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How pregnant women learn about foetal movements: Sources and preferences for information
Abstract
Background:
Unexplained late gestation stillbirth is a significant health issue. Antenatal information about foetal movements has been demonstrated to reduce the stillbirth rate in women with decreased foetal movements. Midwives are ideally placed to provide this information to women.
Aim:
To investigate pregnant women's perceptions of information about foetal movements and preferences for receiving information.
Methods:
This prospective, descriptive study was conducted in the antenatal clinic of a large metropolitan maternity hospital.
Findings:
Pregnant women (n=526) at 34 weeks gestation or later were recruited. Only 67% of women reported receiving information about foetal movements. Women reported that midwives (80%), family (57%), friends (48%) and own mother (48%) provided this information. Midwives were the most preferred source of information. Around half (52%) of the women used the internet for information but only 11% nominated the web as their preferred information source.
Conclusion:
Women prefer to be given as much information about foetal movements as possible. Women favour information from health professionals, mainly from a midwife. Midwives are well-placed to partner with pregnant women and give them unbiased and evidenced based information enabling them to make decisions and choices regarding their health and well-being. While the internet is a prevalent information source, women want to be reassured that it is trustworthy and want direction to reliable pregnancy related websites.
... For many providers, the approach is limited to a closed question of asking the woman if she feels fetal movement, with no further information offered. Between 25% and 60% of women report receiving no fetal movement information at all [34,[36][37][38]. In a Canadian survey, two-thirds of women were unable to describe normal fetal movements or fetal movement monitoring techniques, despite the recent introduction of national guidelines recommending all women are informed about fetal movements [34]. ...
... Healthy fetuses are most active in the evening, and quietest in the morning, according to both ultrasound studies [28] and maternal report [21]. 36 each delay initial identification of the fetal movement sensations by around 7 days [51]. There is significant variation between women, with some reporting they feel movements as early as 12 weeks and others as late as 30 weeks [2]. ...
... The quality of information provided to pregnant women from both professional and consumer sources is inconsistent and frequently not based on evidence. Women have indicated that they would like to receive more information about what is normal, preferably from midwives [36]. Structured approaches to daily fetal movement assessment are generally enjoyable for pregnant women, reduce anxiety and are easy to achieve during the evening. ...
Background
Presentations for decreased fetal movements comprise a significant proportion of acute antenatal assessments. Decreased fetal movements are associated with increased likelihood of adverse pregnancy outcomes including stillbirth. Consensus-based guidelines recommend pregnant women routinely receive information about fetal movements, but practice is inconsistent, and the information shared is frequently not evidence-based. There are also knowledge gaps about the assessment and management of fetal movement concerns. Women have indicated that they would like more accurate information about what to expect regarding fetal movements.
Discussion
Historically, fetal movement information has focussed on movement counts. This is problematic, as the number of fetal movements perceived varies widely between pregnant women, and no set number of movements has been established as a reliable indicator of fetal wellbeing. Of late, maternity care providers have also advised women to observe their baby’s movement pattern, and promptly present if they notice a change. However, normal fetal movement patterns are rarely defined. Recently, a body of research has emerged relating to maternal perception of fetal movement features such as strength, presence of hiccups, and diurnal pattern as indicators of fetal wellbeing in addition to frequency.
Conclusion
Sharing comprehensive and gestation-appropriate information about fetal movements may be more satisfying for women, empowering women to identify for themselves when their baby is doing well, and importantly when additional assessment is needed. We propose a conversational approach to fetal movement information sharing, focusing on fetal movement strength, frequency, circadian pattern, and changes with normal fetal development, tailored to the individual.
... Furthermore, structured assessment of FMs may result in increased antenatal visits related to maternal concerns for FMs 2,14,15 , or conversely, a reduction in the number of unscheduled visits because women become more aware of fetal activity and the norms for their baby 16 . Studies have also found, however, that up to as many as 50% of pregnant women do not receive information about FMs from their healthcare providers 17,18 , and, as a result, women do not understand the importance of being aware of their FMs in pregnancy 2 . Understanding the impact or effects of formal FMC on women's subjective outcomes such as concern/worry and anxiety is essential for healthcare providers who may guide women on assessing or being aware of their FMs in pregnancy. ...
... Three studies (four reports) were assessed as strong on methodological quality 20,21,27,30 , four as moderate (eight reports) 13,14,[22][23][24][25]28,29,31 and two as weak 26,32 . Regarding individual methodological quality components, two studies (five reports) were assessed as strong for selection bias with an 80-100% participation rate [15][16][17][18][19][20][21][22]29 . The remaining seven studies were assessed as moderate on this criterion as less than 80-100% of those invited took part, or because the information to accurately assess participation rates was missing from the study report. ...
... Concern has been expressed that introducing FMC as a routine method of screening FMs could increase the use of resources and admission rates, without influencing perinatal outcomes such as stillbirth and neonatal death 6,27,33 . Although no differences between the groups in hospital attendance or admission for concern regarding fetal activity or reduced FMs was found in this review, one needs to consider the variations and inconsistent definitions that exist globally in clinical practice with regard to FM assessment, as there is no standard protocol 5,18,38 , and many women do not receive adequate information on FMs or FMC methods 17,18 . Clinicians, when advising and instructing women about the significance of FMs in pregnancy, should ensure that the same standard of information is provided to all women. ...
Introduction:
Formally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their fetal movements in a structured, objective way that can potentially improve maternal subjective outcomes such as worry or concern. The aim of this study was to evaluate the effect of formal fetal movement counting versus no formal counting, on maternal worry, concern or anxiety, and maternal-fetal attachment (MFA). Secondary outcomes were compliance with the intervention (counting method) and hospital admission/attendance for fetal activity concerns.
Methods:
CINAHL, MEDLINE and EMBASE were searched systematically for eligible studies from inception dates to June 2020, supplemented by searches of trial databases, grey literature and the reference lists of included studies. Randomized controlled and quasi-randomized trials were included in the review.
Results:
Nine studies reported across 15 publications were included involving 70824 pregnant women. The results showed that MFA levels were significantly higher in women who formally counted fetal movements than those who did not (standardized mean difference=0.72; 95% CI: 0.10-1.33, five studies, 1565 women). There were no differences between the groups in maternal anxiety or worry/concern outcomes. Attendance or admission rates for reduced fetal movements, or concern for fetal activity, did not differ between the groups (OR=1.36; 95% CI: 0.97-1.91, three studies, 1947 women). Compliance in completing fetal movement charts varied, ranging 45-90%, although definitions of compliance differed across studies, which may have affected rates.
Conclusions:
This review has found that formal fetal movement counting in pregnancy has no detrimental effects on maternal psychological or emotional status and positively affects maternal-fetal attachment. Although current evidence does not support the use of formal fetal movement counting for improving perinatal outcomes, such as stillbirth and neonatal death, the results of this review are helpful for clinicians in discussing fetal movements in pregnancy and in discussing the optional methods available to women who may be advised to or choose to objectively assess fetal movements using a formal fetal movement counting method.
... This helped women in recalling information about fetal movements during 3 weeks intervention. The preferred of written educational media also revealed in previous studies (17,25). ...
... The women expect fetal movement information based on scientific evidence (1,17,27), in a uniform guidelines (17,28), and in printed form that can be referenced at any time (17). This study has several limitations which have to be pointed out. ...
... The women expect fetal movement information based on scientific evidence (1,17,27), in a uniform guidelines (17,28), and in printed form that can be referenced at any time (17). This study has several limitations which have to be pointed out. ...
p> Background : Decreased movements of the fetus can indicate decrease supply of oxygen and nutrients to the fetus and increase the risk of fetal compromised, even stillbirth. Providing accurate information on fetal movements will help mother to make right decision when dealing with decreased fetal movements. This study aims to determine the effect of fetal movement counting education on knowledge and compliance of pregnant women in performing fetal movement counting.
Method : This pre-experimental study allocated 32 pregnant women at 28-37 weeks gestation to practice daily fetal movement counting for 3 weeks. The intervention was a package of fetal movement counting education and practice for 3 weeks. Knowledge on fetal movement counting was measured 4 times by a validated questionnaire and compliance was measured in the end of intervention. Friedman test was used to analyze the changes of women knowledge on fetal movement counting.
Results: The results showed that there was an increase in women knowledge on fetal movement counting from 52.94% to 86.10% at the end of intervention, by the highest score in the technihue for fetal movement counting (93.67%). Comparison of 4 measurement periods showed significant changes in knowledge (p <0.000), with a tendency of rise in knowledge. The compliance in performing fetal movement counting was high about 96%.
Conclusion: Education of fetal movement counting will increases the knowledge regarding fetal movement. Providing appropriate education and continuous follow-up will increase women’s awareness on the importance of fetal movement monitoring and rise up their compliance to do so.</p
... The references, and exclusion reasons for these 56 excluded studies are provided in Additional file 3. This resulted in the inclusion of nine studies across 11 publications [28][29][30][31][32][33][34][35][36][37][38]. Figure 2 illustrates the search and selection process. Table 1 presents the summary characteristics of the included studies. ...
... Table 1 presents the summary characteristics of the included studies. Three studies (four reports) were conducted in Sweden [28,32,33,36], three in Australia [34,35,37], two in the UK [31,38] and one (two reports) in New Zealand [29,30]. The majority of the studies (n = 6) were conducted from 2011 onwards, with one conducted in 1986 [31], and for two, the study dates were not provided [29,30,36]. ...
... The majority of the studies (n = 6) were conducted from 2011 onwards, with one conducted in 1986 [31], and for two, the study dates were not provided [29,30,36]. Data collection involved the use of questionnaires with open-ended response options in six studies [28,[31][32][33][34][35][36][37] and interviews in the remaining three studies [29,30,36,38]. In total, 2193 multiparous and primiparous women participated in the nine included studies (Table 1). ...
Background
Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is important for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis.
Methods
A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an Evidence for Policy and Practice Information (EPPI)-Centre quality assessment tool. Data synthesis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual.
Results
Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women’s perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ‘ … like a feather inside my belly’ - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low.
Conclusion
This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMs. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women’s perspective of assessing FMs in pregnancy are required.
... The included studies were published between January 2002 and May 2018, and were from different countries: the USA [14][15][16][17][18], Iran [19][20][21][22], Nigeria [3,9,11,23], Australia [8,24,25], Ghana [26,27], Sweden [28,29], the United Kingdom [30,31], China [32], India [33], Italy [34], Jordan [35], Saudi Arabia [36], Spain [37], and Turkey [38]. Two studies were multinational studies which were conducted in 24 and 19 countries [39,40]. ...
... A variety of research methodologies were utilized to investigate health information seeking behaviors of women during pregnancy. A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
... A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
Introduction: Awareness of health information needs, sources of health information, and
barriers to accessing health information among pregnant women is critical for the development of health interventions and provides high-quality prenatal care for them. Hence, the aim of this review study was to summarize evidence from studies evaluating health information needs, sources of information and barriers to accessing health information of women during pregnancy.
Methods: A systematic literature search was conducted using Web of Science, Scopus, PubMed, ScienceDirect, and Google Scholar for relevant studies published between 1 January 2000 and 24 May 2018. The methodological quality of cross-sectional studies was assessed using the STROBE checklist. The Critical Appraisal Skills Programme (CASP, 2018) was used to appraise the qualitative studies. Data were analyzed descriptively.
Results: Thirty-one studies from 14 countries met criteria for inclusion in this review. The majority of articles focused on information needs and sources of information used by women during pregnancy. The most common information needs among women during pregnancy were information about unborn child, nutrition, and labor/delivery. The most frequent information source used by women during pregnancy was health professionals followed by informal source (family and friends), and Internet. The most prominent barriers to information access included the following: feeling ashamed or embarrassed to talk about pregnancy-related issues, long waiting times at clinic to see a health provider, and lack of adequate information resources.
Conclusions: Due to the limited number of studies examining barriers to health information seeking among pregnant women, further research is warranted. Further qualitative research is also recommended to explore pregnant women’s perceptions of, and satisfaction with the use of health information sources.
... The included studies were published between January 2002 and May 2018, and were from different countries: the USA [14][15][16][17][18], Iran [19][20][21][22], Nigeria [3,9,11,23], Australia [8,24,25], Ghana [26,27], Sweden [28,29], the United Kingdom [30,31], China [32], India [33], Italy [34], Jordan [35], Saudi Arabia [36], Spain [37], and Turkey [38]. Two studies were multinational studies which were conducted in 24 and 19 countries [39,40]. ...
