, slower movements) and "Duration". In addition to the responses categorised in accord with the question, the women likewise 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.
Conclusion
Women reported changes in fetal movement concerning frequency, intensity, character and duration. The claiming 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 delay if the fetus is at risk of fetal compromise.
Trial registration
Not applicative.
Peer Review reports
Background
It is widely acknowledged that a pattern of regular movements is associated with fetal wellbeing [1]. Fetal movements can be defined as whatever discrete kicking, flutter, classy or gyre and are normally first perceived by the mother between 18 and twenty weeks of gestation [two]. The frequency of fetal movements reaches a plateau in gestational calendar week 32 and stays at that level until birth [3]. There is unremarkably a variation in fetal movements with a wide range in the number of movements per hour [four]. The movements are normally absent-minded during slumber and occur regularly throughout the twenty-four hour period and night, normally lasting for 20–xl min. The sleep cycles rarely exceed 90 min in the normal and healthy fetus [5]. Although the move pattern of the individual fetus is unique, it is general cognition that decreased fetal movement is associated with adverse consequence, including stillbirth [6].
The character of the movements changes when the pregnancy approaches delivery due to express space in the uterus, but the frequency and intensity will non commonly decrease [3]. In an interview study, forty term pregnant women with an outcome of a good for you baby described fetal movements during the past week. Almost all experienced fetal movements as "strong and powerful". Half of the women also described the movements as "big" (involving the whole body of the fetus). Some other mutual description was "tedious" equally in "wearisome movement" and "stretching" or "turning". Some of the women stated that they were surprised how powerfully the fetus moved [vii].
Several maternal factors may impair the ability to recognize fetal move [viii]. Amniotic fluid volume [9], fetal position [10], having an anterior placenta [10, eleven], smoking, being overweight [half dozen] and nulliparity [6, 12] accept 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 [thirteen]. Most fifty % of the pregnant women in a written report from Kingdom of norway were sometimes worried about decreased fetal movements [14]. In a review article, it was found that between four and xv pct of meaning women consult health care considering of a subtract in fetal movement in the 3rd trimester [i]. The aim of the nowadays study was to examine how women, who consulted health care due to decreased fetal movements later on gestational week 28, depict how the baby had moved less or differently.
Methods
Settings and participants
Women were recruited from all seven delivery wards in Stockholm, Sweden from 1st Jan to 31st December 2014, and were asked to consummate 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 sympathise Swedish or English and a normal cardiotocography (CTG). Non responders, inadequate answers, multiple pregnancies, undefined gestational week and unknown personal identity number were exclusion criteria (Fig. 1). In full, 3555 questionnaires were completed during the data collection menstruation. Information collection was in progress while the first 1000 questionnaires were analysed. Twenty-eight women completed two questionnaires and three women filled in three questionnaires; they consulted health care more than than once during the data collection period due to concerns over decreased fetal movements. Of the women, 672 (76.vii %) were anile xx–35 years, 582 (66.4 %) had a college or university level of education and 650 (74.2 %) of the women were built-in in Sweden (Table 1). All women gave birth to a live kid.
Flow chart
Data collection
The questionnaire used in the written report was adult from a web survey, an interview study [7, fifteen] and clinical experience. The questionnaire was face up-to-face validated with ten women who consulted health care due to reduced fetal movements, not included in the study. The final version of the questionnaire included a total of 22 questions with multiple-choice or open-ended response alternatives (Additional file i). This study comprises the women's responses to the asking: "Try to describe how your baby has moved less or had changes in motion". The women were asked to describe their experiences in the space provided but could likewise, if necessary, go on on the back of the questionnaire.
Analysis
The women's descriptions (north = 876) of how their unborn baby had moved less or differently were analysed using a modified content analysis [16]. The material consisted of concise descriptions of movements, which were used without editing. The analysis was performed in three 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 accordance with Malterud. Every quotation was read and sorted into codes. In the second phase of the assay the material was organized. Units, the quotations, with the same code were divided into defined chief categories and categories. When appropriate the categories were divided into subcategories [17] The quotations could exist placed in more than than one category. However, each statement was only placed in one subcategory. During the whole process the findings were continually discussed in the enquiry grouping in order to attain agreement. To validate the results, a sample of 50 quotations was randomly selected and re-analysed from the starting time of the analysis process. After consensus had been reached some of the quotations were transferred to other subcategories and 3 quotations were deemed irrelevant and removed. Those carrying out the analysis did not know the gestational week.
Results
Four main categories and vi subcategories were identified: "Frequency" (decreased frequency, absence of kicks and motion), "Intensity" (weaker fetal movements, indistinct fetal movements), "Graphic symbol" (changed design of movements, slower movements) and "Elapsing". The number in each category and subcategory besides as an presentation of the figures for women seeking health care in gestational calendar week 28–32, gestational week 33–36 and during gestational week 37+, are shown in Table 2.
