Is It Normal to Feel Some Movements From 36 Weeks Baby Only Once or Twice a Day
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Fetal movement in late pregnancy – a content analysis of women'south experiences of how their unborn baby moved less or differently
BMC Pregnancy and Childbirth volume 16, Commodity number:127 (2016) Cite this article
Abstract
Background
Meaning women sometimes worry nigh their unborn babe'southward wellness, often due to decreased fetal movements. The aim of this written report was to examine how women, who consulted health care due to decreased fetal movements, depict how the baby had moved less or differently.
Methods
Women were recruited from all seven delivery wards in Stockholm, Sweden, during ane/1 – 31/12 2014. The women completed a questionnaire subsequently information technology was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women's responses to, "Endeavor to describe how your baby has moved less or had changes in movement".
Results
Four categories and six subcategories were identified: "Frequency" (decreased frequency, absenteeism of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Graphic symbol" (inverse pattern of movements, slower movements) and "Duration". In addition to the responses categorised in accordance with the question, the women besides 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 blueprint of fetal movements.
Conclusion
Women reported changes in fetal movement concerning 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 time diminishing the length of pre-infirmary delay if the fetus is at risk of fetal compromise.
Trial registration
Non applicative.
Peer Review reports
Background
It is widely acknowledged that a blueprint of regular movements is associated with fetal wellbeing [i]. Fetal movements can be defined as any discrete kicking, flutter, swish or roll and are normally first perceived by the mother between eighteen and 20 weeks of gestation [2]. The frequency of fetal movements reaches a plateau in gestational week 32 and stays at that level until birth [3]. At that place is normally a variation in fetal movements with a wide range in the number of movements per 60 minutes [iv]. The movements are normally absent-minded during sleep and occur regularly throughout the day and night, normally lasting for twenty–twoscore min. The sleep cycles rarely exceed ninety min in the normal and healthy fetus [5]. Although the motion pattern of the individual fetus is unique, it is full general knowledge that decreased fetal motion is associated with adverse upshot, including stillbirth [6].
The graphic symbol of the movements changes when the pregnancy approaches commitment due to limited space in the uterus, but the frequency and intensity will not normally subtract [3]. In an interview study, 40 term pregnant women with an outcome of a healthy infant described fetal movements during the past week. Almost all experienced fetal movements equally "strong and powerful". Half of the women as well described the movements every bit "big" (involving the whole torso of the fetus). Some other common description was "slow" every bit in "slow move" 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 motility [8]. Amniotic fluid volume [9], fetal position [ten], having an anterior placenta [x, 11], smoking, being overweight [6] and nulliparity [6, 12] have been reported every bit 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 article, it was found that between four and xv percent of pregnant women consult wellness care because of a decrease in fetal move in the 3rd trimester [1]. The aim of the present study was to examine how women, who consulted wellness intendance due to decreased fetal movements after gestational week 28, depict how the baby had moved less or differently.
Methods
Settings and participants
Women were recruited from all 7 delivery wards in Stockholm, Sweden from 1st January to 31st Dec 2014, and were asked to consummate a questionnaire. The inclusion criteria were women in gestational week 28 or more who consulted health care due to concerns over decreased fetal movements, with the ability to empathise Swedish or English language 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 three women filled in three questionnaires; they consulted health care more than in one case during the data drove 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 instruction and 650 (74.two %) of the women were born in Sweden (Table 1). All women gave nascency to a live child.
Flow chart
Data drove
The questionnaire used in the written report was developed from a spider web survey, an interview study [7, fifteen] and clinical experience. The questionnaire was face-to-face validated with ten women who consulted health intendance due to reduced fetal movements, not included in the study. The final version of the questionnaire included a total of 22 questions with multiple-choice or open-ended response alternatives (Additional file 1). This written report comprises the women's responses to the request: "Try to describe how your baby has moved less or had changes in movement". The women were asked to draw their experiences in the space provided but could also, if necessary, continue on the dorsum of the questionnaire.
