Baby Not Moving Too Much in 33 Weeks Pregnant
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Fetal motion in late pregnancy – a content analysis of women'due south experiences of how their unborn baby moved less or differently
BMC Pregnancy and Childbirth volume 16, Article number:127 (2016) Cite this article
Abstruse
Groundwork
Meaning women sometimes worry about their unborn baby's health, often due to decreased fetal movements. The aim of this report was to examine how women, who consulted wellness care due to decreased fetal movements, draw how the babe had moved less or differently.
Methods
Women were recruited from all 7 delivery wards in Stockholm, Sweden, during 1/1 – 31/12 2014. The women completed a questionnaire afterward it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women'southward responses to, "Try to describe how your baby has moved less or had changes in move".
Results
4 categories and 6 subcategories were identified: "Frequency" (decreased frequency, absenteeism of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (inverse pattern of movements, slower movements) and "Duration". In improver to the responses categorised in accordance with the question, the women as well 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 design of fetal movements.
Determination
Women reported changes in fetal movement apropos frequency, intensity, grapheme 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 fourth dimension diminishing the length of pre-hospital delay if the fetus is at run a risk of fetal compromise.
Trial registration
Not applicable.
Peer Review reports
Background
It is widely best-selling that a pattern of regular movements is associated with fetal wellbeing [one]. Fetal movements tin can be divers as any discrete boot, flutter, classy or roll and are normally beginning perceived past the female parent between 18 and 20 weeks of gestation [2]. The frequency of fetal movements reaches a plateau in gestational week 32 and stays at that level until nascence [3]. At that place is normally a variation in fetal movements with a wide range in the number of movements per hour [4]. The movements are normally absent during sleep and occur regularly throughout the twenty-four hours and dark, normally lasting for xx–40 min. The sleep cycles rarely exceed 90 min in the normal and good for you fetus [5]. Although the movement design of the individual fetus is unique, it is general knowledge that decreased fetal motion is associated with adverse upshot, including stillbirth [half-dozen].
The character of the movements changes when the pregnancy approaches delivery due to express space in the uterus, but the frequency and intensity volition not normally decrease [3]. In an interview study, 40 term meaning women with an outcome of a healthy baby described fetal movements during the past calendar week. Almost all experienced fetal movements as "strong and powerful". One-half of the women too described the movements as "big" (involving the whole trunk of the fetus). Another common description was "slow" equally in "ho-hum movement" and "stretching" or "turning". Some of the women stated that they were surprised how powerfully the fetus moved [7].
Several maternal factors may impair the ability to recognize fetal movement [8]. Amniotic fluid book [nine], fetal position [10], having an anterior placenta [10, 11], smoking, being overweight [6] and nulliparity [6, 12] have been reported as such factors. Maternal factors which may enhance the ability to recognize movement are the opportunity to focus on the fetus and the absence of distracting noises [13]. About 50 % of the pregnant women in a study from Norway were sometimes worried about decreased fetal movements [14]. In a review commodity, it was found that between 4 and fifteen per centum of pregnant women consult health care because of a decrease in fetal movement in the third trimester [1]. The aim of the present study was to examine how women, who consulted health care due to decreased fetal movements later gestational calendar week 28, describe how the babe had moved less or differently.
Methods
Settings and participants
Women were recruited from all 7 delivery wards in Stockholm, Sweden from 1st Jan to 31st December 2014, and were asked to complete a questionnaire. The inclusion criteria were women in gestational week 28 or more than who consulted health care due to concerns over decreased fetal movements, with the power to understand Swedish or English and a normal cardiotocography (CTG). Not responders, inadequate answers, multiple pregnancies, undefined gestational calendar week and unknown personal identity number were exclusion criteria (Fig. 1). In total, 3555 questionnaires were completed during the data collection period. Data collection was in progress while the first 1000 questionnaires were analysed. Twenty-eight women completed two questionnaires and 3 women filled in three questionnaires; they consulted health care more than than in one case during the information collection period due to concerns over decreased fetal movements. Of the women, 672 (76.seven %) were aged 20–35 years, 582 (66.four %) had a college or university level of education and 650 (74.2 %) of the women were born in Sweden (Tabular array 1). All women gave birth to a live kid.
Flow nautical chart
Information drove
The questionnaire used in the study was developed from a spider web survey, an interview study [7, 15] and clinical experience. The questionnaire was face-to-face validated with 10 women who consulted health care due to reduced fetal movements, not included in the report. The final version of the questionnaire included a total of 22 questions with multiple-choice or open up-ended response alternatives (Additional file 1). This study comprises the women'southward responses to the asking: "Try to describe how your baby has moved less or had changes in motion". The women were asked to describe their experiences in the space provided but could also, if necessary, continue on the back of the questionnaire.