Frequency
The most commonly 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 generally decreased liveliness in the fetus. The movements were described with words like, "a few", "seldom", "less frequent", "non as many" and "decreased activity".
"Less frequent during the twenty-four hours"
"From being very active and kicking a lot to very few movements during some days"
Absence of kicks and move
Among the answers about the frequency of fetal movements, 137 (16 %) statements were nearly not feeling whatever motion at all.
"I haven't felt any kicking for almost 12 hours"
"Take not felt whatever motion during the whole mean solar day"
Intensity
A total of 343 (39 %) responses were perceptions that the movements had contradistinct in intensity. Two subcategories were formed: "Weaker movements" and "Indistinct movements".
Weaker fetal movements
This subcategory comprised 277 (32 %) statements. Words oft 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 babe felt weaker the few times I have felt my infant"
Indistinct fetal movements
Sixty-six (8 %) statements vicious into this subcategory. Some women were uncertain equally to whether they felt annihilation at all but thought they could imagine movements.
"…The merely matter I felt was non-specific movements deep inside my breadbasket…"
"Have previously felt apparent kicks which can exist both felt and seen distinctly. Since yesterday evening merely pocket-size 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 (16 %) statements. The women described the fetal movements as having changed in pattern and decreased in activity.
"Not the same design of movements as before and not active at the same fourth dimension"
"The baby has non moved at the times that she had moved earlier, post-obit the pattern that she had previously. This has been going on for about 2 days. When she has moved, the movements felt weaker the past two days compared to before."
Slower movements
This subcategory included 111 (thirteen %) statements. When talking virtually the movements women used words such as: "sluggish", "indolent", "slow and sweeping".
"Calmer more than tired movements as if information technology were tired…"
"Slow and smoother movements"
Duration
Thirty-eight (4 %) were included in this category. Women reported that the periods of motility had get shorter and had been reduced from several kicks in a row to occasional ones. However, the frequency of how often the baby had moved had not 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 ofttimes 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 (5 % vs. 15 %) (Table 2).
Four percent, 32/876, of the full number of women in this report simply stated a alter in the character of the movements, not included in any other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.5 %), 33–36, i/263 (0.4 %) and gestational weeks 37+, thirty/423 (vii %). In that location were no statistically significant differences in the other categories (Non in table).
In add-on to the responses categorised in accord with the question, the women too 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 nigh trying to provoke move by triggering the fetus. Most of the women reported that they did this when not having felt movements for a while. When they did not succeed they consulted health care. The methods used to trigger movements were to pull, nudge or push button on the tummy, stimulate with calorie-free or noise, take a shower or bath or to potable cold, sweet drinks. Others said that they had various positions they used to feel the baby more distinctly. Some women described not feeling movements without stimulating the baby.
"No pushes" back when I am pulling on the tummy, no reaction when drinking a glass of lemonade. Otherwise he has been quite active and y'all have been able to see my tummy moving"
"Even if I bear on my tummy, eat, drink, at that place is not much divergence. He is moving considerably less"
Difficult to distinguish fetal movements from contractions
The women stated that the fetal movements ceased or changed in relation to contractions or that information technology was difficult to distinguish movements from contractions. Some women also described that the movements decreased in relation to contractions, hurting in the tummy or the back. We identified twoscore statements (5 %) concerning difficulties in distinguishing fetal movements from contractions.
"Not felt any movements since the contractions became more intensive"
"It has been more difficult to perceive movements. Difficult to distinguish movements from contractions… previously the movements have been very distinct"
Worry due to incidents related to changed pattern of fetal movements
We identified 25 (iii %) statements about external factors, such as the woman was ill and perceived less fetal move. Six women stated that they consulted health intendance due to pain in relation to changed patterns of fetal movement. Two statements referred to the woman having taken a autumn and wanting to be reassured that the fetus had not been damaged. Other reasons related to increased worry were: post maturity, following an expelled mucus plug, an external cephalic version endeavor, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to move a lot during both solar day and nighttime. Have been ill with fever for 3 days then there have been movements iv–v times every twenty-four hours"
"Not every bit often as earlier but I still feel him daily. Nosotros're extremely worried as we lost our first kid in gestational week 33 in utero so information technology may be imagination"
Discussion
We are not aware of whatever studies that have categorized how women draw 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 subtract fetal movements described changes in frequency, intensity, grapheme and duration of the movements. However, all women in this study were reassured after an examination of their unborn infant. In Kingdom of norway, every bit many every bit 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy [14]. In dissimilar populations, between four and 15 % consulted wellness care facilities because of decreased fetal movements in the tertiary trimester [1]. There are several factors which may impair the ability to recognize fetal movements [8]. However, we take no information concerning amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this 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 one hour three times per mean solar day. Viii pct of the pregnant women in the third trimester, who in the end gave birth to a healthy kid, experienced reduced fetal movements. Further, the researchers found that amid women who consulted health intendance for reduced fetal movements but later gave nascence to a healthy child, more of them were working than those who did not perceive reduced fetal movements [18]. We practise non have data as to work status amidst the women participating in our study.