Assay
The women'southward descriptions (north = 876) of how their unborn baby had moved less or differently were analysed using a modified content analysis [16]. The fabric consisted of concise descriptions of movements, which were used without editing. The analysis was performed in iii steps. Firstly, all the answers were read and re-read three times to gain a sense of content in the data. Codes were then revealed in accord 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 exist placed in more than one category. All the same, each statement was just placed in one subcategory. During the whole process the findings were continually discussed in the enquiry group in order to attain understanding. To validate the results, a sample of fifty quotations was randomly selected and re-analysed from the beginning of the analysis process. After consensus had been reached some of the quotations were transferred to other subcategories and three quotations were deemed irrelevant and removed. Those carrying out the analysis did not know the gestational week.
Results
Four master categories and six subcategories were identified: "Frequency" (decreased frequency, absenteeism of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Graphic symbol" (changed pattern of movements, slower movements) and "Duration". The number in each category and subcategory likewise as an presentation of the figures for women seeking health intendance in gestational calendar week 28–32, gestational week 33–36 and during gestational week 37+, are shown in Table 2.
Frequency
The about commonly experienced deviation of fetal movements concerned frequency, which was described in 746 (85 %) of the questionnaires. This category was divided into ii subcategories; "Decreased frequency" and "Absenteeism of kicks and motion".
Decreased frequency of fetal motility
This subcategory comprises 609 (69 %) statements. These statements referred to movements condign less frequent and indicating to the women a generally decreased liveliness in the fetus. The movements were described with words like, "a few", "seldom", "less frequent", "non as many" and "decreased action".
"Less frequent during the day"
"From being very agile and kicking a lot to very few movements during some days"
Absenteeism of kicks and movement
Amid the answers about the frequency of fetal movements, 137 (sixteen %) statements were about not feeling any movement at all.
"I haven't felt any boot for about 12 hours"
"Take not felt any motility during the whole day"
Intensity
A total of 343 (39 %) responses were perceptions that the movements had altered in intensity. 2 subcategories were formed: "Weaker movements" and "Indistinct movements".
Weaker fetal movements
This subcategory comprised 277 (32 %) statements. Words ofttimes used were: "Weaker", "Softer", "Less sharp" and "With less power".
"From obvious, strong movements and nudging to feathery tickling a few times a solar day"
"… The movements of the baby felt weaker the few times I take felt my baby"
Indistinct fetal movements
60-6 (8 %) statements fell into this subcategory. Some women were uncertain as to whether they felt annihilation at all but thought they could imagine movements.
"…The only thing I felt was non-specific movements deep inside my tum…"
"Have previously felt apparent kicks which tin be both felt and seen distinctly. Since yesterday evening simply small occasionally twisting movements"
Grapheme
This category comprised 252 (29 %) statements describing experiences of the fetal movements irresolute in character. The category revealed two subcategories: "Inverse pattern of movements" and "Slower movements".
Changed design of movements
This subcategory comprised 141 (16 %) statements. The women described the fetal movements equally having inverse in design and decreased in action.
"Not the same pattern of movements every bit before and not active at the same time"
"The infant has non moved at the times that she had moved before, post-obit the design that she had previously. This has been going on for about ii days. When she has moved, the movements felt weaker the past 2 days compared to before."
Slower movements
This subcategory included 111 (13 %) statements. When talking about the movements women used words such as: "sluggish", "indolent", "slow and sweeping".
"Calmer more tired movements every bit if it were tired…"
"Slow and smoother movements"
Duration
Thirty-eight (iv %) 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. However, the frequency of how often the baby had moved had not decreased.
"… the periods when it has moved accept been shorter"
"No more lively periods."
Differences according to gestational age
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 inside the category Grapheme and the subcategory Slower movements (five % vs. 15 %) (Table two).