Analysis
The women'due south descriptions (n = 876) of how their unborn baby had moved less or differently were analysed using a modified content analysis [sixteen]. The cloth consisted of concise descriptions of movements, which were used without editing. The analysis was performed in 3 steps. Firstly, all the answers were read and re-read three times to proceeds a sense of content in the data. Codes were then revealed in accordance with Malterud. Every quotation was read and sorted into codes. In the second phase of the analysis the material was organized. Units, the quotations, with the same code were divided into defined main categories and categories. When appropriate the categories were divided into subcategories [17] The quotations could be placed in more than ane category. However, each statement was just placed in one subcategory. During the whole process the findings were continually discussed in the research grouping in social club to reach understanding. To validate the results, a sample of 50 quotations was randomly selected and re-analysed from the beginning of the analysis procedure. After consensus had been reached some of the quotations were transferred to other subcategories and three quotations were accounted irrelevant and removed. Those carrying out the analysis did not know the gestational week.
Results
Four main categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and move), "Intensity" (weaker fetal movements, indistinct fetal movements), "Graphic symbol" (inverse pattern of movements, slower movements) and "Duration". The number in each category and subcategory likewise equally an presentation of the figures for women seeking wellness care in gestational week 28–32, gestational calendar week 33–36 and during gestational calendar week 37+, are shown in Tabular array 2.
Frequency
The most commonly experienced deviation of fetal movements concerned frequency, which was described in 746 (85 %) of the questionnaires. This category was divided into 2 subcategories; "Decreased frequency" and "Absence of kicks and movement".
Decreased frequency of fetal motility
This subcategory comprises 609 (69 %) statements. These statements referred to movements becoming less frequent and indicating to the women a by and large decreased liveliness in the fetus. The movements were described with words like, "a few", "seldom", "less frequent", "not every bit many" and "decreased action".
"Less frequent during the 24-hour interval"
"From being very active and kicking a lot to very few movements during some days"
Absence of kicks and motion
Amidst the answers about the frequency of fetal movements, 137 (16 %) statements were well-nigh not feeling whatsoever motility at all.
"I haven't felt whatever boot for about 12 hours"
"Have not felt any movement during the whole mean solar day"
Intensity
A total of 343 (39 %) responses were perceptions that the movements had contradistinct in intensity. Ii subcategories were formed: "Weaker movements" and "Indistinct movements".
Weaker fetal movements
This subcategory comprised 277 (32 %) statements. Words often used were: "Weaker", "Softer", "Less sharp" and "With less ability".
"From obvious, potent movements and nudging to feathery tickling a few times a day"
"… The movements of the baby felt weaker the few times I accept felt my infant"
Indistinct fetal movements
Sixty-six (8 %) statements barbarous into this subcategory. Some women were uncertain as to whether they felt anything at all just idea they could imagine movements.
"…The only thing I felt was non-specific movements deep inside my tummy…"
"Have previously felt apparent kicks which can be both felt and seen distinctly. Since yesterday evening but minor occasionally twisting movements"
Character
This category comprised 252 (29 %) statements describing experiences of the fetal movements irresolute in character. The category revealed 2 subcategories: "Changed pattern of movements" and "Slower movements".
Changed pattern of movements
This subcategory comprised 141 (16 %) statements. The women described the fetal movements as having changed in pattern and decreased in activity.
"Not the same pattern of movements as before and not active at the same time"
"The baby has not moved at the times that she had moved earlier, post-obit the pattern that she had previously. This has been going on for nigh ii days. When she has moved, the movements felt weaker the past ii days compared to before."
Slower movements
This subcategory included 111 (13 %) statements. When talking about the movements women used words such equally: "sluggish", "indolent", "slow and sweeping".
"Calmer more tired movements as if it were tired…"
"Wearisome and smoother movements"
Duration
30-eight (4 %) were included in this category. Women reported that the periods of movement had become shorter and had been reduced from several kicks in a row to occasional ones. Notwithstanding, the frequency of how often the infant had moved had not decreased.
"… the periods when it has moved have been shorter"
"No more than lively periods."
Differences according to gestational historic period
Women in gestational weeks 33–36 experienced changes more often than women at term regarding the category Frequency (92 % vs. 81 %), the subcategory Decreased frequency (75 % vs. 67 %), and the category Intensity (42 % vs. 35 %). Compared to women at term, those in gestational weeks 28–32 expressed changes to a lesser extent within the category Graphic symbol and the subcategory Slower movements (5 % vs. 15 %) (Table 2).