... A variety of research methodologies were utilized to investigate health information seeking behaviors of women during pregnancy. A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
... A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
barriers to accessing health information among pregnant women is critical for the development of health interventions and provides high-quality prenatal care for them. Hence, the aim of this review study was to summarize evidence from studies evaluating health information needs, sources of information and barriers to accessing health information of women during pregnancy.
Methods: A systematic literature search was conducted using Web of Science, Scopus, PubMed, ScienceDirect, and Google Scholar for relevant studies published between 1 January 2000 and 24 May 2018. The methodological quality of cross-sectional studies was assessed using the STROBE checklist. The Critical Appraisal Skills Programme (CASP, 2018) was used to appraise the qualitative studies. Data were analyzed descriptively.
Results: Thirty-one studies from 14 countries met criteria for inclusion in this review. The majority of articles focused on information needs and sources of information used by women during pregnancy. The most common information needs among women during pregnancy were information about unborn child, nutrition, and labor/delivery. The most frequent information source used by women during pregnancy was health professionals followed by informal source (family and friends), and Internet. The most prominent barriers to information access included the following: feeling ashamed or embarrassed to talk about pregnancy-related issues, long waiting times at clinic to see a health provider, and lack of adequate information resources.
Conclusions: Due to the limited number of studies examining barriers to health information seeking among pregnant women, further research is warranted. Further qualitative research is also recommended to explore pregnant women’s perceptions of, and satisfaction with the use of health information sources.
... The included studies were published between January 2002 and May 2018, and were from different countries: the USA [14][15][16][17][18], Iran [19][20][21][22], Nigeria [3,9,11,23], Australia [8,24,25], Ghana [26,27], Sweden [28,29], the United Kingdom [30,31], China [32], India [33], Italy [34], Jordan [35], Saudi Arabia [36], Spain [37], and Turkey [38]. Two studies were multinational studies which were conducted in 24 and 19 countries [39,40]. ...
... A variety of research methodologies were utilized to investigate health information seeking behaviors of women during pregnancy. A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
... A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
Introduction: Awareness of health information needs, sources of health information, and barriers to accessing health information among pregnant women is critical for the development of health interventions and provides high-quality prenatal care for them. Hence, the aim of this review study was to summarize evidence from studies evaluating health information needs, sources of information and barriers to accessing health information of women during pregnancy. Methods: A systematic literature search was conducted using Web of Science, Scopus, PubMed, ScienceDirect, and Google Scholar for relevant studies published between 1 January 2000 and 24 May 2018. The methodological quality of cross-sectional studies was assessed using the STROBE checklist. The Critical Appraisal Skills Programme (CASP, 2018) was used to appraise the qualitative studies. Data were analyzed descriptively. Results: Thirty-one studies from 14 countries met criteria for inclusion in this review. The majority of articles focused on information needs and sources of information used by women during pregnancy. The most common information needs among women during pregnancy were information about unborn child, nutrition, and labor/delivery. The most frequent information source used by women during pregnancy was health professionals followed by informal source (family and friends), and Internet. The most prominent barriers to information access included the following: feeling ashamed or embarrassed to talk about pregnancy-related issues, long waiting times at clinic to see a health provider, and lack of adequate information resources. Conclusions: Due to the limited number of studies examining barriers to health information seeking among pregnant women, further research is warranted. Further qualitative research is also recommended to explore pregnant women's perceptions of, and satisfaction with the use of health information sources.
... The characteristics of these studies are shown in Table 1. Eleven studies either descriptive or cross-sectional (Bert et al. 2013;Ferraz et al. 2016;Ford and Alwan 2018;Hämeen-Anttila et al. 2014;Huberty et al. 2013;Jacobs et al. 2019;Lagan et al. 2010;McArdle et al. 2015;Narasimhulu et al. 2016;Sinclair et al. 2018;Wallwiener et al. 2016) while six of them were qualitative (Ahman et al. 2016;Criss et al. 2015;Fredriksen et al. 2016;Hinton et al. 2018;Lagan et al. 2011;Shorten et al. 2015). Two studies examined the perceptions of the women about the use of and an Internet-based birth preference decision support system (Shorten et al. 2015) and decision-making assistance (Ahman et al. 2016). ...
... Other articles had been carried out to determine the characteristics and prevalence of Internet users as a source of health information in pregnancy and to assess the impact of the Internet on decision-making about pregnancy-related subjects. Four studies collected the data by using questionnaires (Bert et al. 2013;Ferraz et al. 2016;McArdle et al. 2015;Narasimhulu et al. 2016), while eight studies used online questionnaires (Ford and Alwan 2018;Fredriksen et al. 2016;Hämeen-Anttila et al. 2014;Huberty et al. 2013;Jacobs et al. 2019;Lagan et al. 2010;Sinclair et al. 2018;Wallwiener et al. 2016) and five studies used personal or focus group interview (Ahman et al. 2016;Criss et al. 2015;Hinton et al. 2018;Lagan et al. 2011;Shorten et al. 2015). ...
... The areas in which the Internet affected decisions were prenatal tests (Bert et al. 2013;Narasimhulu et al. 2016), lifestyle during pregnancy (Bert et al. 2013;Jacobs et al. 2019), fetal movements (Criss et al. 2015;McArdle et al. 2015), pregnancy nutrition, physical activity (Huberty et al. 2013;Narasimhulu et al. 2016), medication advice and purchasing medications (Sinclair et al. 2018), vaccinations (Ford and Alwan 2018), birthplace choices (Hinton et al. 2018), and type of birth (Ferraz et al. 2016). ...
The purpose of this review is to explain how the Internet affects decision-making in pregnancy. A systematic review was carried out in accordance with the guidelines developed by the National Institute of Health Research at York University. The PubMed, EBSCOhost, Ulakbim Medical Database, Turkish Medline, Web of Science, and Scopus databases were scanned. Three keywords in the titles, abstracts, and keywords of the articles were searched for in the Medical Subject Headings: "Pregnancy," "Decision-making," and "Internet." A total of 1143 articles were found in the first screening. Duplicate articles were removed. The remaining articles were reviewed according to the inclusion criteria. Only articles about healthy pregnant women were accessed, and only full-text research articles published in English were used. Seventeen articles met the inclusion criteria. The sample size varied between 9 and 7092. Most studies reported that pregnant women use the Internet as a source of information about pregnancy. Pregnancy, development of the fetus, labor, neonatal health, and nutrition were the subjects most researched. It was found that women with a higher education, who were young, nulliparous, and primigravid, looked for more information on the Internet. The Internet affects decisions about the type of delivery, drug use in pregnancy, and physical activity. Using the Internet had a positive effect on the decision-making processes of pregnant women, increased their awareness, and had a visible effect on this process.
... The included studies were published between January 2002 and May 2018, and were from different countries: the USA [14][15][16][17][18], Iran [19][20][21][22], Nigeria [3,9,11,23], Australia [8,24,25], Ghana [26,27], Sweden [28,29], the United Kingdom [30,31], China [32], India [33], Italy [34], Jordan [35], Saudi Arabia [36], Spain [37], and Turkey [38]. Two studies were multinational studies which were conducted in 24 and 19 countries [39,40]. ...
... A variety of research methodologies were utilized to investigate health information seeking behaviors of women during pregnancy. A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
... A quantitative approach was used in 24 studies [3,8,9,11,[17][18][19][20][21][23][24][25][28][29][30][31][32][34][35][36][37][38][39][40] and a qualitative analysis was used in seven studies [14][15][16]22,26,27,33]. Seventeen studies used closed-ended questions [3,9,[17][18][19][20][21]23,25,29,30,34,[36][37][38][39][40], six used closed and open-ended questions [8,24,28,31,32,35], and one used closed-ended questions and interview [11] for data collection, the remainder used interviews with openended questions [16], semistructured interviews [22,26,27,33], and focus group discussions [14,15,26,27,33]. ...
Introduction: Awareness of health information needs, sources of health information, and barriers to accessing health information among pregnant women is critical for the development of health interventions and provides high-quality prenatal care for them. Hence, the aim of this review study was to summarize evidence from studies evaluating health information needs, sources of information and barriers to accessing health information of women during pregnancy.
Methods: A systematic literature search was conducted using Web of Science, Scopus, PubMed, ScienceDirect and Google Scholar for relevant studies published between 1 January, 2000 and 24 May, 2018. The methodological quality of cross-sectional studies was assessed using the STROBE checklist. The Critical Appraisal Skills Programme (CASP, 2018) was used to appraise the qualitative studies. Data were analyzed descriptively.
Results: Thirty one studies from 14 countries met criteria for inclusion in this review. The majority of articles focused on information needs and sources of information used by women during pregnancy. The most common information needs among women during pregnancy were information about unborn child, nutrition, and labor / delivery. The most frequent information source used by women during pregnancy was health professionals followed by informal source (family and friends), and Internet. The most prominent barriers to information access included the following: feeling ashamed or embarrassed to talk about pregnancy related issues, long waiting times at clinic to see a health provider, and lack of adequate information resources.
Conclusions: Due to the limited number of studies examining barriers to health information seeking among pregnant women, further research is warranted. Further qualitative research is also recommended to explore pregnant women’s perceptions of, and satisfaction with the use of health information sources.
... Maternal perception of fetal movements is reassuring of fetal wellbeing. It is well established that perception of decreased fetal movements (DFM) is associated with stillbirth and pregnant women are routinely asked about fetal movements during antenatal visits [1,2]. However, association of DFM with stillbirth is only moderately strong (odds ratio 2.4-14.1) ...
... In a survey, 99.9% of pregnant women reported that it was important for them to feel their baby move every day [9]. Studies report that women would like to receive more information about fetal movements [1,10], preferably written and face-to-face from midwives [1]. However, between 25-60% of pregnant women do not recall receiving any information about fetal movements [1,11,12]. ...
... In a survey, 99.9% of pregnant women reported that it was important for them to feel their baby move every day [9]. Studies report that women would like to receive more information about fetal movements [1,10], preferably written and face-to-face from midwives [1]. However, between 25-60% of pregnant women do not recall receiving any information about fetal movements [1,11,12]. ...
Background and objectives:
Encouraging 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.
Methods:
Participants 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.
Results:
Participants 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.
Conclusions:
Our 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.
... The maternal perception of low fetal movements has been accompanied with increased risk of small for gestational age infants, fetal growth restriction (FGR), and stillbirth (16,17) . However, there is an emerging evidence to suggest that an increase in fetal movement (particularly if this is sudden) is also associated with stillbirth (18) . ...
... Maternal reaction to a decrease or increase in fetal movements helps in the early detection of high-risk fetuses thus saving baby's life (18) . Community health nurses, midwives, obstetricians and other health care providers should routinely provide pregnant women with advice and information about pregnancy related issues including fetal movements, and this topic should be revised in the third trimester of pregnancy (19) . ...
... This was also seen in the Nuzum et al. (2017) study, who reported that those over 45 years were more likely to say they did not know the incidence or risk factors of stillbirth (31% versus 18%). Australian studies have reported that pregnant women receive perinatal information such as fetal movements and stillbirth from a variety of sources not just their health care provider [5,17]. These include their family, friends, and own mother [5,17]. ...
... Australian studies have reported that pregnant women receive perinatal information such as fetal movements and stillbirth from a variety of sources not just their health care provider [5,17]. These include their family, friends, and own mother [5,17]. These results reflect the need for future public health messages to target not only pregnant people, but also older individuals within our community. ...
Background
The prevalence of stillbirth in many high income countries like Australia has remained unchanged for over 30 years. The 2018 Australian government Senate Select Committee on Stillbirth Research and Education highlighted the need for a public health campaign to encourage public conversations and increase awareness. However, there is little evidence about the community’s knowledge and perceptions towards pregnancy and stillbirth, nor their aspirations for a public health campaign.
Aims
To assess the general knowledge, perceptions, myths and attitudes towards stillbirth to inform future public health campaigns.
Methods
Australian participants (n = 344; predominately women n = 294 (85.5%)) were recruited via Facebook.com. They completed a cross-sectional online survey designed to assess their knowledge of pregnancy and stillbirth, with additional questions on socio-demographic characteristics.
Results
Stillbirth knowledge and awareness of incidence was low in this sample. Prominent myths, such as baby runs out of room in the uterus (n = 112, 33%) and baby slows down when preparing for labour (n = 24, 27%) were endorsed. Only 25% (n = 85) knew the prevalence of stillbirth in Australia (six per day). Almost two-thirds (n = 205; 62%) agreed that there needs to be a public health campaign, however one in five (n = 65; 20%) were concerned that talking about stillbirth with pregnant women may cause them to worry.
