Reasons Baby May Be More Ot Less Active in Womb
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Fetal movement in late pregnancy – a content assay of women's experiences of how their unborn infant moved less or differently
BMC Pregnancy and Childbirth volume xvi, Article number:127 (2016) Cite this commodity
Abstract
Background
Pregnant women sometimes worry about their unborn babe'southward health, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, draw how the baby had moved less or differently.
Methods
Women were recruited from all vii commitment wards in Stockholm, Sweden, during one/1 – 31/12 2014. The women completed a questionnaire afterwards information technology was verified that the pregnancy was feasible. A modified content assay was used to analyse 876 questionnaires with the women's responses to, "Try to describe how your baby has moved less or had changes in motion".
Results
Four categories and six subcategories were identified: "Frequency" (decreased frequency, absenteeism of kicks and move), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (changed design of movements, slower movements) and "Duration". In add-on to the responses categorised in accordance with the question, the women as well mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Farther, they described worry due to incidents related to inverse blueprint of fetal movements.
Decision
Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women nigh fetal movements with the goal of minimizing unnecessary consultations whilst at the aforementioned 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 best-selling that a pattern of regular movements is associated with fetal wellbeing [1]. Fetal movements can be defined as any discrete kicking, palpitate, swish or roll and are normally first perceived by 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 usually a variation in fetal movements with a broad range in the number of movements per hour [4]. The movements are unremarkably absent during sleep and occur regularly throughout the mean solar day and night, normally lasting for 20–40 min. The sleep cycles rarely exceed 90 min in the normal and healthy fetus [v]. Although the movement design of the private fetus is unique, information technology is general cognition that decreased fetal movement is associated with adverse outcome, including stillbirth [half-dozen].
The grapheme of the movements changes when the pregnancy approaches commitment due to limited space in the uterus, only the frequency and intensity will non normally decrease [3]. In an interview report, forty term meaning women with an effect of a healthy babe described fetal movements during the past week. Nearly all experienced fetal movements as "strong and powerful". Half of the women also described the movements as "large" (involving the whole torso of the fetus). Another common clarification was "slow" equally in "slow 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 ability to recognize fetal move [8]. Amniotic fluid volume [9], fetal position [10], having an anterior placenta [x, eleven], smoking, being overweight [6] and nulliparity [six, 12] take been reported every bit such factors. Maternal factors which may enhance the ability to recognize movement are the opportunity to focus on the fetus and the absence of distracting noises [13]. About 50 % of the significant women in a study from Norway were sometimes worried about decreased fetal movements [fourteen]. In a review article, information technology was establish that between iv and fifteen percent of significant women consult wellness intendance because of a decrease in fetal motion in the third trimester [1]. The aim of the present written report was to examine how women, who consulted wellness care due to decreased fetal movements after gestational week 28, describe how the infant had moved less or differently.
Methods
Settings and participants
Women were recruited from all seven commitment wards in Stockholm, Sweden from 1st January 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 intendance due to concerns over decreased fetal movements, with the ability to empathize 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. i). In total, 3555 questionnaires were completed during the data collection period. Data collection was in progress while the first 1000 questionnaires were analysed. Xx-viii women completed two questionnaires and 3 women filled in 3 questionnaires; they consulted health care more than once during the data drove flow due to concerns over decreased fetal movements. Of the women, 672 (76.7 %) were aged 20–35 years, 582 (66.four %) had a college or university level of education and 650 (74.2 %) of the women were born in Sweden (Tabular array 1). All women gave birth to a live child.
Menstruation chart
Information collection
The questionnaire used in the written report was developed from a web survey, an interview study [seven, fifteen] and clinical experience. The questionnaire was face-to-face validated with ten women who consulted wellness intendance due to reduced fetal movements, not included in the report. The terminal version of the questionnaire included a total of 22 questions with multiple-choice or open up-concluded response alternatives (Additional file one). This study comprises the women's responses to the asking: "Endeavour to depict how your baby has moved less or had changes in movement". The women were asked to describe their experiences in the infinite provided merely could also, if necessary, continue on the back of the questionnaire.
Analysis
The women's descriptions (due 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 accord 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 main categories and categories. When advisable the categories were divided into subcategories [17] The quotations could be placed in more than 1 category. However, each argument was simply placed in one subcategory. During the whole process the findings were continually discussed in the inquiry grouping in order to reach understanding. To validate the results, a sample of 50 quotations was randomly selected and re-analysed from the offset of the analysis process. Afterward consensus had been reached some of the quotations were transferred to other subcategories and three quotations were deemed irrelevant and removed. Those carrying out the analysis did not know the gestational week.