Four percent, 32/876, of the full number of women in this written report only stated a change in the character of the movements, not included in any other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.v %), 33–36, 1/263 (0.4 %) and gestational weeks 37+, 30/423 (7 %). At that place were no statistically significant differences in the other categories (Non in tabular array).
In addition to the responses categorised in accordance with the question, the women too 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 inverse pattern of fetal movements.
Stimulation due to less movement
Nosotros identified 146 (17 %) statements most trying to provoke movement by triggering the fetus. Virtually of the women reported that they did this when not having felt movements for a while. When they did non succeed they consulted health intendance. The methods used to trigger movements were to pull, nudge or push button on the tummy, stimulate with light or noise, have a shower or bath or to drink cold, sugariness drinks. Others said that they had diverse positions they used to experience the baby more distinctly. Some women described not feeling movements without stimulating the baby.
"No pushes" back when I am pulling on the tummy, no reaction when drinking a glass of lemonade. Otherwise he has been quite active and you lot take been able to see my tummy moving"
"Even if I touch on my tummy, eat, potable, there is not much departure. He is moving considerably less"
Difficult to distinguish fetal movements from contractions
The women stated that the fetal movements ceased or changed in relation to contractions or that it was hard to distinguish movements from contractions. Some women also described that the movements decreased in relation to contractions, pain in the stomach or the back. We identified forty statements (5 %) concerning difficulties in distinguishing fetal movements from contractions.
"Not felt any movements since the contractions became more than intensive"
"It has been more hard to perceive movements. Difficult to distinguish movements from contractions… previously the movements take been very distinct"
Worry due to incidents related to changed pattern of fetal movements
We identified 25 (iii %) statements about external factors, such as the woman was sick and perceived less fetal movement. Six women stated that they consulted health care due to pain in relation to changed patterns of fetal movement. Two statements referred to the woman having taken a fall and wanting to be reassured that the fetus had not been damaged. Other reasons related to increased worry were: post maturity, following an expelled mucus plug, an external cephalic version attempt, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to move a lot during both twenty-four hours and nighttime. Take been sick with fever for three days and and then there have been movements iv–5 times every twenty-4 hours"
"Not as often as earlier only I however experience him daily. Nosotros're extremely worried as nosotros lost our commencement kid in gestational week 33 in utero so it may be imagination"
Give-and-take
We are not aware of any studies that take categorized how women depict the changes they have perceived concerning fetal movements when they seek wellness care due to worry about their unborn infant.
Women who consulted wellness intendance due to decrease fetal movements described changes in frequency, intensity, character and duration of the movements. However, all women in this study were reassured afterward an examination of their unborn baby. In Norway, as many equally 51 % of women reported that they were concerned about decreased fetal movements once or more than in pregnancy [14]. In unlike populations, between iv and 15 % consulted health care facilities because of decreased fetal movements in the third trimester [1]. At that place are several factors which may impair the ability to recognize fetal movements [8]. However, we have no data concerning amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this report. These factors may explain some of the women's perceptions of decreased fetal movements. Also, the plateau in gestational week 32 [3] may be perceived as a decrease. In a written report past Sheikh and colleagues (2014), 729 women counted and registered fetal movements for one hour three times per twenty-four hours. Viii percent of the meaning women in the 3rd trimester, who in the end gave nascency to a healthy kid, experienced reduced fetal movements. Further, the researchers constitute that amongst women who consulted wellness intendance for reduced fetal movements merely later gave nascence to a healthy child, more than of them were working than those who did not perceive reduced fetal movements [xviii]. We do not take information as to piece of work status among the women participating in our written report.
Placental dysfunction is 1 main reason for decreased fetal movements in late pregnancy [19]. Information technology is thus of import for the significant women to recognize the blueprint of move. A change may be a sign of asphyxia due to the redistribution of the apportionment which gives priority to the brain over peripheral parts [xx]. All fetuses in the present study were examined and no symptoms of asphyxia or placental dysfunction were identified at the fourth dimension when the woman consulted health intendance. The women'southward worry virtually their unborn baby'southward health due to decreased fetal movements in this study did non upshot in a diagnosis or actions to induce the delivery.
