Introduction
Effective interventions are needed to meet the Sustainable Development
Goals and The Every Newborn Action Plan for newborn mortality and
stillbirth reduction (≤12 per 1000 births by 2030), particularly in
middle- and low-income countries where the burden is greatest.(1) A
range of simple to sophisticated methods to detect problems during
pregnancy and birth have been developed.(2) Fetal movements (FMs) are
the oldest and most basic form of fetal monitoring and can be done by
the mother herself without any resources. The complexity of movements
requires fetal neuromuscular development and a normal metabolic state of
the central nervous system.(3) Women, on average, start to feel
movements between 18-20 weeks of gestation and will quickly be aware of
a regular, personal pattern of movements of their child.(4, 5) The
amount of daily movements increase during the third semester and reach a
plateau in the last six weeks of pregnancy. Direct experimental evidence
in fetal lambs (6) and observational evidence in human fetuses (7)
indicate that reduced body movements and breathing movements is an
appropriate physiological response to conserve energy during hypoxia or
acidaemia. These alterations in movements have been shown to precede a
stillbirth before any other recordable fetal changes, and are registered
as early as 48 hours to two weeks before the confirmation of fetal
death.(8-12) Newborn babies with hypoxia are typically limp and
immobile, until the physiological transition to continuous
respiration.(13) This suggests that early detection and management of
reduced FMs may prevent adverse perinatal outcomes. (8-11) However there
is insufficient evidence from randomized trials to guide clinical
practice. (14-16) Limitations of these randomized trials is that
reporting decreased fetal movements is an intuitive action which cannot
be eliminated from the control group and the fact that all trials have
been conducted in high-income countries.(17) There is a dearth of
evidence on women’s and healthcare provider’s awareness, knowledge,
subsequent practices and use of FMs as a strategy to prevent stillbirths
in low-resource settings. Therefore, this study aimed to explore
knowledge and perspectives on maternal perception of FMs and practices
on perceived abnormal fetal movements among mothers and healthcare
providers in a busy maternity unit in a low-income country.