Discussion and conclusion
Our findings reinforce the need for a targeted campaign, which educates the general population about the definition and prevalence of stillbirth, stillbirth risks and modifiable health behaviours. Appropriate messaging should target pregnant women during antenatal care as well as their support and care systems (family, friends, and care providers).
... The trial found no difference in perinatal outcomes between the groups, although spontaneous onset of labour was higher in the Mindfetalness group, and caesarean section rates were lower [12]. Variation in guidance, recommendations and practices for assessing FMs in pregnancy thus remains [13][14][15], and women continue to receive varied levels of information and advice from healthcare professionals regarding FM assessment [16,17]. ...
... 'Close to birth…..movements will less a bit' [41] and 'slow down' because there is 'less room' [41,43] versus 'movements should not slow down towards the end of pregnancy even if the baby has less room' [41, p.5] Timing and frequency of FMs Variations in frequency and timing of FMs was a common experience for women, with some experiencing regular FMs throughout the day [35,36,43], while others experienced less movement during the day, more commonly experiencing FMs in the evening [36,37]. Expectations as to when rst FMs should be felt varied between [12][13][14][15][16][17][18][19] weeks and 17-20 weeks, although many women (approx. 25% in one study [43]) report feeling their rst FMs after 20 weeks' gestation [41,43]. ...
Background: Raising awareness of the importance of fetal movements (FMs) and advising women on the appropriate action to take if they experience reduced FMs, is critical for minimising or avoiding adverse perinatal outcomes. To gain insight and understanding of women’s perspectives of assessing FMs in pregnancy, we conducted a qualitative evidence synthesis.
Methods: A qualitative evidence synthesis using thematic synthesis was conducted. Studies were eligible if they included pregnant women who were at least 20 weeks gestation and reported qualitative data from women on assessing FMs in pregnancy. MEDLINE, CINAHL, EMBASE, PsycINFO and Social Science Citation Index, from inception to July 2020, were searched. The methodological quality of included studies was assessed by at least two reviewers using an EPPI-Centre quality assessment tool. Data analysis, using the Thomas and Harden framework, involved line by line coding of extracted data, establishing descriptive themes, and determining analytical themes. Confidence in the findings was assessed using GRADE CER-Qual.
Results: Nine studies, involving 2193 women, were included in the review. The methodological quality of the studies was overall generally high. The synthesis revealed three dominant themes, and seven sub-themes that reflected women’s perspectives of assessing FMs in pregnancy. These were; 1) How women engage with FMs, with subthemes of informal engagement, formal engagement, and strategies to stimulate FMs; 2) ‘…like a feather inside my belly’ - articulating and describing FMs, with sub-themes of sensations associated with FMs and timing and frequency of FMs; and 3) FMs and help/health seeking, with sub-themes of information sources and interacting with healthcare professionals. Confidence in the findings was either high or moderate, although two findings were rated low confidence and one very low.
Conclusion: This qualitative evidence synthesis reveals that women informally engage with FMs during pregnancy. Women commonly adopt strategies to stimulate FMs when concerned. The use of the internet was a common source of obtaining information regarding FMS. Women require better support when contacting healthcare professionals about FMs. As only three of the nine included studies were exclusively qualitative in design, further qualitative studies exploring women’s perspective of assessing FMs in pregnancy are required.
... Women are positive about receiving as much information about fetal movements as possible [14]. In an antenatal care clinic in Australia, a questionnaire was distributed to 526 pregnant women from 34 weeks' gestation and 67% stated that they had received information about fetal movements [14]. ...
... Women are positive about receiving as much information about fetal movements as possible [14]. In an antenatal care clinic in Australia, a questionnaire was distributed to 526 pregnant women from 34 weeks' gestation and 67% stated that they had received information about fetal movements [14]. The majority requested further information from their midwife or healthcare provider and additional written material to refer to at any time. ...
Background
Information given to pregnant women about fetal movements is important in maternity care and decreased fetal movements is associated with fetal growth restriction and stillbirth. The fetal movement pattern is different for every fetus and women perceive different types of movements. Mindfetalness is a self-assessment method for a woman to use to become familiar with her unborn baby’s fetal movement pattern.
Aim
We aimed to explore midwives’ perceptions about informing pregnant women about fetal movements and their experiences of working with Mindfetalness in their daily work.
Methods
A web-questionnaire was distributed to midwives who participated in a randomized controlled trial evaluating Mindfetalness, a method for the observation of fetal movements. In total, 67 maternity clinics in Stockholm, Sweden, were randomized to Mindfetalness or routine care. Of the 144 midwives working in maternity clinics randomized to Mindfetalness, 80% answered the questionnaire.
Findings
The midwives thought that the leaflet about Mindfetalness was supportive in their work when informing women about fetal movements and the majority wanted to continue to distribute the leaflet when the trial ended. The midwives also expressed that the study increased their own knowledge about fetal movements. Women embraced the information about Mindfetalness positively and appreciated the written material. The midwives thought that talking about fetal movements in maternity care is an important but challenging task.
Conclusion
Mindfetalness is a useful tool to use in maternity clinics when informing pregnant women about fetal movements. The written information was appreciated by both pregnant women and midwives.
... Despite provider-to-patient communication being such an important aspect of risk prevention, relatively little is known on exactly how providers should communicate this information to their patients. While face-to-face conversations are ideal, ample clinic time with every patient is frequently cited as a limitation to adequate communication and discussion of all risks [15][16][17][18][19][20]. Since clinic time is limited, knowing what other modes of communication women would like their prenatal care providers to use to relay Zika virus information may be helpful for managing patient queries and more effectively disseminating public health guidance. ...
... During an evolving public health threat that disproportionally affects pregnant women, it is important for prenatal care providers to know how best to communicate with their patients. We already know from research on topics like routine maternal vaccinations and general pregnancy-related information that women trust their obstetric care providers and prefer face-to-face discussions with them [15,17,19,[22][23][24][25]. But in situations where there is not enough time to thoroughly discuss all pertinent information and answer every question a patient has, there is a dearth of research on what secondary communication modalities women prefer and the qualities of public health information they value most. ...
Background
Because of the particularly severe perinatal outcomes associated with antenatal Zika virus infection, it is important for prenatal care providers to communicate Zika virus risks and strategies for prevention to their patients. Although face-to-face communication is ideal, clinic visits may not allow for in-depth discussion of all concerns. While previous studies have shown prenatal providers to be pregnant women’s most trusted sources of health information, there is little knowledge on what secondary communication modalities pregnant women prefer for receiving information from their providers about an evolving public health emergency. MethodsA cross-sectional, descriptive anonymous 27-item survey was distributed to pregnant women at four clinics around Atlanta, Georgia from May 5th to June 20th, 2016. The survey assessed women’s interest in and communication preferences about prenatal topics, including Zika virus. Descriptive statistics were calculated and chi-square tests were used to evaluate associations between the primary outcomes and patient characteristics. ResultsFour-hundred and eight women completed the survey. The most popular resource for obtaining Zika virus information was the Centers for Disease Control and Prevention (CDC) website (73.0%). While their prenatal provider’s own website for Zika information ranked 5th among sources currently accessed for Zika information, it ranked third behind educational brochures and emails for ways in which women wanted to receive information. The characteristics of Zika virus information deemed most important were: evidence-based (87.5%), endorsed by the CDC (74.1%), and endorsed by their own provider (67.9%). Conclusion
In any public health emergency affecting pregnant women, women are going to seek advice from their obstetric providers. Because providers may lack sufficient time to discuss concerns with every patient, they may consider providing patient education in other ways. For the women included in this study, educational brochures, emails and providers’ own practice websites were preferred. Providers should consider taking greater advantage of these modalities to supplement in-person exchanges, particularly during a public health emergency.
... The maternal perception of low fetal movements has been accompanied with increased risk of small for gestational age infants, fetal growth restriction (FGR), and stillbirth (16,17) . However, there is an emerging evidence to suggest that an increase in fetal movement (particularly if this is sudden) is also associated with stillbirth (18) . ...
... Maternal reaction to a decrease or increase in fetal movements helps in the early detection of high-risk fetuses thus saving baby's life (18) . Community health nurses, midwives, obstetricians and other health care providers should routinely provide pregnant women with advice and information about pregnancy related issues including fetal movements, and this topic should be revised in the third trimester of pregnancy (19) . ...
... Midwives, obstetricians, and other health care providers should frequently offer guidance and information to pregnant women on issues related to pregnancy, including fetal movements, and this subject should be revisited during the third trimester of pregnancy (Sterpu et al., 2020& Freeman et al., 2012. Many studies analyze various methods for counting fetal movement among normal pregnant women (Delaram, Shams, 2016& Olagbuji et al., 2014& McArdle et al., 2015. But there is insufficient evidence to date that daily fetal movement counting is beneficial or not in terms of early detection and avoidance of adverse pregnancy outcomes for pregnant women who already have a history of risky pregnancy. ...
... 32 Internet and the web have also proven to be essential sources of information for pregnant women. 33 Today's technology played a role in providing a new definition of proximity because proximity was no longer defined as the accurate distance through the internet. New parents could find friendship and closeness by communicating through the internet and WhatsApp groups. ...
Introduction: Although it has proven to be helpful, the attendance of pregnant mothers in Antenatal Classes (AC) was still low, so an ineffective breakthrough application of AC was needed according to the mother's wishes and interests.Objective: The study aimed to compare various models of practical AC for pregnant mothers to improve behavior prevention of high-risk pregnancies.Method: This study is quasi-experimental with a nonequivalent control group and pre-posttest design. The population of all pregnant mothers in Semarang City, with 181 samples, was divided into three groups (Extended, Virtual and Conventional). Measurements were carried out four times to see the mean score increasing, and the results of the last measurement were analyzed using the One Way ANOVA test to compare the effectiveness of these three groups.Results: There was an increase in the mean value of all dimensions of the behavior of high-risk prevention based on its measurement stages. The extended model has the highest improvement, followed by the Virtual model. Statistically, there was a better chance in all behavioral dimensions after the intervention. There were differences in all dimensions of maternal behavior between the extended and the conventional model. In contrast, only knowledge and practice differed in the virtual model but not in attitudes, beliefs, and intentions.Conclusion: Extended and virtual models of AC effectively improved high-risk prevention behaviors better than conventional models. Although the increase was not as high as the extended model, the virtual model has an excellent opportunity to be developed as a strategy to overcome time constraints for mothers and health providers.
... Our findings are in line with previous research that have highlighted that CMV is not routinely included in antenatal education and most pregnant women felt frustrated and annoyed that they haven't been given the chance to implement changes to reduce risk of congenital CMV for their unborn child (e.g. Vandrevala et al., 2019 ;Wood, 2017 ;ComRes, 2014 ) and there was a unanimous agreement that they wanted information about CMV to be provided to them by HCPs, particularly midwives, as their most trusted resource in antenatal education ( McArdle et al., 2015 ;Grimes et al., 2014 ;Lavender et al., 1999 ). This contrasts with the views expressed by HCPs who assisted with showing pregnant women the film that midwives often lacked adequate time to provide CMV education within routine care. ...
Objective
The study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood.
Design
This process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews.
Setting
Recruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London
Participants
The study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy.
Findings
Pregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women.
Key conclusions and implications for practice
There is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.
... 15,16 Recently, the UK-based AFFIRM (Awareness of fetal movements and care package to reduce fetal mortality) trial showed that a package of care to improve DFM awareness and management did not reduce stillbirth and increased induction of labour, caesarean section and neonatal unit admission for >48 hours. 17 In Australia and New Zealand (ANZ) the wide variation in care for women reporting DFM, 18 and deficits in the information provided to women, 19 led to the development of bi-national guidelines in 2010 and information resources for women. 20 However, concerns about a lack of awareness and suboptimal management for women with DFM remained. ...
Objective:
The My Baby's Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (MBM intervention).
Design:
Stepped-wedge cluster-randomised controlled trial.
Setting:
Twenty-seven maternity hospitals in Australia and New Zealand.
Population/sample:
Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks' gestation from August 2016-May 2019.
Methods:
The MBM intervention was implemented at randomly assigned time points with sequential introduction into 8 groups of 3-5 hospitals at four-monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and intervention periods adjusting for calendar time, study population characteristics, and hospital effects.