Results
Four main 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 "Elapsing". The number in each category and subcategory as well every bit an presentation of the figures for women seeking health care in gestational week 28–32, gestational week 33–36 and during gestational calendar week 37+, are shown in Table 2.
Frequency
The virtually 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 move".
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 solar day"
"From being very active and kicking a lot to very few movements during some days"
Absence of kicks and movement
Amid the answers near the frequency of fetal movements, 137 (16 %) statements were about not feeling any movement at all.
"I haven't felt whatsoever kicking for near 12 hours"
"Have non felt any motility during the whole day"
Intensity
A total of 343 (39 %) responses were perceptions that the movements had altered in intensity. 2 subcategories were formed: "Weaker movements" and "Indistinct movements".
Weaker fetal movements
This subcategory comprised 277 (32 %) statements. Words often used were: "Weaker", "Softer", "Less sharp" and "With less ability".
"From obvious, strong movements and nudging to feathery tickling a few times a day"
"… The movements of the baby felt weaker the few times I have felt my baby"
Indistinct fetal movements
Sixty-half dozen (8 %) statements fell into this subcategory. Some women were uncertain equally to whether they felt annihilation at all but idea they could imagine movements.
"…The only thing I felt was non-specific movements deep inside my tummy…"
"Have previously felt credible kicks which tin exist both felt and seen distinctly. Since yesterday evening only small occasionally twisting movements"
Character
This category comprised 252 (29 %) statements describing experiences of the fetal movements irresolute in character. The category revealed ii subcategories: "Changed pattern of movements" and "Slower movements".
Changed design of movements
This subcategory comprised 141 (16 %) statements. The women described the fetal movements as having changed in design and decreased in activeness.
"Non the aforementioned pattern of movements as before and not agile 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 near two days. When she has moved, the movements felt weaker the by two days compared to earlier."
Slower movements
This subcategory included 111 (thirteen %) statements. When talking about the movements women used words such equally: "sluggish", "indolent", "dull and sweeping".
"Calmer more than tired movements as if it were tired…"
"Slow and smoother movements"
Duration
Xxx-eight (4 %) 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. Even so, the frequency of how often the baby had moved had not decreased.
"… the periods when it has moved accept been shorter"
"No more lively periods."
Differences according to gestational age
Women in gestational weeks 33–36 experienced changes more often 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 inside the category Grapheme and the subcategory Slower movements (5 % vs. fifteen %) (Table ii).
4 percentage, 32/876, of the full number of women in this written report only stated a alter in the character of the movements, non included in whatever other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.5 %), 33–36, 1/263 (0.iv %) and gestational weeks 37+, xxx/423 (seven %). At that place were no statistically pregnant differences in the other categories (Non in table).
In addition 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 pattern of fetal movements.
Stimulation due to less movement
We identified 146 (17 %) statements about trying to provoke motion past 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 on the breadbasket, stimulate with light or racket, take a shower or bathroom or to drink common cold, sugariness 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 agile and you have been able to see my tummy moving"
"Fifty-fifty if I touch my tummy, eat, drink, there is not much difference. 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 information technology was hard to distinguish movements from contractions. Some women also described that the movements decreased in relation to contractions, pain in the tummy or the back. Nosotros identified xl statements (5 %) apropos difficulties in distinguishing fetal movements from contractions.
"Not felt any 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 have been very distinct"
Worry due to incidents related to changed pattern of fetal movements
We identified 25 (three %) statements about external factors, such as the adult female was sick and perceived less fetal movement. Six women stated that they consulted health intendance due to pain in relation to changed patterns of fetal move. Two statements referred to the woman having taken a fall and wanting to be reassured that the fetus had not been damaged. Other reasons related to increased worry were: mail maturity, following an expelled mucus plug, an external cephalic version attempt, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to move a lot during both day and night. Accept been ill with fever for three days and then at that place accept been movements four–5 times every solar day"
"Not every bit ofttimes equally earlier but I yet feel him daily. We're extremely worried equally we lost our offset child in gestational week 33 in utero so it may exist imagination"
Discussion
We are not aware of whatsoever studies that take 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, graphic symbol and duration of the movements. However, all women in this study were reassured after an test of their unborn babe. In Norway, as many as 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy [xiv]. In different populations, between iv and fifteen % consulted wellness 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 information apropos amniotic fluid book, 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 exist perceived as a decrease. In a study by Sheikh and colleagues (2014), 729 women counted and registered fetal movements for 1 hour three times per day. Eight percent of the meaning women in the third trimester, who in the finish gave birth to a healthy child, experienced reduced fetal movements. Further, the researchers found that among women who consulted wellness intendance for reduced fetal movements simply after gave birth to a salubrious kid, more than of them were working than those who did non perceive reduced fetal movements [xviii]. We do not accept data as to work status amongst the women participating in our study.