Four percent, 32/876, of the total number of women in this study only stated a change in the character of the movements, non included in whatever other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.5 %), 33–36, 1/263 (0.4 %) and gestational weeks 37+, 30/423 (7 %). There were no statistically pregnant differences in the other categories (Non in table).
In add-on to the responses categorised in accordance with the question, the women likewise mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Farther, they described worry due to incidents related to changed design of fetal movements.
Stimulation due to less movement
Nosotros identified 146 (17 %) statements about trying to provoke move past triggering the fetus. Near of the women reported that they did this when not having felt movements for a while. When they did not succeed they consulted health care. The methods used to trigger movements were to pull, nudge or push on the tummy, stimulate with light or noise, take a shower or bath or to beverage cold, sugariness drinks. Others said that they had various positions they used to experience the babe more distinctly. Some women described non feeling movements without stimulating the baby.
"No pushes" back when I am pulling on the stomach, no reaction when drinking a glass of lemonade. Otherwise he has been quite active and y'all have been able to see my tum moving"
"Even if I bear on my tum, swallow, beverage, there is not much divergence. He is moving considerably less"
Hard to distinguish fetal movements from contractions
The women stated that the fetal movements ceased or changed in relation to contractions or that it was difficult to distinguish movements from contractions. Some women too described that the movements decreased in relation to contractions, pain in the tummy or the dorsum. Nosotros identified forty statements (5 %) concerning difficulties in distinguishing fetal movements from contractions.
"Not felt whatever movements since the contractions became more intensive"
"It has been more difficult 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 (three %) statements most external factors, such as the adult female was ill and perceived less fetal motion. Six women stated that they consulted wellness 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 endeavour, rupture of the membranes and previous stillbirth in the same gestational week.
"Used to move a lot during both mean solar day and night. Take been ill with fever for iii days and and then there have been movements 4–v times every twenty-4 hours"
"Not as often every bit before only I still feel him daily. Nosotros're extremely worried as we lost our first child in gestational calendar week 33 in utero and then it may be imagination"
Give-and-take
We are not aware of whatsoever studies that have categorized how women describe the changes they have perceived apropos fetal movements when they seek health care due to worry about their unborn baby.
Women who consulted health intendance due to subtract fetal movements described changes in frequency, intensity, character and duration of the movements. Withal, all women in this written report were reassured after an exam of their unborn baby. In Kingdom of norway, as many as 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy [14]. In different populations, betwixt iv and 15 % consulted health care facilities because of decreased fetal movements in the third trimester [one]. In that location are several factors which may impair the ability to recognize fetal movements [eight]. However, we have no information apropos amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this study. These factors may explicate some of the women's perceptions of decreased fetal movements. Also, the plateau in gestational week 32 [iii] may be perceived equally a decrease. In a study by Sheikh and colleagues (2014), 729 women counted and registered fetal movements for 1 60 minutes 3 times per day. Viii percent of the pregnant women in the third trimester, who in the stop gave birth to a good for you kid, experienced reduced fetal movements. Farther, the researchers found that among women who consulted health care for reduced fetal movements but later gave nativity to a healthy child, more than of them were working than those who did not perceive reduced fetal movements [18]. We do not have data as to work status amidst the women participating in our report.
Placental dysfunction is 1 main reason for decreased fetal movements in tardily pregnancy [19]. Information technology is thus important for the pregnant women to recognize the blueprint of movement. A change may be a sign of asphyxia due to the redistribution of the circulation which gives priority to the brain over peripheral parts [twenty]. All fetuses in the nowadays study were examined and no symptoms of asphyxia or placental dysfunction were identified at the time when the woman consulted health intendance. The women'south worry nearly their unborn baby's health due to decreased fetal movements in this study did not result in a diagnosis or actions to induce the commitment.
