Interpretation of fetal movements and their abnormal patterns
All women interviewed in the ANC considered FMs as a sign of life of the fetus and a form of communication between fetus and mother.
When the baby is kicking, I know it’s continuing in good health. It’s doing well.’ (Antenatal)
‘When I’m too busy the baby will let me know by kicking me once very strongly. That’s how it tells me to slow down. Normally the baby is quiet at night, but when I’m lying on one side for too long the baby will kick strongly, as if to tell me, or reminds me ‘Hey! Turn the other side!” (Antenatal)
Half the ANC women perceived FMs as abnormal, or worrisome, if they become absent. Other women found FMs abnormal if they become weaker or less frequent than usually.
‘I would be worried if the baby won’t kick when I’m used to feeling it kick or when I feel that it’s uncomfortable’ (Antenatal)
 ‘If the baby is not kicking, I will be worried (…). Because maybe the baby already started to die.’ (Antenatal)
Furthermore, women also perceived FMs and their changes during labor:
‘When my blood pressure was high [250/120 mmHg], I felt the baby was moving differently. It moved slower than before that. During labor also it sometimes stopped moving which worried me.’ (Postpartum)
‘At home it [FMs] was just fine, but since I arrived, I felt it became less and less. I already started to drain [losing amniotic fluid] at home but once I arrived here, I drained more and after that the movements became even weaker.’ (Postpartum, baby died soon after birth)
All health care providers also considered the presence of FMs as a sign of health of the fetus and mother. Reported worrying changes included reduced (n =23, 82,1%), absent (54.6%, n=15) and increased FMs (46.4%, n=15). (Table 2) Various causes of abnormal FMs were given such as maternal as well as fetal conditions such as fetal maternal emotions, activity, hunger, intake of herbal medication, anemia, infection, hypertension and bleeding, position and sleep state of the baby, polyhydramnios and oligohydramnios. Pointing to a poster on the wall, an ANC nurse also indicated that abnormal FMs is one of the danger signs they look out for.
‘To ask a mother whether her baby moves or not helps us to decide whether it’s alive or not. They [FMs] may be increased or decreased which will help us to know whether the baby is healthy or not.'  (Healthcare provider)  
If it’s absent, the baby died already, if it’s decreased the baby could be in distress.’   (Healthcare provider)