Outcome measures:
Stillbirth at ≥28 weeks' gestation.
Results:
There were 304,850 births with 290,105 meeting inclusion criteria: 150,053 in control and 140,052 in intervention periods. The stillbirth rate was lower (although not statistically significantly) during the intervention compared with the control period (2.2 versus 2.4/1000 births; aOR 1.18, 95% CI 0.93-1.50; p=0.18) The decrease in stillbirth rates was larger across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident.
Conclusion:
The MBM intervention did not reduce stillbirths beyond the downward trend over time. Due to low uptake, the role of the intervention remains unclear, though the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, awareness of fetal movements may have reached pregnant women and clinicians prior to implementation of the intervention.
... Access to information and maternal health-seeking behaviour is linked to a gap in knowledge, which an individual tries to bridge (Onuoha & Amuda 2013), and is key to obtaining health information during pregnancy (Mulauzi & Daka 2018). Although pregnant women may have a number of information sources to choose from when seeking information regarding pregnancy (Grimes, Forster & Newton 2014), such as the Internet, popular media or family and friends, health workers remain the most frequently used source of information (Ebijuwa, Ogunmodede & Oyetola 2013;McArdle et al. 2015; Owusu-Addo, Owusu-Addo & Morhe 2016; Song et al. 2013). However, access to information is not equitable in low-and high-income settings where differing levels of opportunities and availability of information sources are experienced. ...
Background: The quality of the decisions made by women during pregnancy, especially their
first visit, depends on their health needs, their health-seeking behaviour and the type of
information available to them.
Aim: This study describes the health education needs, information barriers and health
information-seeking behaviour of pregnant women on their first visit to antenatal clinics in a
low-income setting in the Western Cape.
Setting: The setting was two antenatal facilities in Khayelitsha Health District facilities in
South Africa.
Methods: A quantitative descriptive survey was conducted. A systematic random sample of
261 antenatal first visit attendees between May and July 2016 was selected. Data were collected
using a researcher-administered questionnaire and was analysed using descriptive statistics,
95% confidence intervals and non-parametric tests.
Results: The response rate of the study was 92% (n = 240). Pregnant women attending an
antenatal clinic for the first time reported high information needs with low health informationseeking behaviours and high information barriers. Doctors, nurses (2.2, ±1.0), family and
friends (2.0, ±0.6) were the most frequently used sources of health information, while watching
television or listening to the radio (1.5, ±0.9) were the least used sources of health information.
Having a medical diagnosis ( p < 0.001) and being of an advanced maternal age ( p = 0.005)
were predictive of higher health-seeking behaviour. The reliance on passively receiving
information from health sources may indicate low levels of health literacy and its inverse
relationship to health promoting behaviours which should be the subject of further
investigation.
... The high reported need for health education during the first visit of pregnant women might be related to the assumption of pregnant women that they have gaps in their health knowledge and therefore require a variety of health education on their first visit (Baron et al. 2017). Furthermore, pregnant women are more likely to have a high number of questions on their first visit as they mostly reinforce written information (McArdle et al. 2015). This is further supported in our study where the strongest predictor for the high needs score for health education was respondents' lack of knowledge about pregnancy (unaware of duration of pregnancy) (Table 3). ...
Health education is a key component of first antenatal visits. The aim of this study was to describe the health education needs of pregnant women on their first visit to antenatal clinics in Khayelitsha, South Africa. A quantitative descriptive survey was conducted, to investigate the lifestyle, pregnancy-related, psycho-social health education needs and predictors of health education needs during pregnant women’s first antenatal clinic visit. The research was conducted at two purposively selected antenatal clinics in Khayelitsha, a low-income suburb in Cape Town, South Africa. The respondents were considered eligible for the study if they were Xhosa speaking, pregnant, older than 18 years, making a first visit to antenatal care, and able to complete their consent form or provide consent from parents or relatives. Respondents were eligible for the study regardless of the number of pregnancies they had previously had, their age and previous medical conditions. There were a total of 240 (92%) respondents. Overall pregnancy-related health education needs were rated the highest (m=4.0, [95%CI3.95–4.09]), with information on how the baby grows and develops during pregnancy (m=4.6, [95%CI4.5–4.7]) the highest. The lowest rated health information needs were testing for HIV and prevention thereof (m=3.5, [95%CI3.3–3.7]) and how to use seat belts during pregnancy (m=3.2, [95%CI3.0–3.4]). A lack of awareness of the duration of pregnancy predicted significantly higher overall health education needs and lifestyle education needs. The study recommends that pregnant women should be provided with prioritised health information during their first antenatal visit, especially given the high risk of late bookings for first antenatal visits.
... Women often report not receiving information about DFM and many delay seeking care when DFM occurs [44]. Women who do receive information are more likely to know what to do when concerned [45]. To enhance consistency and quality of care for women presenting with DFM, a clinical practice guideline on DFM has been developed [24] with an accompanying brochure for women, which has been translated into 19 languages [46]. ...
Background:
Stillbirth is a devastating pregnancy outcome that has a profound and lasting impact on women and families. Globally, there are over 2.6 million stillbirths annually and progress in reducing these deaths has been slow. Maternal perception of decreased fetal movements (DFM) is strongly associated with stillbirth. However, maternal awareness of DFM and clinical management of women reporting DFM is often suboptimal. The My Baby's Movements trial aims to evaluate an intervention package for maternity services including a mobile phone application for women and clinician education (MBM intervention) in reducing late gestation stillbirth rates.
Methods/design:
This is a stepped wedge cluster randomised controlled trial with sequential introduction of the MBM intervention to 8 groups of 3-5 hospitals at four-monthly intervals over 3 years. The target population is women with a singleton pregnancy, without lethal fetal abnormality, attending for antenatal care and clinicians providing maternity care at 26 maternity services in Australia and New Zealand. The primary outcome is stillbirth from 28 weeks' gestation. Secondary outcomes address: a) neonatal morbidity and mortality; b) maternal psychosocial outcomes and health-seeking behaviour; c) health services utilisation; d) women's and clinicians' knowledge of fetal movements; and e) cost. 256,700 births (average of 3170 per hospital) will detect a 30% reduction in stillbirth rates from 3/1000 births to 2/1000 births, assuming a significance level of 5%. Analysis will utilise generalised linear mixed models.
Discussion:
Maternal perception of DFM is a marker of an at-risk pregnancy and commonly precedes a stillbirth. MBM offers a simple, inexpensive resource to reduce the number of stillborn babies, and families suffering the distressing consequences of such a loss. This large pragmatic trial will provide evidence on benefits and potential harms of raising awareness of DFM using a mobile phone app.
Trial registration:
ACTRN12614000291684. Registered 19 March 2014.
Version:
Protocol Version 6.1, February 2018.
... This study also explored the sources of information women accessed regarding fetal movements. McArdle et al.'s study 42 reported that women received education about fetal movements from midwives (n = 420, 79.8%), Obstetricians (n = 206, 39.1%), and GPs (n = 290, 55.1%). Half of their participants accessed further information through the internet. ...
Background:
Every year, 2.6 million babies are stillborn worldwide. Despite these figures, stillbirth remains a relatively ignored public health issue. The wider literature suggests that this is due to the stigma associated with stillbirth. The stigma of stillbirth is seen as possibly one of the greatest barriers in reducing stagnant stillbirth rates and supporting bereaved parents. However, empirical evidence on the extent, type, and experiences of stillbirth stigma remain scarce.
Aim:
This study aimed to explore the stigma experiences of bereaved parents who have endured a stillbirth.
Methods:
An online survey of closed and open-questions with 817 participants (n=796 female; n=17 male) was conducted in high-income countries.
Findings:
Based on self-perception, 38% of bereaved parents believed they had been stigmatised due to their stillbirth. Thematic data analysis revealed several themes consistent with Link and Phelan's stigma theory- labelling, stereotyping, status loss and discrimination, separation, and power. One more theme outside of this theory- bereaved parents as agents of change was also discovered.
Conclusion:
Bereaved parents after stillbirth may experience stigma. Common experiences included feelings of shame, blame, devaluation of motherhood and discrimination. Bereaved parents also reported the silence of stillbirth occurred during their antenatal care with many health care providers not informing them about the possibility of stillbirth. Further research needs to be undertaken to explore further the extent and type of stigma felt by bereaved parents after stillbirth, and how stigma is impacting the health care professional disseminating and distributing resources to pregnant women.
... This study also explored the sources of information women accessed regarding fetal movements. McArdle et al.'s study 42 reported that women received education about fetal movements from midwives (n = 420, 79.8%), Obstetricians (n = 206, 39.1%), and GPs (n = 290, 55.1%). Half of their participants accessed further information through the internet. ...
Background:
Fetal movements are a key indicator of fetal health. Research has established significant correlations between altered fetal activity and stillbirth. However, women are generally unaware of this relationship. Providing pregnant women with information about the importance of fetal movements could improve stillbirth rates. However, there are no consistent fetal movements awareness messages globally for pregnant women.
Aims:
This study aimed to explore the antenatal care experiences of Australian mothers who had recently had a live birth to determine their knowledge of fetal movements, the nature and source of that information.
Methods:
An online survey method was used for 428 women who had a live birth and received antenatal care in Australia. Women's knowledge of fetal movements, stillbirth risk, and the sources of this knowledge was explored.
Findings:
A large proportion of participants (84.6%; n=362) stated they had been informed by health care professionals of the importance of fetal movements during pregnancy. Open-ended responses indicate that fetal movements messages are often myth based. Awareness that stillbirth occurs was high (95.2%; n=398), although, 65% (n=272) were unable to identify the current incidence of stillbirth in Australia.
Conclusion:
Women who received antenatal care have high-awareness of fetal movements, but the information they received was inconsistent. Participants knew stillbirth occurred but did not generally indicate they had obtained that knowledge from health care professionals. We recommend a consistent approach to fetal movements messaging throughout pregnancy which focuses on stillbirth prevention.
... As with FMC, evidence concerning the appropriate management and identification of RFM is inconsistent and inconclusive (Tveit et al, 2009;Unterscheider et al, 2010). Education regarding the significance of fetal movement is of vital importance and should be prioritised (McArdle et al, 2015); however, insufficient evidence on RFM definitions may impact maternal compliance with inconsistent advice (Draper et al, 2015). In addition, with the ever-increasing popularity of message boards and social media, pregnant women have easy access to information that may be of variable quality and lack an evidence-based foundation (Warland and Glover, 2017). ...
Background
Stillbirths represent a significant global issue, with 2.6 million cases reported in 2015. Stillbirths are often unexplained and preceded by changes in fetal movement patterns. Fetal movement counting methods may be used to monitor maternally perceived fetal movement to identify pregnancies at increased risk.
Aims
This article reports on an in-depth, evidence-based practice review conducted to investigate the relationship between fetal movement counting and stillbirth rates.
Methods
A comprehensive search of online databases was undertaken to identify relevant literature using keywords. The results were then appraised.
Findings
Although a lack of conclusive evidence exists to support or refute the routine implementation of fetal movement counting to reduce stillbirth, indirect evidence suggests that increased maternal and professional awareness of fetal movement may assist in reducing stillbirth rates.
Conclusions
Further research is required to develop an appropriate definition of reduced fetal movement, and to determine the potential implications of fetal movement counting as a diagnostic screening tool to reduce stillbirths.
... Pregnant women indicated that, in addition to verbal communication, they also wanted written information from their maternity caregivers about foetal movements. 17 Therefore, it is useful to explore women's preferences about how they want to receive information about RFM, for example via an information brochure or digitally, such as via smartphone and whether presenting information through animations is more effective than a written brochure. ...
Background:
Perinatal audits in the Netherlands showed that stillbirth was nearly always preceded by a period of reduced foetal movements. Patient or caregiver delay was identified as a substandard care factor.
Aim:
To determine whether the use of a new information brochure for pregnant women on foetal movements results in less patient delay in contacting their maternity caregiver.
Methods:
A pre- and post-survey cohort study in the Netherlands, including 140 women in maternity care with a singleton pregnancy, expecting their first child. All participating women filled out a baseline questionnaire, Cambridge Worry Scale and pre-test questionnaire at the gestational age of 22-24 weeks. Subsequently, the intervention group received a newly developed information brochure on foetal movements. At a gestational age of 28 weeks, all women received the post-test questionnaire. Multiple regression analyses were used.
