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Fetal Movement Monitoring: How Are We Doing as Educators?

      Abstract

      Objective

      When decreased fetal movement is noticed, delay in seeking care is associated with poor perinatal outcomes, including stillbirth. Health care providers are responsible for educating women about normal fetal movement and the appropriate actions they should take if it decreases. This study aimed to demonstrate our pregnant population's understanding of normal fetal movement and responses to decreased fetal movement, and to potentially guide educational interventions to improve perinatal outcomes.

      Methods

      We surveyed 304 pregnant women (over 26 weeks' gestation) during clinic visits at the IWK Health Centre, Halifax, NS. Information collected in the survey included demographics, knowledge about normal fetal movement, monitoring techniques, and response to decreased fetal movement.

      Results

      Eighteen percent of women (55/298) demonstrated knowledge of normal fetal movement and fetal monitoring, indicating that they would seek assessment promptly if they experienced decreased fetal movement. Although 54.7% of participants (164/300) would contact a health care professional if they noticed decreased fetal movement, approximately two thirds of participants were unable to describe normal fetal movement or monitoring techniques. Almost 30% of participants (90/304) did not identify daily fetal movement as normal, and 37.5% (114/304) reported it may be normal for fetal movement to stop around their due date. Written and verbal communication regarding fetal movement from a health care provider significantly increased the likelihood of appropriate intended self-management in the context of decreased fetal movement.

      Conclusion

      Education influences the anticipated behaviour of pregnant women regarding decreased fetal movement. Specific areas of misinformation which may guide future education strategies are identified. There is room for improvement in this area of patient education.

      Résumé

      Objectif

      Lorsqu'une baisse du nombre de mouvements fœtaux est constatée, la présence d'un délai avant l'obtention de soins est associée à de piètres issues périnatales, y compris la mortinaissance. Les fournisseurs de soins de santé ont la responsabilité de sensibiliser les femmes aux mouvements normaux du fœtus et de les aviser des mesures appropriées à prendre si le nombre de ces mouvements en vient à connaître une baisse. Cette étude visait à démontrer la compréhension des mouvements normaux du fœtus et des façons de réagir à la baisse du nombre de ces mouvements au sein de notre population de femmes enceintes, ainsi qu'à potentiellement orienter les interventions pédagogiques visant l'amélioration des issues périnatales.

      Méthodes

      Nous avons sondé 304 femmes enceintes (plus de 26 semaines de gestation) dans le cadre de consultations cliniques menées au IWK Health Centre de Halifax, en Nouvelle-Écosse. Parmi les renseignements recueillis au cours du sondage, on trouvait les caractéristiques démographiques, les connaissances au sujet des mouvements normaux du fœtus, les techniques de suivi et la réaction à la baisse du nombre de mouvements fœtaux.

      Résultats

      Dix-huit pour cent des femmes (55/298) ont démontré des connaissances au sujet des mouvements normaux du fœtus et du suivi fœtal, et ont indiqué qu'elles chercheraient à obtenir une évaluation sans délai si elles en venaient à constater une baisse du nombre de mouvements fœtaux. Bien que 54,7 % des participantes (164/300) aient affirmé qu'elles communiqueraient avec un professionnel de la santé si elles en venaient à constater une baisse du nombre de mouvements fœtaux, environ les deux tiers des participantes n'étaient pas en mesure de décrire les mouvements normaux du fœtus ou les techniques de suivi. Près de 30 % des participantes (90/304) n'ont pas identifié les mouvements fœtaux quotidiens comme étant normaux et 37,5 % d'entre elles (114/304) ont signalé qu'il pourrait être normal que les mouvements fœtaux cessent aux alentours de la date prévue de l'accouchement. L'offre de documents et la tenue de conversations au sujet des mouvements fœtaux par le fournisseur de soins entraînaient une hausse significative de la probabilité de l'autogestion visée appropriée en présence d'une baisse du nombre de mouvements fœtaux.

      Conclusion

      L'offre de services de sensibilisation influence les comportements anticipés des femmes enceintes en ce qui concerne la baisse du nombre de mouvements fœtaux. Nous avons identifié des domaines particuliers présentant des renseignements erronés, et ce, en vue d'orienter les stratégies pédagogiques à venir. Il y a place à l'amélioration dans ce domaine de la sensibilisation des patientes.

