How Early in Pregnany Can My Feel Baby Move
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Fetal move in late pregnancy – a content analysis of women's experiences of how their unborn infant moved less or differently
BMC Pregnancy and Childbirth volume 16, Article number:127 (2016) Cite this article
Abstruse
Groundwork
Pregnant women sometimes worry virtually their unborn baby's health, frequently due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, describe how the infant had moved less or differently.
Methods
Women were recruited from all seven commitment wards in Stockholm, Sweden, during i/ane – 31/12 2014. The women completed a questionnaire afterwards it was verified that the pregnancy was viable. A modified content assay was used to analyse 876 questionnaires with the women'south responses to, "Try to describe how your babe has moved less or had changes in movement".
Results
Four categories and six subcategories were identified: "Frequency" (decreased frequency, absenteeism of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (inverse blueprint 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. Farther, they described worry due to incidents related to changed pattern of fetal movements.
Conclusion
Women reported changes in fetal move apropos frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-infirmary delay if the fetus is at take chances of fetal compromise.
Trial registration
Not applicable.
Peer Review reports
Background
Information technology is widely best-selling that a blueprint of regular movements is associated with fetal wellbeing [one]. Fetal movements can be defined every bit any discrete boot, palpitate, swish or roll and are normally showtime perceived by the mother betwixt xviii and xx weeks of gestation [2]. The frequency of fetal movements reaches a plateau in gestational week 32 and stays at that level until nascence [3]. There is normally a variation in fetal movements with a wide range in the number of movements per hr [4]. The movements are normally absent-minded during sleep and occur regularly throughout the 24-hour interval and nighttime, normally lasting for twenty–40 min. The sleep cycles rarely exceed ninety min in the normal and good for you fetus [v]. Although the movement pattern of the individual fetus is unique, it is general knowledge that decreased fetal move is associated with agin outcome, including stillbirth [six].
The character of the movements changes when the pregnancy approaches delivery due to limited infinite in the uterus, but the frequency and intensity will not usually decrease [3]. In an interview study, 40 term significant women with an upshot of a healthy baby described fetal movements during the past calendar week. Well-nigh all experienced fetal movements as "stiff and powerful". Half of the women also described the movements equally "large" (involving the whole body of the fetus). Another common description was "slow" as in "slow motion" and "stretching" or "turning". Some of the women stated that they were surprised how powerfully the fetus moved [seven].
Several maternal factors may impair the ability to recognize fetal movement [eight]. Amniotic fluid volume [9], fetal position [10], having an inductive placenta [10, 11], smoking, being overweight [vi] and nulliparity [6, 12] have been reported as 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 Kingdom of norway were sometimes worried well-nigh decreased fetal movements [14]. In a review article, it was found that between four and fifteen percent of significant women consult health care because of a decrease in fetal movement in the third trimester [ane]. The aim of the nowadays report was to examine how women, who consulted health intendance due to decreased fetal movements later on gestational calendar week 28, depict how the infant had moved less or differently.
Methods
Settings and participants
Women were recruited from all 7 delivery wards in Stockholm, Sweden from 1st January to 31st Dec 2014, and were asked to complete a questionnaire. The inclusion criteria were women in gestational week 28 or more than who consulted health intendance due to concerns over decreased fetal movements, with the ability to empathize Swedish or English and a normal cardiotocography (CTG). Not responders, inadequate answers, multiple pregnancies, undefined gestational week and unknown personal identity number were exclusion criteria (Fig. 1). In total, 3555 questionnaires were completed during the data collection period. Information collection was in progress while the kickoff chiliad questionnaires were analysed. Twenty-eight women completed ii questionnaires and three women filled in 3 questionnaires; they consulted health care more than one time during the data collection menstruum due to concerns over decreased fetal movements. Of the women, 672 (76.7 %) were anile 20–35 years, 582 (66.4 %) had a college or university level of education and 650 (74.2 %) of the women were born in Sweden (Table ane). All women gave nascence to a live child.
Flow chart
Data drove
The questionnaire used in the study was developed from a spider web survey, an interview study [7, 15] and clinical experience. The questionnaire was contiguous validated with x women who consulted health care due to reduced fetal movements, not included in the written report. The final version of the questionnaire included a total of 22 questions with multiple-selection or open up-ended response alternatives (Additional file 1). This study comprises the women's responses to the request: "Try to describe how your babe has moved less or had changes in movement". The women were asked to describe their experiences in the space provided only could as well, if necessary, go on on the dorsum of the questionnaire.
