Maternal perception of fetal movements: A qualitative description

Background: Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women. Methods: Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes. Results: Fetal activity as described by pregnant women demonstrated a sustained increase in strength, frequency and variation from quickening until 28-32 weeks. Strength of movements continued to increase at term, but variation in movement types reduced. Kicking and jolting movements decreased at term with pushing or stretching movements dominating. In this study increased strength and frequency of movements at term as determined qualitatively by the mother was associated with higher mean customised birthweight of newborns, whilst decreased frequency was in all cases associated with either maternal obesity, customised birthweight under the 20th centile or operative delivery for non-reassuring fetal status. A novel finding of a complex pattern of fetal movements in relation to mealtimes is reported here. More than a third of participants (37%) described marked increases in fetal movements in response to hunger, in many cases subsiding postprandially. The women who described this pattern in response to hunger and eating, subsequently gave birth to infants significantly smaller (mean difference 364gm) than those who did not describe a fetal response to hunger. Patterns of fetal movements were reported to be influenced by time of day, maternal position and activity, with an inverse relationship between maternal activity and fetal activity described by all participants. Conclusions: Maternal descriptions of fetal movements with advancing gestation and in relation to time of day are consistent with fetal activity as described in ultrasound studies, lending reliability to the maternal account. Maternal perception of fetal movements in response to environmental stimuli such as maternal meals and maternal position-changes may constitute a maternal-fetal communication in the interests of maintaining the pregnancy. Pregnant women are reassured by fetal movements occurring at a usual time or situation, suggesting that maternal monitoring of fetal movements is a dynamic process taking into account a broad range of fetal functions

Prevalence of female genital mutilation and associated factors among daughters aged 0–14 years in sub-Saharan Africa : a multilevel analysis of recent demographic health surveys

Publisher Copyright: 2023 Ayenew, Mol, Bradford and Abeje.Peer reviewedPublisher PD

Care, Connection, and Social Distancing:The challenges of baby loss during the COVID-19 pandemic in Aotearoa New Zealand

Problem: The COVID-19 pandemic hindered access to routine healthcare globally,prompting concerns about possible increases in pregnancy loss and perinatal death.Background: PUDDLES is an international collaboration exploring the impact of theCOVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand.Aim: To explore parents’ experiences of access to healthcare services and supportfollowing baby loss during the COVID-19 pandemic in Aotearoa New Zealand.Methods: We conducted in-depth, semi-structured interviews with 26 bereavedparents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and oneneonatal death. Participant ethnicities were broadly representative of Aotearoa NewZealand’s multi-ethnic society. Data were analysed using Template Analysis.Findings: Analysis revealed five themes relating to pandemic impact on bereavedparent’s experiences. These were: ‘Distanced and Impersonal care’; ‘NavigatingHospital Rules’; Exclusion of Non-birthing Parents; ‘Hindered Access to SocialSupport’; and ‘Continuity of Relational Care’.Discussion: The COVID-19 pandemic exacerbated isolation of bereaved parentsthrough perceived impersonal care by healthcare professionals and restrictions onmovement hindered access to social and cultural support. Compassionate bending ofthe rules by healthcare professionals and community postnatal visits by continuity ofcare midwives following the bereavement appeared to be mitigating factors.Conclusion: Social isolation is an added challenge for parents experiencing baby lossduring a pandemic, which may be mitigated by flexible and compassionate care fromhealthcare professionals, especially continuity of care midwives

Maternal perception of fetal movements: A qualitative description

Background: Maternal perception of decreased fetal movements is a specific indicator of fetal compromise, notably in the context of poor fetal growth. There is currently no agreed numerical definition of decreased fetal movements, with subjective perception of a decrease on the part of the mother being the most significant definition clinically. Both qualitative and quantitative aspects of fetal activity may be important in identifying the compromised fetus.Yet, how pregnant women perceive and describe fetal activity is under-investigated by qualitative means. The aim of this study was to explore normal fetal activity, through first-hand descriptive accounts by pregnant women. Methods: Using qualitative descriptive methodology, interviews were conducted with 19 low-risk women experiencing their first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis and patterns of fetal activity identified were then considered along-side the characteristics of the women and their birth outcomes. Results: Fetal activity as described by pregnant women demonstrated a sustained increase in strength, frequency and variation from quickening until 28-32 weeks. Strength of movements continued to increase at term, but variation in movement types reduced. Kicking and jolting movements decreased at term with pushing or stretching movements dominating. In this study increased strength and frequency of movements at term as determined qualitatively by the mother was associated with higher mean customised birthweight of newborns, whilst decreased frequency was in all cases associated with either maternal obesity, customised birthweight under the 20th centile or operative delivery for non-reassuring fetal status. A novel finding of a complex pattern of fetal movements in relation to mealtimes is reported here. More than a third of participants (37%) described marked increases in fetal movements in response to hunger, in many cases subsiding postprandially. The women who described this pattern in response to hunger and eating, subsequently gave birth to infants significantly smaller (mean difference 364gm) than those who did not describe a fetal response to hunger. Patterns of fetal movements were reported to be influenced by time of day, maternal position and activity, with an inverse relationship between maternal activity and fetal activity described by all participants. Conclusions: Maternal descriptions of fetal movements with advancing gestation and in relation to time of day are consistent with fetal activity as described in ultrasound studies, lending reliability to the maternal account. Maternal perception of fetal movements in response to environmental stimuli such as maternal meals and maternal position-changes may constitute a maternal-fetal communication in the interests of maintaining the pregnancy. Pregnant women are reassured by fetal movements occurring at a usual time or situation, suggesting that maternal monitoring of fetal movements is a dynamic process taking into account a broad range of fetal functions

Midwifery continuity of care: A scoping review of where, how, by whom and for whom?

Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level

A diurnal fetal movement pattern: Findings from a cross-sectional study of maternally perceived fetal movements in the third trimester of pregnancy.

Background and objectivesEncouraging awareness of fetal movements is a common strategy used to prevent stillbirths. Information provided to pregnant women about fetal movements is inconsistent perhaps due to limited knowledge about normal fetal movement patterns in healthy pregnancies. We aimed to describe maternally perceived fetal movement strength, frequency, and pattern in late pregnancy in women with subsequent normal outcomes.MethodsParticipants were ≥28 weeks' gestation, with a non-anomalous, singleton pregnancy who had been randomly selected from hospital booking lists and had consented to participate. Fetal movement data was gathered during pregnancy via a questionnaire administered face-to-face by research midwives. Participants remained eligible for the study if they subsequently gave birth to a live, appropriate-for-gestational-age baby at ≥37 weeks.ResultsParticipants were 274 women, with normal pregnancy outcomes. The majority (59.3%, n = 162) of women reported during antenatal interview that the strength of fetal movements had increased in the preceding two weeks. Strong fetal movements were felt by most women in the evening (72.8%, n = 195) and at night-time including bedtime (74.5%, n = 199). The perception of fetal hiccups was also reported by most women (78.8%). Women were more likely to perceive moderate or strong fetal movements when sitting quietly compared with other activities such as having a cold drink or eating.ConclusionsOur data support informing women in the third trimester that as pregnancy advances it is normal to perceive increasingly strong movement, episodes of movements that are more vigorous than usual, fetal hiccups, and a diurnal pattern involving strong fetal movement in the evening. This information may help pregnant women to better characterise normal fetal movement and appropriately seek review when concerned about fetal movements. Care providers should be responsive to concerns about decreased fetal movements in the evening, as this is unusual