Placental dysfunction is 1 main reason for decreased fetal movements in late pregnancy [19]. It is thus important for the significant women to recognize the pattern of movement. A alter 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 nowadays report were examined and no symptoms of asphyxia or placental dysfunction were identified at the time when the woman consulted health care. The women'southward worry nearly their unborn babe's wellness due to decreased fetal movements in this report did non result in a diagnosis or actions to induce the delivery.
Our results indicate that some women at term seek health intendance due only to a modify in the character of the fetal movements. Although these women were asked to describe how their babe had moved less or differently, they did not mention a decrease in frequency in the fetal movements or a modify 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 [vii]. The women in our study who consulted wellness care but due to a change in the character of the movements and non because of contradistinct frequency and intensity might non have been aware of normal changes in the fetal movement patterns in late pregnancy. The changes they reported equally dissimilar can exist physiological due to limited space in the uterus at term [3]. In that location is no routine in Swedish antenatal health care for giving information almost fetal movements but women are recommended to consult wellness care if they experience decreased fetal movements [21]. Yet, pregnant women inquire for data about fetal movements in general and for information about the number and type of fetal movements they can expect, besides as how the movements are supposed to change over time in pregnancy [22].
In that location were no stillbirths among the women in this study. Thus, we can only speculate that it is possible that women who consult health intendance due to decreased or changed patterns of fetal movement may exist aware of the importance of detecting fetuses at gamble as early as possible. Detection of decreased fetal movements can better the outcome and reduce filibuster in consulting wellness care [23, 24]. Farther, the fetuses in this study who could be at risk were examined and chance factors such as placental abruptions, growth retardation or malformations [25] may have been detected. The principal reason for consulting health intendance due to decreased fetal movements is worry well-nigh the health of the baby [xiv]. None of the women in our study consulted health care without cause, just their worry was plain unfounded from a medical perspective in the brusk term.
Strengths and limitations
Women in this study had a normal CTG earlier they completed the questionnaire. Yet, aside from no stillbirths among the participating women, nosotros have no data regarding the health status of the baby after birth. This is a major limitation of the written report. In that location is besides just sparse data about the women'due south' sociodemographic groundwork.
One forcefulness of the report is the big number of participants. Another force is that all delivery wards in Stockholm participated in the study. Withal, all women came from the capital city in Sweden where women in generally are older and well educated compared with women outside the upper-case letter. Farther, 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 motility" might have influenced the responders to utilize the words "decreased" and "differently" in their descriptions of their experiences. The results may have yielded even more if the initial asking had been broader or more open, for case, "Endeavour to describe how your baby has moved". Notwithstanding, 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 tin 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 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 volition 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 exist unnecessary from a medical perspective, volition have wellness 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 take given birth to a hypoxic or anaemic kid, report the changes in character of movements as only symptoms when they seek care for decreased fetal movements. Future studies are needed.
Conclusions
Women reported changes in fetal movement concerning frequency, intensity, character and duration; they described decreased, absence, weaker, slower and changed pattern of the movements.
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Funding
The Little Child'southward Foundation, Sophiahemmet Foundation, The Swedish National Baby Foundation and Capo's Inquiry Foundation funded this report.
Availability of data and materials
The information volition not be fabricated available in social club to protect the participant'southward identity.
Authors' contributions
AL, KP and IR participated in the design of the study. AL, SG and IR performed the qualitative analyses. SH and EN carried out the kickoff and primary function of the analysis. KP contributed to the word 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 canonical the terminal manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Non applicable.
Ideals approval and consent to participate
The women gave consent to participate and permission to access supporting data when receiving information about the study. The data volition non be fabricated available in order to protect the participant'southward identity. The written report was canonical by the Regional Ethical Review Lath in Stockholm: DNR: 2013/1077-31/iii.
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Linde, A., Georgsson, Southward., Pettersson, K. et al. Fetal motion in late pregnancy – a content analysis of women's experiences of how their unborn baby moved less or differently. BMC Pregnancy Childbirth 16, 127 (2016). https://doi.org/10.1186/s12884-016-0922-z
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DOI : https://doi.org/x.1186/s12884-016-0922-z
Keywords
- Pregnancy
- Fetal movement
- Decreased fetal movements
- Content analysis
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0922-z
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