Analysis
The women's descriptions (n = 876) of how their unborn infant had moved less or differently were analysed using a modified content analysis [sixteen]. The textile consisted of curtailed descriptions of movements, which were used without editing. The analysis was performed in 3 steps. Firstly, all the answers were read and re-read 3 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 cloth 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 be placed in more than 1 category. However, each argument was only placed in one subcategory. During the whole process the findings were continually discussed in the research group in order to accomplish understanding. To validate the results, a sample of l quotations was randomly selected and re-analysed from the starting time of the analysis procedure. 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 assay did not know the gestational week.
Results
Four main categories and half dozen 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". 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 commonly experienced difference 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 motility
This subcategory comprises 609 (69 %) statements. These statements referred to movements becoming 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", "not as many" and "decreased activity".
"Less frequent during the day"
"From beingness very active and kicking a lot to very few movements during some days"
Absence of kicks and movement
Amongst the answers about the frequency of fetal movements, 137 (16 %) statements were about not feeling any move at all.
"I haven't felt whatever kicking for about 12 hours"
"Take not felt whatsoever motility 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 babe felt weaker the few times I have felt my babe"
Indistinct fetal movements
Sixty-6 (8 %) statements brutal into this subcategory. Some women were uncertain as to whether they felt anything at all only idea they could imagine movements.
"…The only matter I felt was non-specific movements deep within my tummy…"
"Take previously felt apparent kicks which can be both felt and seen distinctly. Since yesterday evening only pocket-sized occasionally twisting movements"
Graphic symbol
This category comprised 252 (29 %) statements describing experiences of the fetal movements changing in character. The category revealed two subcategories: "Inverse 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 blueprint and decreased in activity.
"Not the same pattern of movements as before and non active at the aforementioned time"
"The babe has not moved at the times that she had moved before, post-obit the design 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 (13 %) statements. When talking near the movements women used words such every bit: "sluggish", "indolent", "irksome and sweeping".
"Calmer more than tired movements equally if it were tired…"
"Slow and smoother movements"
Duration
30-8 (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. However, the frequency of how often the infant had moved had not decreased.
"… the periods when it has moved take 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 within the category Character and the subcategory Slower movements (five % vs. xv %) (Table 2).
Iv percentage, 32/876, of the full number of women in this study only stated a change in the graphic symbol of the movements, non included in whatsoever other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.5 %), 33–36, 1/263 (0.4 %) and gestational weeks 37+, xxx/423 (7 %). In that location were no statistically significant differences in the other categories (Not in table).
In improver to the responses categorised in accord with the question, the women also mentioned how they had tried to stimulate the fetus to motility 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 move
Nosotros identified 146 (17 %) statements about trying to provoke move by triggering the fetus. Well-nigh of the women reported that they did this when non having felt movements for a while. When they did not succeed they consulted wellness care. The methods used to trigger movements were to pull, nudge or push on the tummy, stimulate with light or noise, take a shower or bathroom or to drinkable cold, sweet drinks. Others said that they had various positions they used to feel the babe more than distinctly. Some women described not feeling movements without stimulating the infant.
"No pushes" dorsum when I am pulling on the tummy, no reaction when drinking a drinking glass of lemonade. Otherwise he has been quite agile and you lot have been able to encounter my tummy moving"
"Even if I touch my tummy, 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, hurting in the tummy or the back. We identified 40 statements (5 %) concerning difficulties in distinguishing fetal movements from contractions.
"Non felt whatever 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 design of fetal movements
We identified 25 (3 %) statements almost external factors, such as the adult female was ill and perceived less fetal movement. 6 women stated that they consulted health intendance due to pain in relation to changed patterns of fetal movement. Ii 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: postal service maturity, post-obit an expelled mucus plug, an external cephalic version effort, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to motility a lot during both day and night. Take been sick with fever for three days and and so in that location accept been movements 4–five times every twenty-four hours"
"Non as ofttimes equally before simply I still feel him daily. We're extremely worried equally we lost our outset child in gestational week 33 in utero so it may be imagination"
Discussion
We are non enlightened of whatsoever studies that accept categorized how women describe the changes they have perceived concerning fetal movements when they seek health intendance due to worry most their unborn baby.