Our results indicate that some women at term seek health care due only to a change in the character of the fetal movements. Although these women were asked to describe how their baby had moved less or differently, they did not mention a decrease in frequency in the fetal movements or a change in intensity. Slow, every bit in slow motion, stretching and turning, are descriptions of the character of fetal movements used by women in full term pregnancy, pregnancies that resulted in a healthy kid [7]. The women in our study who consulted health care just due to a change in the character of the movements and not considering of altered frequency and intensity might not take been aware of normal changes in the fetal movement patterns in belatedly pregnancy. The changes they reported every bit unlike can exist physiological due to express space in the uterus at term [3]. In that location is no routine in Swedish antenatal health treat giving data about fetal movements simply women are recommended to consult health intendance if they experience decreased fetal movements [21]. However, meaning women ask for information nigh fetal movements in full general and for information most the number and type of fetal movements they can expect, besides as how the movements are supposed to alter over time in pregnancy [22].
There were no stillbirths among the women in this study. Thus, we tin can only speculate that it is possible that women who consult wellness care due to decreased or changed patterns of fetal movement may be aware of the importance of detecting fetuses at take chances as early on as possible. Detection of decreased fetal movements can improve the outcome and reduce filibuster in consulting health care [23, 24]. Farther, the fetuses in this study who could be at risk were examined and take a chance factors such equally placental abruptions, growth retardation or malformations [25] may have been detected. The primary reason for consulting health care due to decreased fetal movements is worry near the health of the baby [xiv]. None of the women in our study consulted health care without cause, but their worry was evidently 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. However, aside from no stillbirths among the participating women, we have no data regarding the wellness status of the infant afterward nativity. This is a major limitation of the report. In that location is also simply thin information virtually the women'due south' sociodemographic groundwork.
One force of the written report is the large number of participants. Another force is that all commitment wards in Stockholm participated in the written report. Nevertheless, all women came from the capital city in Sweden where women in generally are older and well educated compared with women outside the uppercase. Further, the number of those who declined to participate and their reasons for doing then are not known.
The wording of the request, "Endeavour to draw how your baby has moved less or had changes in movement" might have influenced the responders to use the words "decreased" and "differently" in their descriptions of their experiences. The results may accept yielded fifty-fifty more if the initial request had been broader or more open up, for example, "Try to describe how your baby has moved". However, the context in which the women completed the questionnaire was ane of already perceived decreased fetal movements.
Clinical implications
Increased knowledge nigh the normal changes in the fetal movement patterns in tardily pregnancy tin can be one 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 challenge from a clinical perspective is to inform and suggest pregnant women about fetal movements with the goal of diminishing the length of pre-hospital delay if the fetus is at chance and at the same time reduce worry leading to unnecessary consultation. Reducing the pre-infirmary filibuster when the intrauterine environs is a threat to the unborn baby'southward life volition provide a window of opportunity to save a greater number of children from death or compromised health. Further, fewer visits to obstetric clinics, over concern that turns out to exist unnecessary from a medical perspective, will have health economic benefits. Earlier giving definitive advice that tin can reduce unnecessary controls at the terminate of the pregnancy, distinct differences must be identified regarding how women who lost their child intrauterine or take given birth to a hypoxic or anaemic child, report the changes in graphic symbol of movements as only symptoms when they seek treat 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 design of the movements.
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Funding
The Footling Kid's Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo's Research Foundation funded this study.
Availability of data and materials
The data volition not be made available in order to protect the participant's identity.
Authors' contributions
AL, KP and IR participated in the pattern of the study. AL, SG and IR performed the qualitative analyses. SH and EN carried out the first and main part of the assay. KP contributed to the give-and-take 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 final manuscript.
Competing interests
The authors declare that they take no competing interests.
Consent for publication
Not applicable.
Ethics approving and consent to participate
The women gave consent to participate and permission to access supporting information when receiving information near the study. The data will not be made available in order to protect the participant's identity. The study was approved by the Regional Ethical Review Lath in Stockholm: DNR: 2013/1077-31/three.
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Linde, A., Georgsson, S., Pettersson, Chiliad. et al. Fetal motility in late pregnancy – a content analysis of women'southward experiences of how their unborn baby 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 assay
Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0922-z
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