Our results indicate that some women at term seek health care due merely to a modify in the character of the fetal movements. Although these women were asked to depict how their infant had moved less or differently, they did not mention a decrease in frequency in the fetal movements or a change in intensity. Tedious, as in irksome motion, stretching and turning, are descriptions of the character of fetal movements used past women in total term pregnancy, pregnancies that resulted in a healthy child [7]. The women in our study who consulted health care only due to a change in the character of the movements and not considering of contradistinct frequency and intensity might not have been aware of normal changes in the fetal motility patterns in late pregnancy. The changes they reported equally different tin can exist physiological due to limited space in the uterus at term [3]. At that place is no routine in Swedish antenatal health care for giving information about fetal movements but women are recommended to consult health intendance 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 await, also equally how the movements are supposed to change over time in pregnancy [22].
There were no stillbirths among the women in this written report. Thus, we tin only speculate that it is possible that women who consult health intendance due to decreased or changed patterns of fetal movement may exist aware of the importance of detecting fetuses at risk as early as possible. Detection of decreased fetal movements can better the result and reduce delay in consulting wellness care [23, 24]. Further, the fetuses in this report who could be at risk were examined and risk factors such equally placental abruptions, growth retardation or malformations [25] may have been detected. The main reason for consulting health care due to decreased fetal movements is worry about the health of the baby [14]. None of the women in our study consulted health care without cause, but their worry was apparently unfounded from a medical perspective in the short term.
Strengths and limitations
Women in this study had a normal CTG earlier they completed the questionnaire. Nevertheless, bated from no stillbirths among the participating women, we have no data regarding the health condition of the baby afterwards birth. This is a major limitation of the study. There is besides just sparse data about the women's' sociodemographic background.
One forcefulness of the study is the big number of participants. Another strength is that all delivery wards in Stockholm participated in the written report. Still, all women came from the capital metropolis in Sweden where women in generally are older and well educated compared with women outside the capital. Farther, the number of those who declined to participate and their reasons for doing so are not known.
The diction of the request, "Effort to describe how your baby has moved less or had changes in move" might accept influenced the responders to use the words "decreased" and "differently" in their descriptions of their experiences. The results may take yielded fifty-fifty more if the initial request had been broader or more than open, for example, "Try to describe how your baby has moved". However, the context in which the women completed the questionnaire was i of already perceived decreased fetal movements.
Clinical implications
Increased knowledge virtually the normal changes in the fetal movement patterns in late pregnancy can be 1 way to lessen the number of visits to obstetric clinics from women over concerns that plough out to be unnecessary from a medical perspective. The claiming from a clinical perspective is to inform and advise meaning women virtually fetal movements with the goal of diminishing the length of pre-hospital filibuster if the fetus is at take a chance and at the same time reduce worry leading to unnecessary consultation. Reducing the pre-hospital delay when the intrauterine environment is a threat to the unborn infant's life will provide a window of opportunity to save a greater number of children from death or compromised wellness. Farther, fewer visits to obstetric clinics, over concern that turns out to be unnecessary from a medical perspective, will accept health economic benefits. Earlier giving definitive advice that can reduce unnecessary controls at the end of the pregnancy, distinct differences must be identified regarding how women who lost their child intrauterine or accept given birth to a hypoxic or anaemic child, report the changes in grapheme of movements as only symptoms when they seek care for decreased fetal movements. Future studies are needed.
Conclusions
Women reported changes in fetal movement concerning frequency, intensity, character and duration; they described decreased, absence, weaker, slower and changed pattern of the movements.
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Funding
The Little Kid's Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo'due south Enquiry Foundation funded this report.
Availability of data and materials
The data will not be made available in society to protect the participant'south identity.
Authors' contributions
AL, KP and IR participated in the design of the report. AL, SG and IR performed the qualitative analyses. SH and EN carried out the first and main part of the analysis. KP contributed to the discussion of the analysis. AL, SG, KP and IR drafted all versions of the manuscript. AL, SG, KP, SH, EN and IR commented on the draft. All authors read and approved the terminal manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicative.
Ethics blessing and consent to participate
The women gave consent to participate and permission to access supporting data when receiving information near the study. The data will not be fabricated available in social club to protect the participant's identity. The study was approved by the Regional Ethical Review Board in Stockholm: DNR: 2013/1077-31/3.
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Linde, A., Georgsson, S., Pettersson, G. et al. Fetal move in tardily pregnancy – a content analysis of women's experiences of how their unborn babe moved less or differently. BMC Pregnancy Childbirth xvi, 127 (2016). https://doi.org/10.1186/s12884-016-0922-z
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DOI : https://doi.org/10.1186/s12884-016-0922-z
Keywords
- Pregnancy
- Fetal movement
- Decreased fetal movements
- Content analysis
Baby Not Moving Too Much in 33 Weeks Pregnant
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0922-z