Inability to always express concerns about perceived abnormal
fetal movements
Many postpartum women said that they experienced worrying reduced or
absent FM by the time of admission (11/28, 39.3%) and/or during labor
care (13/28, 46.4%). We confirmed through our main study (18) that 7/11
of the women reported abnormal FMs on admission but, according to the
documentation, four women did not report their concerns.
Only one third of women with reduced/absent FMs said that they expressed
their concerns about FMs in the labor room. Reasons for not reporting
include: women thought it was not important, they did not feel free,
they were not asked, or the doctor was too busy. The majority of women
who said they had perceived abnormal FMs on admission and during labor
care (84.6%, n=11/13) had adverse perinatal outcomes (9/14 were
perinatal deaths). The remaining two women had pre-eclampsia and
delivered vaginally with healthy babies.
‘During labor I was very worried because I didn’t feel the baby
moving the way I was used to. In the evening the baby totally stopped
moving and then I got an ultrasound scan. The baby was already dead when
they did the ultrasound scan. Before the operation I heard it wasn’t
alive anymore.’ (Postpartum, delivered a stillborn baby)
‘This is my first child
and I didn’t know anything about pregnancy or how my baby should be
moving. Before I was in labor my baby was moving just fine. When I got
into labor, it was moving very slowly. I didn’t tell the doctor because
I didn’t know anything about it. I was worried because I wasn’t
experienced: I never delivered before.’ (Postpartum, baby died after birth)
Additionally, both nurse-midwives and registrar doctors stated that
women rarely present at the hospital because of decreased FMs or present
if it is too late (e.g. the fetus has died or there are serious
obstetric complications). If women are not asked, they will not express
their concerns.
‘Mothers who come here don’t tell you ‘I haven’t felt my baby
kicking for 4 hours’. They tell you: ‘I haven’t felt my baby move since
yesterday, or longer” (Healthcare provider)
‘Yes, it does happen that women express concerns about the way
their baby is moving. There are some mothers that are really concerned
about their baby. They come to you and tell you that their baby is
moving differently. Not all mothers, just a few. Very few!’ (Healthcare provider)