Findings:
Per-protocol analysis showed less patient delay in the intervention group compared to the control group (Odds Ratio 0.43; 95% Confidence Interval 0.17-0.86, p=0.02). A significant linear relation was observed between reading the information brochure and an increase of knowledge about foetal movements (B=1.2, 95% Confidence Interval 1.0-1.4, p<0.001). Maternal concerns did not affect patient delay to report reduced foetal movements.
Conclusion:
Use of an information brochure regarding foetal movements has the potential to reduce patient delay and increase knowledge about reduced foetal movements. A national survey to determine the effect of an information brochure about reduced foetal movements on patient delay and stillbirth rates is needed.
... Prenatal information is a decisive determinant of health choices made by pregnant women and their partners as they move through the continuum of perinatal services [1,2]. Considering the myriad of information sources publicly available and their variable quality [3][4][5][6][7], prenatal education remains a health promotion strategy at the core of perinatal care and services provided by health and social services centers [8][9][10] [S-10] and is supported by public policies [10,11]. Group prenatal education is one of the most common educational models [12]. ...
Background:
Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners.
Methods:
This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group).
Discussion:
This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services.
Protocol version:
Version 1 (February 9 2018).
... A recent study of 526 pregnant women at a metropolitan maternity hospital in Australia found that more than one-third of women at 34 weeks' gestation or later did not recall receiving information about fetal movements from their healthcare provider. 14 ...
The National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Stillbirth and the Perinatal Society of Australia and New Zealand (PSANZ) have recently partnered in updating an important clinical practice guideline, Care of pregnant women with decreased fetal movements. This guideline offers 12 recommendations and a suggested care pathway, with the aim to improve the quality of care for women reporting decreased fetal movements through an evidence-based approach. Adoption of the guideline by clinicians and maternity hospitals could result in earlier identification of higher-risk pregnancies, improved perinatal health outcomes for women and their babies, and reduced stillbirth rates.
... Ideally, providers would have in-depth in-person discussions with each patient about relevant heath topics, but ample clinic time with each patient is often cited as a limitation to conveying all relevant information. [21][22][23][24][25][26] Also, the frequency of prenatal care visits is weighted towards the end of pregnancy, when the window of opportunity may have passed for education about time-sensitive topics like seasonal influenza vaccination. ...
Objective:
Prenatal providers are pregnant women's most trusted sources of health information, and a provider's recommendation is a strong predictor of maternal vaccine receipt. However, other ways women prefer receiving vaccine-related information from prenatal providers, aside from face-to-face conversations, is unclear. This study explores what secondary communication methods are preferred for receiving maternal vaccine-related information.
Study design:
Obstetric patients at four prenatal clinics around Atlanta, Georgia received a 27-item survey between May 5th, 2016 and June 15th, 2016. Participants were asked about sources they currently use to obtain prenatal health information and their preferences for receiving vaccine-related information from providers. Descriptive statistics were calculated and chi-square tests were used to evaluate associations between participant characteristics and outcomes.
Results:
Women primarily reported using the CDC website (57.7%) and pregnancy-related websites (53.0%) to obtain vaccine information. Apart from clinical conversations, educational brochures (64.9%) and e-mails (54.7%) were the preferred methods of receiving vaccine information from providers, followed by their provider's practice website (42.1%). Communication preferences and interest in maternal immunization varied by race/ethnicity, age and education; white women were twice as likely to want information on a provider's practice website compared to African-American women (OR = 2.06; 95% CI: 1.31, 3.25).
Conclusions:
Pregnant women use the Internet for information about vaccines, but they still value input from their providers. While e-mails and brochures were the preferred secondary modes of receiving information, a provider's existing practice website offers a potential communications medium that capitalizes on women's information seeking behaviors and preferences while limiting burden on providers.
... Despite the large-scale use of the internet as a health consultant (Larsson, 2009;Peragallo-Urrutia et al., 2015), women who use it tend to have a medium to high educational level (Sayakhot and Carolan-Olah, 2016;Guillory et al., 2014;Nölke et al., 2015) and do not always agree with the information obtained (Lima-Pereira et al., 2012;McArdle et al., 2015). Indeed, they often seek a second opinion, usually from a healthcare professional (Farrant and Heazell, 2016;Grimes et al., 2014;Lewallen and Côté-Arsenault, 2014;Lima-Pereira et al., 2012). ...
Objective:
the aim of this study is to evaluate the quality of web pages found by women when carrying out an exploratory search concerning pregnancy, childbirth, the postpartum period and breastfeeding.
Design/setting:
a descriptive study of the first 25 web pages that appear in the search engines Google, Yahoo and Bing, in October 2014 in the Basque Country (Spain), when entering eight Spanish words and seven English words related to pregnancy, childbirth, the postpartum period, breastfeeding and newborns. Web pages aimed at healthcare professionals and forums were excluded. The reliability was evaluated using the LIDA questionnaire, and the contents of the web pages with the highest scores were then described.
Findings:
a total of 126 web pages were found using the key search words. Of these, 14 scored in the top 30% for reliability. The content analysis of these found that the mean score for "references to the source of the information" was 3.4 (SD: 2.17), that for "up-to-date" was 4.30 (SD: 1.97) and the score for "conflict of interest statement" was 5.90 (SD: 2.16). The mean for web pages created by universities and official bodies was 13.64 (SD: 4.47), whereas the mean for those created by private bodies was 11.23 (SD: 4.51) (F (1,124)5.27. p=0.02). The content analysis of these web pages found that the most commonly discussed topic was breastfeeding, followed by self-care during pregnancy and the onset of childbirth.
Conclusion:
in this study, web pages from established healthcare or academic institutions were found to contain the most reliable information. The significant number of web pages found in this study with poor quality information indicates the need for healthcare professionals to guide women when sourcing information online. As the origin of the web page has a direct effect on reliability, the involvement of healthcare professionals in the use, counselling and generation of new technologies as an intervention tool is increasingly essential.
... However, midwives reportedly lack awareness and knowledge of popular pregnancy websites and their use by and importance to, pregnant women (Weston & Anderson, 2014). It is recommended that antenatal health care professionals should be able to guide pregnant women to high-quality reliable sources of information online and assist them with interpreting and applying it (Lagan et al., 2011;Larsson, 2009;McArdle et al., 2015). ...
Aim:
The aim of this study was to assess pregnant women's Internet searching activity about medication safety, knowledge and perceptions of medication risk and willingness to take prescribed and non-prescribed medication or make online medication purchases.
Background:
Online medication advice for pregnant women is complex. The quality and veracity of this data is increasingly important as more midwives report women are bringing retrieved online information to clinical appointments. Pregnant women's use of the Internet for seeking medication advice and purchasing medications has not yet been fully investigated.
Design:
Online survey conducted from January - March 2013.
Findings:
Of the 284 respondents, 39% were taking a medication when they became pregnant and 76% had searched the Internet for medication safety information. Analgesics were the most commonly searched category (41%). Health service sites were the most common online source and regarded as the most helpful and trusted. Regardless of age and education level, 90% of women agreed that if trying to become pregnant they would reconsider taking any medications because of the potential risk to their unborn baby. Forty-six percent of women with higher levels of education consider buying medication online as safe, a greater proportion than those of lower education. Five percent of women reported buying medication online.
Conclusion:
The lack of specific recommendations for medication use during pregnancy is challenging for healthcare staff and pregnant women who need robust evidence to make informed treatment decisions. The Internet is a recognized, commonly accessed, source of medication information for pregnant women.
... A study by Frøen (2004) report that four to sixteen percent consult care during the latter part of the pregnancy. General recommendations are requested by pregnant women (McArdle et al., 2015) and Jokhan et al. demonstrated that clinical guidance is needed (Jokhan et al., 2015). ...
Background:
decreased fetal movement is a reason for women to seek health care in late pregnancy.
Objective:
to examine what pregnant women who present with decreased fetal movements want to communicate to health care professionals and to other women in the same situation.
Design:
a qualitative descriptive study.
Setting and participants:
questionnaires were distributed in all seven labour wards in Stockholm from 1 January to 31 December 2014 to women who consulted care due to decreased fetal movements. In total, 3555 questionnaires were completed of which 1 000 were included in this study. The women's responses to the open ended question: "Is there something you want to communicate to health care professionals who take care of women with decreased fetal movement or to women who experience decreased fetal movements?", were analysed with manifest content analysis.
Finding:
three categories were revealed about requests to health care professionals: Pay attention to the woman and take her seriously, Rapid and adequate care and Improved information on fetal movements. Regarding what the women want to communicate to other pregnant women, four categories were revealed: Contact health care for check-up, Pay attention to fetal movement, Recommended source of information and Practical advice.
Conclusion:
pregnant women who consult health care due to decreased fetal movements want to be taken seriously and receive rapid and adequate care with the health of the infant as the primary priority. The women requested uniform information about decreased fetal movements. They wished to convey to others in the same situation the importance of consulting care once too often rather than one time too few.
... There is no routine in Swedish antenatal health care for giving information about fetal movements but women are recommended to consult health care if they experience decreased fetal movements [21]. However, pregnant women ask for information about fetal movements in general and for information about the number and type of fetal movements they can expect, as well as how the movements are supposed to change over time in pregnancy [22]. ...
Background
Pregnant women sometimes worry about their unborn baby’s 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, describe how the baby had moved less or differently. Methods
Women were recruited from all seven delivery 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, “Try to describe how your baby has moved less or had changes in movement”. ResultsFour 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 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. Conclusion
Women reported changes in fetal movement concerning 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-hospital delay if the fetus is at risk of fetal compromise. Trial registrationNot applicable.
... 16 Women want to obtain information about foetal movements from midwives providing antenatal care. 18 However, studies indicate that women do not recall being given information about foetal movements from health care providers. 19 It seems essential to encourage women in late pregnancy to focus on the unique pattern of the baby's movements, as these observations may reinforce prenatal attachment. ...
Objective:
To investigate the association between the magnitude of foetal movements and level of prenatal attachment within a 24h period among women in the third trimester of pregnancy.
Design:
a prospective population-based survey.
Setting:
A county in central Sweden.
Participants:
Low risk pregnant women from 34 to 42 weeks gestation, N=456, 299 multiparous and 157 primiparous women.
Measurements:
The revised version of the Prenatal Attachment Inventory (PAI-R) and assessment of the perception of foetal movements per 24h in the current gestational week.
Findings:
A total of 81 per cent of the eligible women completed the questionnaire. The overall sample of women found that the majority (96%) felt their baby move mostly in the evening. More than half of the respondents (55%) stated that they perceived frequent foetal movement on two occasions during a 24h period, while almost a fifth (18%) never or only once reported frequent foetal movement in a 24h period. Just over a quarter (26%) of respondents perceived frequent movement at least three times during a 24h period. Perceiving frequent foetal movements on three or more occasions during a 24h period, was associated with higher scores of prenatal attachment in all the three subscales.
Key conclusion:
Perceiving frequent foetal movements at least during three occasions per 24h periods in late pregnancy was associated with prenatal attachment.
Implications for practice:
encouraging women to focus on foetal movements may positively affect prenatal attachment, especially among multiparous women >35 years.
Background/Aims
Globally, 2 million stillbirths occur annually, 98% of which occur in low-income settings. In low-income settings, stillbirth may be associated with maternal perception of reduced fetal movements. However, little is known about maternal experiences of reduced fetal movements and subsequent engagement with health services in low-income settings. This narrative literature review initially aimed to improve understanding of views and experiences of reduced fetal movements in pregnant women in low-income settings using information synthesised from international studies. However, only a small number of articles from low-resource settings were found.
Methods
The literature reviewed qualitative, quantitative and mixed-method studies guided by a systematic approach. The findings were discussed narratively.
Results
A total of 40 studies were identified, only four of which were from low-income settings. The four main themes identified were: maternal perception of fetal movements, facilitators and barriers to seeking healthcare, reduced fetal movements as a predictor of fetal outcomes and knowledge of fetal movements and management strategies.
Conclusions
A variety of factors may influence maternal perception of reduced fetal movements and experience of care. As most studies were conducted in high-income settings, it is imperative to describe women's experiences of reduced fetal movements in low-income settings.
Objectives
To identify predictors of seeking care for decreased fetal movements and assess whether care-seeking behaviour is influenced by Mindfetalness.
Design
Observational study with data from a cluster-randomised controlled trial.
Setting
67 maternity clinics and 6 obstetrical clinics in Sweden.
Participants
All pregnant women with a singleton pregnancy who contacted the obstetrical clinic due to decreased fetal movements from 32 weeks’ gestation of 39 865 women.