      Key Words

      INTRODUCTION

      Stillbirth is a tragic outcome to a pregnancy, occurring in approximately 1/200 Canadian births.
      Canadian perinatal health report
      Ottawa: Health Canada.
      Insufficient placental perfusion and fetal hypoxia are associated with a decrease in fetal movement.
      • Bocking A.D.
      Assessment of fetal heart rate and fetal movements in detecting oxygen deprivation in-utero.
      When a pregnant woman feels a decrease in fetal movement there is a greater risk of adverse pregnancy outcomes such as stillbirth, intrauterine growth restriction, and prematurity.
      • Sinha D.
      • Sharma A.
      • Nallaswamy V.
      • Jayagopal N.
      • Bhatti N.
      Obstetric outcome in women complaining of reduced fetal movements.
      • Frøen J.F.
      A kick from within—fetal movement counting and the cancelled progress in antenatal care.
      • Liston R.
      • Sawchuck D.
      • Young D.
      SOGC Fetal Health Surveillance Committee. Fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline no. 197, September 2007.
      • Heazell A.E.
      • Sumathi G.M.
      • Bhatti N.R.
      What investigation is appropriate following maternal perception of reduced fetal movements?.
      • O’Sullivan O.
      • Stephen G.
      • Martindale E.
      • Heazell A.E.
      Predicting poor perinatal outcome in women who present with decreased fetal movements.
      • Tveit J.V.H.
      • Saastad E.
      • Stray-Pedersen B.
      • Børdahl P.E.
      • Frøen J.F.
      Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy.
      • Saastad E.
      • Ahlborg T.
      • Frøen J.F.
      Low maternal awareness of fetal movement is associated with small for gestational age infants.
      A woman’s ability to keep track of her fetus’s movement and knowing how to respond to changes in movement is the first line of defence against stillbirth and perinatal hypoxic events. However, in a study in Norway it was found that over one half of women with an unexplained intrauterine death waited over 24 hours without any perceivable fetal movement before contacting a health care professional, and one third waited more than 48 hours.
      • Frøen J.F.
      • Arnestad M.
      • Frey K.
      • Vege Á.
      • Saugstad O.D.
      • Stray-Pedersen B.
      Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986-1995.
      Exactly what, if any, alarm limit should be used to quantify decreased fetal movement remains poorly defined.
      • Moore T.R.
      • Piacquadio K.
      A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death.
      • Winje B.
      • Saastad E.
      • Gunnes N.
      • Tveit J.
      • Stray-Pedersen B.
      • Flenady V.
      • et al.
      Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study.
      However, enhancing maternal awareness of fetal movement through education has been shown in a prospective cohort study to decrease the stillbirth rate by almost 50% in those who present with decreased fetal movement.
      • Tveit J.V.H.
      • Saastad E.
      • Stray-Pedersen B.
      • Børdahl P.E.
      • Flenady V.
      • Fretts R.
      • et al.
      Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement.
      • Tveit J.V.H.
      • Saastad E.
      • Stray-Pedersen B.
      • Børdahl P.E.
      • Flenady V.
      • Fretts R.
      Correction: Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement.
      Monitoring fetal movement is the oldest and least expensive form of prenatal surveillance. It is readily available, and most women can perceive fetal movement accurately enough to use fetal movement as a reasonable form of monitoring.
      • Rayburn W.F.
      Monitoring fetal body movement.
      • Hertogs K.
      • Roberts A.B.
      • Cooper D.
      • Griffin D.R.
      • Campbell S.
      Maternal perception of fetal motor activity.
      It has been found to have a low “false alarm” rate of 2% to 3%,
      • Frøen J.F.
      A kick from within—fetal movement counting and the cancelled progress in antenatal care.
      is generally considered to be an acceptable form of surveillance in the majority of women,
      • Eggertsen S.C.
      • Benedetti T.J.
      Maternal response to daily fetal movement counting in primary care settings.
      • Liston R.M.
      • Bloom K.B.
      • Zimmer P.
      The psychological effects of counting fetal movements.
      and it may also enhance the maternal-fetal attachment process.
      • Mikhail M.S.
      • Freda M.C.
      • Merkatz R.B.
      • Polizzotto R.
      • Mazloom E.
      • Merkatz I.R.
      The effect of fetal movement counting on maternal attachment to fetus.
      The mean time to count 10 movements has been found to be less than 10 minutes,
      • Winje B.
      • Saastad E.
      • Gunnes N.
      • Tveit J.
      • Stray-Pedersen B.
      • Flenady V.
      • et al.
      Analysis of ‘count-to-ten’ fetal movement charts: a prospective cohort study.
      making formal monitoring feasible and not overly time consuming.
      In November 2007, the Society of Obstetricians and Gynaecologists of Canada released practice guidelines on antepartum fetal monitoring.
      • Liston R.
      • Sawchuck D.
      • Young D.
      SOGC Fetal Health Surveillance Committee. Fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline no. 197, September 2007.
      These noted that awareness of fetal movement starting between 26 and 32 weeks’ gestation is the only type of prenatal fetal surveillance recommended for all pregnant women, independent of risk, and that women with risk factors for stillbirth should, in addition, formally count fetal movements daily.
      When a pregnant woman perceives a decrease or cessation of fetal movement, it is her responsibility to decide if and when to seek help from a health care provider. Universal education about fetal movement has been shown to decrease the stillbirth rate in primiparous women with decreased fetal movement, and to decrease the time from perceiving a decrease in movement to seeking help.
      • Saastad E.
      • Tveit J.V.H.
      • Flenady V.
      • Stray-Pedersen B.
      • Fretts R.C.
      • Børdahl P.E.
      • et al.
      Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women—a clinical quality improvement.
      Therefore, effective education for pregnant women about awareness of fetal movement can be an important part of reducing rates of stillbirth and poor neonatal outcome.
      This study was designed to determine whether pregnant women over 26 weeks’ gestation know how to respond to a perceived decrease in fetal movement. We evaluated the effect of self-reported education about fetal movement on participants’ knowledge. We aimed to provide information about populations that might be more likely to lack information about fetal movement. We evaluated specific areas of misinformation. As Canada does not currently have standardized patient educational material on fetal movement, the knowledge gained from this study will inform education efforts that may reduce rates of stillbirth and other poor pregnancy outcomes.

