Management of abnormal maternal perception of fetal movements
During pregnancy, women said they would eat, rest, massage the abdomen
and wait if they get worried about the way their baby was moving. For
how long they would wait before seeking health care differed from a few
hours (22.2%, n=4), to more than 24 hours (44,4%, n=8) or up to two
weeks (27.8%, n=5). All women who said they would present within a few
hours had received health education in peripheral ANC clinics.
Twenty-two percent (n=4) of the ANC women mentioned they had a history
of seeking medical help because of abnormal FMs and wanted a fetal
ultrasound. One woman in the ANC said she went to a midwife in her
community for an abdominal massage.
‘When the baby will stop moving or I’m worried about it, I
will not directly come to the hospital. First, I will wait and see what
the situation is. If it’s still not moving after 2 days, I will come to
the hospital. I’m afraid to directly come to the hospital because maybe
I will get shocking information or they will send me home because it was
nothing. I prefer to wait and see.’ (Antenatal)
Asking for advice from relatives, their husband, friends or neighbors in
case of worrisome FMs was mentioned by 10/18 (55,6%) of women in the
ANC.
‘I was
concerned on admission, but actually 3 days before already, my baby had
stopped moving. I asked my neighbor about this, she told me it was
normal for the baby to stop moving towards term. So, I didn’t worry that
much. I also asked my mom whether it was normal for the baby to stop,
but she didn’t remember it anymore because it was too long ago she was
pregnant herself. She could not advise me on this.’ (Postpartum, delivered a stillborn baby)
Midwives stated that they will first assess a mother’s mental, physical
and social health and lifestyle because these all can contribute to
abnormal FMs. All health providers stated they advise women to stimulate
their baby with various means in case of absence of FMs: to exercise,
drink cold water, eat something (sweet), change position or rest.
Moreover, the staff unanimously responded that women should go to nearby
clinic or hospital ‘immediately’ or ‘as soon as possible ’,
‘even during the night ’ in case of worrisome changes in FMs.
‘You can save a baby or lose a baby in 1 hour, so why waste
any time? Why wait?’ (Healthcare provider)
Management of decreased or absent FMs at the clinic or hospital
consisted of auscultation of fetal heart rate (FHR) and performing fetal
ultrasound. Nurse-midwives commonly evaluated the mother and fetus to
rule out problems and reassure mothers while registrars doctors usually
suspected intrauterine fetal death. Women were advised and reassured if
fetal viability was confirmed or they proceeded to further management in
case of a intrauterine death or other complications.
‘First, I will ask the mother what happened before I can think
of what caused the changes in FMs. Then we do an ultrasound and advise
the mother to change position, especially if the ultrasound is normal.
If it is abnormal we have to take action accordingly.’ (Healthcare provider)
'When a woman for example comes to the hospital in the evening
and complains about reduced fetal movements or that the movements have
been absent for a couple of hours: you check FHR and you confirm
[fetal] death.’ (Healthcare provider)
‘…we check FHR and if it’s there and there are no other
danger signs, we tell her to come back in 2 weeks…. Why not
observe her here if there’s any change in fetal movements?’ (Healthcare provider)