Methods
Data were collected from a cluster-randomised controlled trial where maternity clinics were randomised to Mindfetalness or routine care. Mindfetalness is a self-assessment method for women to use daily to become familiar with the unborn baby’s fetal movement pattern.
Outcome measures
Predictors for contacting healthcare due to decreased fetal movements.
Results
Overall, 5.2% (n=2059) of women contacted healthcare due to decreased fetal movements, among which 1287 women (62.5%) were registered at a maternity clinic randomised to Mindfetalness and 772 women (37.5%) were randomised to routine care. Predictors for contacting healthcare due to decreased fetal movements were age, country of birth, educational level, parity, prolonged pregnancy and previous psychiatric care (p<0.001). The main differences were seen among women born in Africa as compared with Swedish-born women (2% vs 6%, relative risk (RR) 0.34, 95% CI 0.25 to 0.44) and among women with low educational level compared with women with university-level education (2% vs 5.4%, RR 0.36, 95% CI 0.19 to 0.62). Introducing Mindfetalness in maternity care increased the number of women seeking care due to decreased fetal movements overall.
Conclusion
Women with country of birth outside Sweden and low educational level sought care for decreased fetal movements to a lesser extent compared with women born in Sweden and those with university degrees. Future research could explore whether pregnancy outcomes can be improved by motivating women in these groups to contact healthcare if they feel a decreased strength or frequency of fetal movements.
Trial registration number
NCT02865759 .
Background:
The Movements Matter campaign aimed to raise awareness of decreased fetal movements (DFM) among pregnant women and inform clinicians of best practice management.
Aim:
To conduct a process evaluation of campaign implementation, and an impact evaluation of the campaign's effects on knowledge and experiences of pregnant women, and attitudes and practices of clinicians in relation to DFM.
Methods:
This study used a cross-sectional before-after design. Pregnant women and clinicians were sampled at five hospitals. Women were surveyed about their knowledge of DFM, and actions to take if they noticed DFM. Clinicians were asked about their current practices and attitudes about informing women about DFM. Logistic regression was used to calculate campaign effects on outcome measures.
Results:
The Movements Matter campaign reached 653 262 people on social media, as well as being covered on news media and popular women's websites. The evaluation surveyed 1142 pregnant women pre-campaign and 473 post-campaign, and 372 clinicians pre-campaign and 149 post-campaign. Following the campaign, women were more likely to be aware that babies should move the same amount in late pregnancy (adjusted odds ratio (aOR) 1.81, 95% CI 1.43-2.27), and were more likely to contact their health service immediately if their baby was moving less (aOR 1.52, 95% CI 1.22-1.91). Clinicians were 2.84 times more likely to recommend women should come in for assessment if they experience DFM (95% CI 1.35-5.97).
Conclusions:
This evaluation has shown that a campaign using social media and in-hospital education materials led to some increases in knowledge about fetal movements among pregnant women.
First-time mothers have a unique and varied set of information needs, but at present, these needs are seldom adequately addressed by libraries in China. As a first step in making libraries more helpful to this group, this study reports the results of a series of interviews aimed at understanding new mothers’ current information seeking behaviors. Thirty-seven first-time mothers (children from first year of birth to six years of age) took part in semi-structured in-depth interviews, answering questions about their information demand, information source selection (and factors influencing this selection), and obstacles encountered in the process of information search. It was found that first-time mothers’ information-seeking behavior varies from stage to stage, e. g. between pregnancy and the immediate postpartum period. Internet search plays an important role because of its perceived convenience and accessibility, but trust is the key factor during the process of information selection, regardless of source. Overall, the mothers we interviewed seldom use the library. This paper puts forward some suggestions to remedy that situation: libraries might consider opening a first-time-mothers reading room, increasing cooperative promotions with other institutions, providing diversified service projects, and organizing reading-promotion activities for first-time mothers at different stages. If implemented, these suggestions promise to help mothers navigate the transitions of pregnancy, childbirth, and childcare.
Background: Pregnant women create their childbirth expectations from their available information. Therefore, they should have access to reliable and quality medical information. However, the literature points a knowledge gap with respect to the sources of information used by them.
Objectives: The primary objective was to analyse the most influential and widely used sources of information about childbearing in Spanish pregnant women. The secondary objectives were to assess the quality and usefulness of the information sources, to identify those regarded as deficient by pregnant women and to discover differences in information use related to parity.
Design and methods: A cross-sectional descriptive study was undertaken involving the administration of questionnaires to 40 primiparous and 40 multiparous (taking into account their first and second pregnancy). Social Network Analysis was used, as well as descriptive and inferential statistics for secondary objectives.
Results: Midwives were the most widely used (degree 0.988) and influential source of information (degree 0.600). Although the Internet was very much used (degree 0.738), its influence was very limited (degree 0.050). Healthcare professionals provided the most useful and highest quality information. Statistically significant differences have been found between first and second pregnancy of multiparous women in relation to the utilisation of some sources of information.
Conclusions: Midwives were identified as the key professionals for informing pregnant women. The most influential sources were always people (this underscoring the importance of the face-to-face contact in the search for information). Although new technologies offered support, were unable to replace the information provided by healthcare professionals.
Objectives:
We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.
Methods:
A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.
Results:
There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.
Conclusions:
Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.
Background
Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women’s attitudes, experiences and compliance in using Mindfetalness.
Methods
We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28–32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.
Results
Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.
Conclusion
Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.
Background:
Experience of reduced fetal movements is a common reason for consulting health care in late pregnancy. There is an association between reduced fetal movements and stillbirth.
Aim:
To explore why women decide to consult health care due to reduced fetal movements at a specific point in time and investigate reasons for delaying a consultation.
Methods:
A questionnaire was distributed at all birth clinics in Stockholm during 2014, to women seeking care due to reduced fetal movements. In total, 3555 questionnaires were collected, 960 were included in this study. The open-ended question; "Why, specifically, do you come to the clinic today?" was analyzed using content analysis as well as the complementary question "Are there any reasons why you did not come to the clinic earlier?"
Results:
Five categories were revealed: Reaching dead line, Receiving advice from health care professionals, Undergoing unmanageable worry, Contributing external factors and Not wanting to jeopardize the health of the baby. Many women stated that they decided to consult care when some time with reduced fetal movements had passed. The most common reason for not consulting care earlier was that it was a new experience. Some women stated that they did not want to feel that they were annoying, or be perceived as excessively worried. Not wanting to burden health care unnecessarily was a reason for prehospital delay.
Conclusion:
Worry about the baby is the crucial reason for consulting care as well as the time which has passed since the women first experienced decreased fetal movements.
Information that women receive about the importance of monitoring fetal movements and what to do if there are changes is inconsistent and may not be evidence based.
This paper reports a of the kind of messages a group of South Australian midwives (_n_ = 72) currently give pregnant women.
Comment data from two questions in a larger survey asking (1) what information midwives routinely provide to women about fetal movements and (2) their practice regarding advice they give to women reporting reduced fetal movements. Data were analysed using summative content analysis.
Four main recurring words and phrases were identified. With respect to information midwives give all women about monitoring fetal movements, recurring words were “10”, “normal”, “kick charts” and “when to contact” their care-provider. Recurrent words and phrases arising from answers to the second question about advice midwives give to women reporting reduced fetal movement were “ask questions,” “suggest fluids,” “monitor at home and call back” or “come in for assessment”.
These findings suggest that a group of South Australian midwives are providing pregnant women with inconsistent information, often in conflict with best practice evidence.
As giving correct, evidence based information about what to do in the event of an episode of reduced fetal movement may be a matter of life or death for the unborn baby it is important that midwives use existing guidelines in order to deliver consistent information which is based on current evidence to women in their care.
Objective:
reduced fetal movements (RFM) are experienced by 46-50% of women prior to the diagnosis of stillbirth. Empowering women with evidenced-based information regarding RFM may allow for prompt contact with a health care provider and access to appropriate management. Use of the Internet is growing in popularity as a source of pregnancy information to aid mothers׳ decision-making. This study aimed to identify and examine the available online information for pregnant women regarding RFM.
Design:
a systematic search was performed using Google, Yahoo and Bing to identify the most popular websites giving information about RFM. The websites were assessed for readability, accountability and content using the Flesh-Kincaid ease of readability score; the Silberg criteria; and by comparison to evidence-based guidelines respectively. Chat forums were assessed using a qualitative thematic analysis.
Findings:
70 information articles and 63 chat forums were analysed from 77 unique websites. The mean readability score was 65.7 (suitable for the average 13-15 year old) and therefore above the recommended level set for health materials; only 15 (21.4%) websites met all accountability criteria; and 43 (70%) websites contained information that was not in accordance with evidence-based recommendations. Typical questions on forums were 'Is this normal? What should I do?' and responses were 'Better safe than sorry', 'There is no harm in calling'.
Key conclusion:
overall, there was wide variation in the quality of information regarding RFM on the Internet. However, the study identified four excellent websites on RFM that may be suitable sources of information for women. Women׳s uncertainty displayed in the chat forums may suggest that clearer, accessible guidance is needed if they experience RFM.
Implications for practice:
the Internet can compliment and support current methods of antenatal information provision. However, due to varying levels of quality it is essential that professionals discuss and direct women to useful evidenced-based websites. Care must be taken to ensure consistent advice and management of those presenting with RFM and that women׳s concerns are addressed.
Background:
Stillbirth occurring after 28 weeks gestation affects between 1.5-4.5 per 1,000 births in high-income countries. The majority of stillbirths in this setting occur in women without risk factors. In addition, many established risk factors such as nulliparity and maternal age are not amenable to modification during pregnancy. Identification of other risk factors which could be amenable to change in pregnancy should be a priority in stillbirth prevention research. Therefore, this study aimed to utilise an online survey asking women who had a stillbirth about their pregnancy in order to identify any common symptoms and experiences.
Methods:
A web-based survey.
Results:
A total of 1,714 women who had experienced a stillbirth >3 weeks prior to enrolment completed the survey. Common experiences identified were: perception of changes in fetal movement (63% of respondents), reports of a "gut instinct" that something was wrong (68%), and perceived time of death occurring overnight (56%). A quarter of participants believed that their baby's death was due to a cord issue and another 18% indicated that they did not know the reason why their baby died. In many cases (55%) the mother believed the cause of death was different to that told by clinicians.
Conclusions:
This study confirms the association between altered fetal movements and stillbirth and highlights novel associations that merit closer scrutiny including a maternal gut instinct that something was wrong. The potential importance of maternal sleep is highlighted by the finding of more than half the mothers believing their baby died during the night. This study supports the importance of listening to mothers' concerns and symptoms during pregnancy and highlights the need for thorough investigation of stillbirth and appropriate explanation being given to parents.
Simulation has become a major player in the medical world. Still way behind other high-risk industries, simulation is being increasingly accepted and finds its ways into many clinical areas. Simulation offers the possibility to train individual skills as well as to evaluate performance, provide group crisis management training or even investigate the safety of installed systems and algorithms without risking patient's life. Obstetric units and labor suites have been identified as high-risk areas in the hospital setting and can be challenging environments for the anesthesiologist. Simulators can be used to improve communication skills and workload distribution, and specifically drill for obstetric-relevant crisis scenarios. However, it remains unclear how well these trainings do transfer into clinical performance and improved patient outcome. Being a relevant cost factor, simulation will have to provide answers to these questions; hence, more research is needed in the future.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Background:
Fetal movement, a sign of life, is widely considered as an indicator of fetal health status. Therefore, perceived alteration in regular fetal movement after the age of viability may signify impending adverse perinatal outcome.
Aims:
This study aimed to determine maternal knowledge, behavior, and concerns about abnormal fetal movement in the third trimester of pregnancy.
Materials and methods:
A total of 225 women were surveyed using a self-administered questionnaire at the out-patient prenatal clinics of two tertiary health facilities in Nigeria between December 1, 2012 through January 31, 2013. Questions addressed knowledge, perception behavior, and concerns about experience of abnormal fetal movement.
Results:
Correct Knowledge of excessive and decreased fetal movement was found in 47% and 31.1% of respondents, respectively. Majority of women (87.6%) either had no knowledge of normal parameters of fetal activity or did not recall being told that movement frequency and strength should increase in the third trimester. The proportion of women who expressed concern over excessive and decreased fetal movement was 31.1% and 21.8%, respectively. Maternal education was significantly associated with correct knowledge of decreased fetal movement ( P = 0.026). Almost 36% of respondents had knowledge of at least one potential consequence of abnormal fetal movement.