Placental dysfunction is one main reason for decreased fetal movements in late pregnancy [19]. It is thus of import for the meaning women to recognize the pattern of motility. A change may be a sign of asphyxia due to the redistribution of the circulation which gives priority to the encephalon over peripheral parts [20]. All fetuses in the present written report 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 well-nigh their unborn baby's health due to decreased fetal movements in this report did not result in a diagnosis or actions to induce the delivery.
Our results indicate that some women at term seek health care due merely to a modify in the graphic symbol of the fetal movements. Although these women were asked to depict 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 enlightened of normal changes in the fetal movement patterns in belatedly pregnancy. The changes they reported as unlike 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 intendance if they experience decreased fetal movements [21]. Withal, pregnant women enquire for information about fetal movements in general and for information about the number and type of fetal movements they can await, also as how the movements are supposed to alter over time in pregnancy [22].
At that place were no stillbirths amongst the women in this study. Thus, we tin 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 risk as early as possible. Detection of decreased fetal movements can amend the effect and reduce delay in consulting wellness care [23, 24]. Further, the fetuses in this study who could be at gamble were examined and risk factors such as placental abruptions, growth retardation or malformations [25] may take been detected. The primary reason for consulting health care due to decreased fetal movements is worry virtually the health of the baby [14]. None of the women in our report consulted health care without cause, merely their worry was patently unfounded from a medical perspective in the short term.
Strengths and limitations
Women in this report had a normal CTG before they completed the questionnaire. However, aside from no stillbirths amid the participating women, we have no data regarding the health status of the baby after nascency. This is a major limitation of the study. There is too but sparse information near the women's' sociodemographic background.
One strength of the study is the large number of participants. Another strength is that all commitment 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 letter. Further, the number of those who declined to participate and their reasons for doing so are not known.
The wording of the request, "Endeavour 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 up, for example, "Endeavour 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 motion patterns in tardily 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 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 aforementioned time reduce worry leading to unnecessary consultation. Reducing the pre-hospital filibuster when the intrauterine environs is a threat to the unborn baby's life will provide a window of opportunity to save a greater number of children from decease or compromised wellness. Further, fewer visits to obstetric clinics, over concern that turns out to be unnecessary from a medical perspective, will take health economical benefits. Before giving definitive advice that can reduce unnecessary controls at the end of the pregnancy, distinct differences must exist identified regarding how women who lost their child intrauterine or have given birth to a hypoxic or anaemic child, report the changes in graphic symbol of movements equally only symptoms when they seek treat decreased fetal movements. Time to come studies are needed.
Conclusions
Women reported changes in fetal motility concerning frequency, intensity, character and elapsing; they described decreased, absence, weaker, slower and inverse pattern of the movements.
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Funding
The Little Child'due south Foundation, Sophiahemmet Foundation, The Swedish National Babe Foundation and Capo's Enquiry Foundation funded this study.
Availability of information and materials
The data will non be made available in order to protect the participant'southward identity.
Authors' contributions
AL, KP and IR participated in the design of the written report. AL, SG and IR performed the qualitative analyses. SH and EN carried out the first and main function of the analysis. 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 canonical the last manuscript.
Competing interests
The authors declare that they accept no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
The women gave consent to participate and permission to admission supporting information when receiving data about the written report. The data volition non exist fabricated available in order to protect the participant's identity. The study was approved 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 16, 127 (2016). https://doi.org/ten.1186/s12884-016-0922-z
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DOI : https://doi.org/ten.1186/s12884-016-0922-z
Keywords
- Pregnancy
- Fetal movement
- Decreased fetal movements
- Content analysis
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