Women who consulted health intendance due to subtract fetal movements described changes in frequency, intensity, graphic symbol and duration of the movements. Nevertheless, all women in this written report were reassured afterward an exam of their unborn infant. In Kingdom of norway, equally many equally 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy [fourteen]. 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]. Even so, nosotros have no information apropos amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this study. These factors may explicate some of the women's perceptions of decreased fetal movements. Also, the plateau in gestational week 32 [iii] may be perceived equally a subtract. In a study by Sheikh and colleagues (2014), 729 women counted and registered fetal movements for ane hour three times per 24-hour interval. Eight percent of the pregnant women in the tertiary trimester, who in the end gave birth to a good for you child, experienced reduced fetal movements. Further, the researchers institute that among women who consulted health intendance for reduced fetal movements simply after 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 every bit 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 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 [xx]. All fetuses in the nowadays written report were examined and no symptoms of asphyxia or placental dysfunction were identified at the time when the woman consulted wellness care. The women's worry about their unborn baby's health due to decreased fetal movements in this study did non result 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 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, equally in slow motion, stretching and turning, are descriptions of the character of fetal movements used by women in total term pregnancy, pregnancies that resulted in a healthy child [7]. The women in our study who consulted health care merely due to a modify in the graphic symbol of the movements and non considering of contradistinct frequency and intensity might not have been aware of normal changes in the fetal motility patterns in late pregnancy. The changes they reported as different tin be physiological due to limited space in the uterus at term [3]. At that place is no routine in Swedish antenatal health intendance for giving information almost fetal movements simply women are recommended to consult health care if they experience decreased fetal movements [21]. Even so, pregnant women ask for information about fetal movements in general and for information virtually the number and blazon of fetal movements they tin 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 exist aware of the importance of detecting fetuses at take chances as early every bit possible. Detection of decreased fetal movements can ameliorate the result and reduce delay in consulting health care [23, 24]. Further, the fetuses in this written report who could be at risk were examined and adventure factors such as placental abruptions, growth retardation or malformations [25] may take been detected. The principal reason for consulting health care due to decreased fetal movements is worry near the health of the infant [14]. None of the women in our written report consulted wellness care without cause, but their worry was obviously unfounded from a medical perspective in the curt term.
Strengths and limitations
Women in this written report had a normal CTG before they completed the questionnaire. All the same, aside from no stillbirths amidst the participating women, we accept no data regarding the health condition of the infant later on nascency. This is a major limitation of the study. There is likewise only sparse data about the women's' sociodemographic groundwork.
I strength of the study is the big number of participants. Another strength is that all commitment wards in Stockholm participated in the study. However, all women came from the capital letter city 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 so are not known.
The wording of the request, "Attempt to describe how your baby has moved less or had changes in move" 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 instance, "Endeavor to describe how your baby has moved". Nonetheless, the context in which the women completed the questionnaire was one of already perceived decreased fetal movements.
Clinical implications
Increased noesis about the normal changes in the fetal movement patterns in late pregnancy can be 1 way to lessen the number of visits to obstetric clinics from women over concerns that plow out to exist unnecessary from a medical perspective. The challenge from a clinical perspective is to inform and advise meaning women nearly fetal movements with the goal of diminishing the length of pre-hospital filibuster 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 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 wellness. Further, fewer visits to obstetric clinics, over business organization that turns out to be unnecessary from a medical perspective, will take health economic benefits. Before giving definitive advice that can reduce unnecessary controls at the end of the pregnancy, singled-out 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 merely symptoms when they seek care for decreased fetal movements. Future studies are needed.
Conclusions
Women reported changes in fetal movement apropos frequency, intensity, character and duration; they described decreased, absence, weaker, slower and changed pattern of the movements.
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Funding
The Piddling Child's Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo's Research Foundation funded this study.
Availability of data and materials
The data will not be made bachelor in order 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 first 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 canonical the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ideals approval and consent to participate
The women gave consent to participate and permission to access supporting data when receiving information virtually the report. The information will non be made available in order to protect the participant's identity. The study was canonical by the Regional Upstanding Review Board in Stockholm: DNR: 2013/1077-31/3.
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Linde, A., Georgsson, S., Pettersson, K. et al. Fetal motion in late pregnancy – a content assay of women'southward 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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