Conclusion:
Maternal educational level is an important factor in the early identification of abnormality of fetal movement. The unsatisfactory knowledge and poor perception behavior among respondents reflect the need for a guideline, particularly during antenatal care, on information and management of abnormal fetal movement in our setting to prevent avoidable stillbirth.
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Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency.
To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM).
Prospective cohort study.
305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression.
22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31-38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01-1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94-0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02-0.99) were independently related to pregnancy outcome. hPL was related to placental mass.
Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.
This paper examines the willingness of pregnant women to participate in research on health. We investigate attitudes toward multiple methods of data collection including survey and biomarker data collection. Complete interviews were obtained from a sample of 90 pregnant women in a matched control-comparison study of patients receiving prenatal care in private practice and clinic settings. Women experiencing prenatal care at a clinic reported less willingness to participate in research than women experiencing prenatal care at a private practice. Women who deemed "contributing to science", "learning about pregnancy health", and "helping future patients" as important motivations for participating in research were more likely to express willingness to participate in a study. African American women reported less willingness to answer questions in a survey compared to white women. The results suggest that motivational factors should be integrated into the design of a study of pregnant women to encourage participation.
While most births result in a live baby, stillbirth (the birth of a dead baby) occurs in nearly 1 in 110 pregnancies. This study examined whether levels of maternal anxiety and depression are lower amongst mothers who received social support after stillbirth. Using non-probability sampling, data were collected from 769 mothers residing within the USA who experienced a stillbirth within the past 18 months and for whom we have complete data. The study Maternal Observations and Memories of Stillbirth and the website http://www.momstudy.com containing the questionnaire were open in the period 8 February 2004–15 September 2005. Congruent with the family stress and coping theory, mothers of stillborn babies who perceived family support in the period after stillbirth experienced levels of anxiety and depression that were notably lower than those of their counterparts. Nurses, physicians and support groups also were important sources of support after a stillbirth; however, these sources of support alone were not statistically significant in reducing anxiety and depression in grieving mothers. Community interventions should focus on the grieving mother and her family system, including her partner and surviving children.
Over the years, maternal perception of foetal movement has become recognised as a valuable tool for early detection of foetal compromise.
Opsomming
Oor die jare is moederlike waarneming van fetale beweging erken as ’n belangrike instrument in die vroeë identifisering van fetale nood.
*Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Women experiencing decreased fetal movements (DFM) are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1) written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2) guidelines for management of DFM for health-care professionals.
All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively.
Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32-0.81), and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48-0.93). There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced.
Improved management of DFM and uniform information to women is associated with fewer stillbirths.
This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.
to investigate whether pregnant Swedish women used the Internet to retrieve pregnancy-related information, how they perceived the reliability of the information, and whether they discussed this information with their midwife during antenatal care visits.
a descriptive, cross-sectional design using waiting-room questionnaires to obtain information from pregnant women attending 11 antenatal clinics in a county in mid-Sweden during 2004.
all Swedish-speaking women who visited the clinics during a 2-week period, and who were at least 32 weeks pregnant, were invited to participate. A total of 182 women, with a mean age of 31 years, participated in the study; the response rate 85%.
most (91%) of the women had access to the Internet and, to a great extent (84%), used it to retrieve information, most often in the early stages of their pregnancy. Fetal development and stages of childbirth were the two most often mentioned topics of interest. Most participants considered the information to be reliable, and the two most important criteria for judging the trustworthiness of web-based information were if the facts were consistent with information from other sources and if references were provided. Most (70%) of the women did not discuss the information they had retrieved from the Internet with their midwife, but more than half of them (55%) searched for information on topics brought up by the midwife.
Swedish pregnant women often use the Internet to find information on various topics related to pregnancy, childbirth and the expected baby. They perceive the information to be reliable but rarely discuss it with their midwives. Antenatal care providers should be able to guide pregnant women to high-quality, web-based information and then take the opportunity to discuss this information with them during antenatal visits.
Our aim was to identify associations between information given to pregnant women about fetal activity, level of maternal awareness of fetal activity, maternal concern about decreased fetal movement, and pregnancy outcomes. This was a population-based cross-sectional study. Mothers with a singleton delivery were invited to answer an anonymous structured questionnaire before discharge from the delivery unit. Six hundred and ninety-one mothers participated (60.4% of eligible women). Women were highly aware of fetal activity. Yet, 25% did not receive any information from care providers about expected normal fetal activity. Receiving information about fetal activity was associated with increased maternal awareness (odds ratio, 2.0; 95% confidence interval [CI], 1.2-3.4). Low maternal awareness of fetal activity was associated with an increased risk of having a small for gestational age infant (odds ratio, 6.5; 95% CI, 3.5-12.3). Expectations about the normal frequency of fetal movements, as reported by the mothers, varied from 25 kicks/hour to 3 kicks/24 hours. Receiving information about expected fetal activity was associated with maternal concerns about decreased fetal movement, but not with improved outcomes. We conclude that receiving information about expected fetal activity was associated with maternal concerns, but not with improved outcomes.
This study evaluates the psychological impact of antenatal services on pregnant teenagers in Hull and the surrounding areas. Participants were recruited from the two main maternity units in the area. The study was designed particularly to examine the role of the midwife in empowering and facilitating autonomy in these expectant mothers. The perceptions, views and knowledge of a sample of 99 expectant teenagers regarding their antenatal consultations and parentcraft classes were recorded as part of structured interviews undertaken at 20 and 37weeks gestation. Participants completed a structured interview at 20 and 37weeks gestation. The results highlight problems surrounding the amount of time given during antenatal consultations and the teenagers understanding of the information given. The results are discussed in relation to other research regarding information provision, and question the adequacy of information given by health professionals to this population.
This article presents some preliminary results from a larger ongoing study on health information in media. An attempt is made to profile typical users of Web resources concerning health. Three groups of people in different health situations were interviewed on their use of different information sources in their search for health information. In this paper the focus is on health information sources found on the Internet. The aim was to examine whether there are any differences in the use due to gender, age, education and occupation as well as current health status. The use of a point-giving system, which gave higher points to sources used more frequently or considered more reliable by the respondents, revealed differences between pregnant women, persons with diabetes and a control group consisting of healthy people. The groups of pregnant women and diabetics were generally more active Web-users than the control group and used discussion forums and health portals more while members of the control group read online newspapers more actively than the others did. Some differences in gender and age were also found: men were more likely to read newspapers than women, but women were more active users of discussion forums. The younger respondents were also often more active than the older ones were. The findings were generally similar to those of previous studies.
Objective:
When decreased fetal movement is noticed, delay in seeking care is associated with poor perinatal outcomes, including stillbirth. Health care providers are responsible for educating women about normal fetal movement and the appropriate actions they should take if it decreases. This study aimed to demonstrate our pregnant population's understanding of normal fetal movement and responses to decreased fetal movement, and to potentially guide educational interventions to improve perinatal outcomes.
Methods:
We surveyed 304 pregnant women (over 26 weeks' gestation) during clinic visits at the IWK Health Centre, Halifax, NS. Information collected in the survey included demographics, knowledge about normal fetal movement, monitoring techniques, and response to decreased fetal movement.
Results:
Eighteen percent of women (55/298) demonstrated knowledge of normal fetal movement and fetal monitoring, indicating that they would seek assessment promptly if they experienced decreased fetal movement. Although 54.7% of participants (164/300) would contact a health care professional if they noticed decreased fetal movement, approximately two thirds of participants were unable to describe normal fetal movement or monitoring techniques. Almost 30% of participants (90/304) did not identify daily fetal movement as normal, and 37.5% (114/304) reported it may be normal for fetal movement to stop around their due date. Written and verbal communication regarding fetal movement from a health care provider significantly increased the likelihood of appropriate intended self-management in the context of decreased fetal movement.
Conclusion:
Education influences the anticipated behaviour of pregnant women regarding decreased fetal movement. Specific areas of misinformation which may guide future education strategies are identified. There is room for improvement in this area of patient education.
Pregnant women with decreased fetal movements (DFM) are at increased risk of adverse outcomes such as fetal growth restriction, preterm birth, and fetal death. There is no universally accepted methodology for assessing or defining DFM and no universally accepted guidelines for the management of DFM. This prospective population-based cohort study evaluated the effectiveness of 2 specific interventions to reduce the rate of adverse pregnancy outcomes associated with decreased fetal movement in the third trimester. The first intervention was provision of information to the women on fetal activity and DFM and an invitation to monitor fetal movement. The second was preparation and distribution of DFM management guidelines for health-care professionals. All participants had singleton pregnancies of at least 28 weeks' gestation and had registered prospectively at 14 delivery units in Norway. The baseline control cohort was a group of women who had no intervention. Between 2005 and 2007, 7 months of baseline observation was followed by 17 months of intervention. The total births before and during the intervention were 19,407 and 46,143, respectively. Of these, 1215 and 3038 women with DFM were identified in the baseline and intervention cohorts, respectively. No increase was found in the number of women with DFM during the intervention. Among women with DFM, stillbirth rates were reduced by nearly 50% (adjusted odds ratio [OR], 0.51; 95% confidence interval [CI] 0.32–0.81, P = 0.004) from 4.2% (n = 50) to 2.4% (n = 73) during the intervention. Among women in the entire cohort, stillbirth rates were reduced by one-third from 3.0/1000 to 2.0/1000 (unadjusted OR, 0.67; 95% CI, 0.48–0.93, P = 0.02). No increase was found during the intervention period in rates of preterm births, fetal growth restriction, severe neonatal depression, or transfers to neonatal care among women with DFM. There was increased use of ultrasound in management and fewer additional follow up consultations and admissions for induction.
These findings show that providing improved guidelines for management of DFM to health professionals together with uniform information on fetal activity to expectant women is associated with reduced stillbirth rates in this patient population.
Fetal movement counting may improve timely identification of decreased fetal activity and thereby contribute to prevent adverse pregnancy outcomes, but it may also contribute to maternal concern. This study aimed to test whether fetal movement counting increased maternal concern.
In a multicenter, controlled trial 1,013 women with a singleton pregnancy were randomly assigned either to perform daily fetal movement counting from pregnancy week 28 or to follow standard Norwegian antenatal care where fetal movement counting is not encouraged. The primary outcome was maternal concern, measured by the Cambridge Worry Scale. Analysis was by intention-to-treat.
The means and SDs on Cambridge Worry Scale scores were 0.77 (0.55) and 0.90 (0.62) for the intervention and the control groups, respectively, a mean difference between the groups of 0.14 (95% CI: 0.06-0.21, p<0.001). Decreased fetal activity was of concern to 433 women once or more during pregnancy, 45 and 42 percent in the intervention and control groups, respectively (relative risk=1.1, 95% CI: 0.9-1.2). Seventy-nine percent of the women responded favorably to the use of counting charts.
Women who performed fetal movement counting in the third trimester reported less concern than those in the control group. The frequency of maternal report of concern about decreased fetal activity was similar between the groups. Most women considered the use of a counting chart to be positive.
A change in the pattern of movement of her unborn baby could be indicative that the baby might die.
To study mothers' experiences during the time prior to receiving news that their baby has died.
Interviews with 26 mothers.
Premonition that something had happened to their baby, a sense based on a lack of movements were experienced. Six categories describe the mother's insight that the baby's life was threatened: not feeling in touch with their baby; worry feeling something is wrong; not understanding the unbelievable; wanting information; and being certain that their baby had died. The overarching theme "There is something wrong" was formulated.
The mother could not understand the unbelievable: that the baby had died in utero.
Mother's should be cautioned to trust their insights and seek medical advice if they are concerned over the lack of movement from the unborn baby.
Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. The proportion of unexplained stillbirths associated with under investigation continues to impede efforts in stillbirth prevention. Overweight, obesity, and smoking are important modifiable risk factors for stillbirth, and advanced maternal age is also an increasingly prevalent risk factor. Intensified efforts are needed to ameliorate the effects of these factors on stillbirth rates. Culturally appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates in high-income countries. Implementation of national perinatal mortality audit programmes aimed at improving the quality of care could substantially reduce stillbirths. Better data on numbers and causes of stillbirth are needed, and international consensus on definition and classification related to stillbirth is a priority. All parents should be offered a thorough investigation including a high-quality autopsy and placental histopathology. Parent organisations are powerful change agents and could have an important role in raising awareness to prevent stillbirth. Future research must focus on screening and interventions to reduce antepartum stillbirth as a result of placental dysfunction. Identification of ways to reduce maternal overweight and obesity is a high priority for high-income countries.
Abstract
Background: If a mother experiences a change in the pattern of movement of her unborn baby, it could be indicative that the baby is unwell or has died in utero. Aim: To study mothers’ experiences during the time prior to receiving news that their unborn baby has died in utero. Method: In-depth interviews were conducted with 26 mothers whose babies died prior to birth, which were then analysed using content analysis.
Results: Twenty-two mothers described a premonition that something had happened to their unborn baby, a sense based on a lack of movement from the baby. Six categories were constructed from the analysis of the interviews describing the mother’s insight that the baby’s life was threatened; 1. Not feeling in touch with their baby 2. Worry 3. Feeling something is wrong 4. Not understanding the unbelievable 5. Wanting information 6. Being certain that their baby had died.
The overarching theme – “There is something wrong” was formulated. The mothers’ experiences can be illustrated as gradually descending a staircase towards the insight that their baby’s life was threatened.
Conclusion: The mothers tried to curb their worry by normalising the baby’s lack of movement. Additionally, reassurance from family and health-care professionals delayed an investigation of the baby’s wellbeing. The mother could not understand the unbelievable; that the baby had died in utero. Implications: Expectant mothers should be cautioned to trust their insights and seek medical advice straightaway if they are concerned over the lack of movement from the unborn baby.
Key words: stillborn, premonition, intuition, in utero movement, content analysis
Internet access and usage is almost ubiquitous, providing new opportunities and increasing challenges for health care practitioners and users. With pregnant women reportedly turning to the Internet for information during pregnancy, a better understanding of this behavior is needed. The objective of this study was to ascertain why and how pregnant women use the Internet as a health information source, and the overall effect it had on their decision making. Kuhlthau's (1993) information-seeking model was adapted to provide the underpinning theoretical framework for the study.
The design was exploratory and descriptive. Data were collected using a valid and reliable web-based questionnaire. Over a 12-week period, 613 women from 24 countries who had confirmed that they had used the Internet for pregnancy-related information during their pregnancy completed and submitted a questionnaire.
Most women (97%) used search engines such as Google to identify online web pages to access a large variety of pregnancy-related information and to use the Internet for pregnancy-related social networking, support, and electronic commerce (i.e., e-commerce). Almost 94 percent of women used the Internet to supplement information already provided by health professionals and 83 percent used it to influence their pregnancy decision making. Nearly half of the respondents reported dissatisfaction with information given by health professionals (48.6%) and lack of time to ask health professionals questions (46.5%) as key factors influencing them to access the Internet. Statistically, women's confidence levels significantly increased with respect to making decisions about their pregnancy after Internet usage (p < 0.05).
In this study, the Internet played a significant part in the respondents' health information seeking and decision making in pregnancy. Health professionals need to be ready to support pregnant women in online data retrieval, interpretation, and application.
Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM.
To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM.
A postal survey of Fellows and Members, and obstetric trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Of the 1700 surveys distributed, 1066 (63%) were returned, of these, 805 (76% of responders) were currently practising and included in the analysis. The majority considered that asking women about fetal movement should be a part of routine care. Sixty per cent reported maternal perception of DFM for 12 h was sufficient evidence of DFM and 77% DFM for 24 h. KICK charts were used routinely by 39%, increasing to 66% following an episode of DFM. Alarm limits varied, the most commonly reported was < 10 movements in 12 h (74%). Only 6% agreed with the internationally recommended definition of < 10 movements in two hours. Interventions for DFM varied, while 81% would routinely undertake a cardiotocograph, 20% would routinely perform ultrasound and 20% more frequent antenatal visits.
While monitoring fetal movement is an important part of antenatal care in Australia and New Zealand, variation in obstetric practice for DFM is evident. Large-scale randomised controlled trials are required to identify optimal screening and management options. In the interim, high quality clinical practice guidelines using the best available advice are needed to enhance consistency in practice including advice provided to women.
To describe the most acceptable methods for educating women in Medrogongkar County, Tibet, about healthy pregnancy and safe motherhood.
Focus group discussions with key informants were used to develop a quantitative, orally administered random sample survey.
Thirty-two randomly selected villages in Medrogongkar County.
One hundred and forty-eight multigravida over the age of 18 living in Medrogongkar County.
Most participants reported receiving pregnancy-related information either from family members (n=85, 57.4%) or from community health workers (n=81, 54.7%), while very few reported group teaching or radio/television/videos as sources. When asked what modalities of health communication are most effective for them, participants preferred discussions with family members (n=59, 39.8%), specifically their mothers (n=34, 23.0%). Community health worker teaching (n=15, 10.1%) or group teaching (n=7, 4.7%) were reported as less effective.
Despite recent efforts in Tibet to use group teaching, television/radio programs, and health professionals visiting patients' homes as health communication modalities, participants preferred to learn pregnancy-related health messages from their close family, especially their mothers. Future health communication interventions in rural Tibet and similar communities should consider targeting close family members as well as pregnant women to maximize acceptability of advice on healthy pregnancy and delivery.
Internet use among pregnant women is common and frequent, while attendance at childbirth education classes appears to be on the decline. This article explores why women turn to the Internet in pregnancy and how Internet use may affect their knowledge, attitudes, and behaviors. It suggests strategies for engaging women's interest in the Internet and describes how doing so may help increase the effectiveness of "traditional" childbirth education while mitigating the potentially overwhelming and confusing aspects of Internet use.
Helping women to make informed choices during pregnancy is an important and complex part of a midwife's role that does not appear as yet to have been investigated in depth. The purpose of this study was to use a grounded theory approach to investigate the processes involved when midwives engage in facilitating the making of informed choices for women in the United Kingdom. Interactions between midwives and pregnant women were observed and recorded and focused interviews were conducted with the midwives. Data were analysed according to the grounded theory method. The core category was identified as protective steering, whereby midwives were concerned to protect the women in their care, as well as themselves, when choices were made. Substantive categories were orienting, protective gatekeeping and raising awareness.
This study evaluated women's perceptions of a new community-based model of continuity of antenatal care, the St George Outreach Maternity Project (STOMP). The model was established in an attempt to address some of the ongoing concerns and criticisms regarding antenatal care in Australia: lack of continuity of care and caregiver; prolonged waiting times; and inaccessible clinics.
A randomised controlled trial was conducted with 1,089 women (550 in the experimental group and 539 in the control group). The experimental group (the STOMP group) received antenatal care from small teams of midwives and an obstetrician in community-based settings. Data were collected using a questionnaire administered at 36 weeks' gestation, with a response rate of 75%.
Women in the STOMP group reported waiting significantly less time for antenatal visits with easier access to care. STOMP group women also reported a higher perceived 'quality' of antenatal care compared with the control group. STOMP group women saw slightly more midwives and fewer doctors than control group women did.
This model of care has implications for the planning and provision of antenatal services within the Australian public health system, which is increasingly moving towards a community-based emphasis. Antenatal care is a service that can be successfully transferred into community-based settings with benefits for women.
This study evaluates the effectiveness of a set of information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, delivery, or the postpartum period among pregnant or recently pregnant women.
Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling and the provision of educational media to clients; (2) a community-based strategy consisting of radio messages regarding obstetric complications; and (3) educational sessions conducted through women's groups. Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, we model awareness of danger signs as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions.
Among women using health clinics, the likelihood of having heard of danger signs nearly tripled between 1997 and 1998, when the clinic interventions were fully implemented. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy.
Safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.
Antenatal care has undergone continuous development over the past decades, but little is known about women's views and expectations. The objective of this study was to explore women's expectations on antenatal care, preferences regarding number of visits and attitudes to continuity of midwife caregiver in a national sample of Swedish-speaking women.
All Swedish-speaking women booked for antenatal care during 3 weeks spread over 1 year (1999-2000) were invited to participate in the study. A questionnaire was mailed shortly after the first visit.
Three thousand and sixty-one women completed the questionnaire, corresponding to 91% of women who consented to participate after exclusion of reported miscarriages. Checking the baby's health was the most important aspect of antenatal care, followed by checking the mother's health and making the partner feel involved. Seventy per cent preferred to follow the standard schedule of antenatal visits, 23% preferred more and 7% fewer visits. In primiparas, age < 25 years, a previous miscarriage and assisted conception were associated with a wish for more visits; in multiparas, previous miscarriage, previous stillbirth and a previous negative birth experience. A wish for fewer antenatal visit was associated with age over 35 years and unfortunate timing of pregnancy among primiparas, and with having more than two children and unfortunate timing of pregnancy in multiparas. Most women (97%) saw continuity of midwife caregiver during pregnancy as important.
Women had high expectations of antenatal care in terms of possibilities of preventing fetal morbidity, a result that may reflect worries about the baby's health rather than a realistic assessment of the potential of antenatal care procedures. One-third of the women wanted more or fewer visits than the standard schedule, and special attention should be paid to women with a previous stillbirth, miscarriage or a negative birth experience. The Swedish system with continuity of midwife carer during pregnancy was much appreciated.
During the data analysis of a much larger study on 13 women's experiences of their first pregnancy, their interactions with the health system emerged as significant. Two grounded theory procedures, the making of comparisons and the asking of questions were used to analyse their experiences. Elements of three models of care were identified, medical/technocratic model, midwifery model, and a feminist perspective model. In some instances, there was blurring and overlapping of models. Tape-recorded, individual interviews were held with 13 pregnant women (aged 34-42 years) in their homes at the end of each trimester and with 10 women again 10-14 days post birth. (Three women were unavailable.) All the women delivered their babies in hospital. Eleven women had an epidural anaesthetic and 11 women had an episiotomy. Information received at antenatal education classes had a marked effect on the women's expectations and the reality of their experiences. The future of implementing midwifery models of care into the hospital system will depend on effective change management and an acknowledgment of consumer needs by administrators.
Abstract This article addresses responses from two open-ended questions, describing the healthy behaviors and sources of health information in 150 low-income pregnant women. Data for this exploratory study were collected as part of a larger descriptive correlational study. Qualitative content analysis was used in the analysis. One hundred fifty English-speaking pregnant women aged 18 and over were interviewed at a public prenatal clinic in the Southeastern United States at their first prenatal visit.
Health behaviors were placed into seven mutually exclusive categories: food-related behaviors, substance-related behavior, exercise/rest/activity, self-awareness/appearance, learning, focus on baby, and no specific behaviors. Sources of information questions were placed into seven mutually exclusive categories: family, health personnel, reading, hearing, other people, self-intuitive, and no response.
Low-income pregnant women are aware of healthy behaviors and report practicing them during their pregnancies. Because family members are a common source of information for health practices, they should be included in health education efforts.
The national recommendation in Sweden regarding number of antenatal care visits was reduced in 1996. The aim of this study was to explore the factors associated with number of visits made and with women's own opinions about these visits. Another aim was to study associations between the number of visits and satisfaction with antenatal care overall.
All Swedish-speaking women who came for their first visit to the midwife in 593 participating clinics during 3 weeks evenly spread over 1 year in 1999-2000 were invited to participate in the study. Information was collected by postal questionnaires after the booking visit and 2 months after childbirth. Cases of preterm delivery and intrauterine death were excluded.
After excluding miscarriages, non-Swedish-speaking women, and women booked at non-participating clinics, about 69% of all women booked in antenatal care were recruited. Of these, 2421 (83%) completed the two questionnaires. About 25% followed the standard visiting schedule for a normal pregnancy, 57% made more visits, and 17% fewer visits. The number of visits made was associated with parity, medical diagnosis, depressive symptoms, level of education, and women's preferences in early pregnancy. Women's own opinion that they made too few visits was associated with a preference for more visits in early pregnancy and actually receiving fewer visits than the standard schedule. The view that they made too many visits was associated with a previous negative birth experience, a wish for fewer visits, having a medical diagnosis, many children, and major worries. The vast majority of women (87.6%) were satisfied with antenatal care overall but less with emotional (76.9%) than with medical (82.3%) aspects. No association was found between number of visits made and satisfaction, but women's own opinion that they had too few visits was associated with dissatisfaction with medical as well as emotional aspects of care and the opinion that they made too many visits with the emotional aspects of care.
Two-thirds of the women did not follow the standard visiting schedule, the majority of women made more visits. The number of antenatal visits seemed to be fairly well adapted to women's individual needs and, to some extent, to their own wishes. Very few women were dissatisfied with the number of visits made as well as the antenatal care overall.