      METHODS

      This study was conducted in prenatal clinics at the IWK Health Centre in Halifax, Nova Scotia, the major tertiary care maternity hospital in the Canadian Maritimes.
      We designed a survey to assess patients’ knowledge and decision-making that would lead them to seek help from a health care provider if they experienced decreased fetal movement. Surveys were collected between September 2008 and December 2009.
      The design of the questionnaire was submitted for constructive criticism to the Dalhousie Department of Obstetrics and Gynaecology Resident Research Day, attended by staff obstetricians and gynaecologists, nurses who work with pregnant women, and residents. A pilot study with 12 nurses
      • Julious S.A.
      Sample size of 12 per group rule of thumb for a pilot study.
      who work with pregnant women was run to validate and time the questionnaire. It was calculated that at least 278 surveys would be needed to be representative of two months of unique patients (approximately 1000 patients) seen at the IWK Health Centre (accepting a 5% margin of error
      Creative Research Systems
      Sample size calculator.
      ).
      Women were included in this study if they were currently at more than 26 weeks’ gestation. Exclusion criteria consisted of having previously completed the survey, not being able to read English, and having opened the patient information sheet prior to completing the survey.
      Potential participants were provided with a survey package when they registered for a clinic appointment for prenatal care. This package included an introductory letter to the patient explaining the study, the survey itself, and a sealed envelope with information regarding appropriate management of decreased fetal movement, based on the SOGC clinical practice guideline.
      • Liston R.
      • Sawchuck D.
      • Young D.
      SOGC Fetal Health Surveillance Committee. Fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline no. 197, September 2007.
      Consent was implied by the completion of the survey, and this was explained in the introductory letter.
      Demographic data in the survey included age, gestational age, education level, height and weight, weight gained during pregnancy, parity, and smoking status. Risk level for stillbirth (high risk vs. low risk) was determined by asking about current and past pregnancies according to the SOGC guideline. BMI was calculated using self-reported height and pre-pregnancy weight. Participants were asked why and when they thought they should be feeling fetal movement, what their source of information was, how they monitored fetal movement, and what they would do if movements decreased.
      To discover if women knew how to monitor fetal movement, they were asked to complete the statement “Paying attention to my baby’s movement means to me . . .”, selecting from a series of options regarding methods of fetal movement monitoring. The SOGC has different surveillance recommendations for women who are considered high risk for stillbirth and those considered low risk.
      • Liston R.
      • Sawchuck D.
      • Young D.
      SOGC Fetal Health Surveillance Committee. Fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline no. 197, September 2007.
      In this study, women were identified as high risk or low risk, using age, BMI, and information on past and current pregnancies from the survey, according to the SOGC’s definitions.
      • Liston R.
      • Sawchuck D.
      • Young D.
      SOGC Fetal Health Surveillance Committee. Fetal health surveillance: antepartum and intrapartum consensus guideline. SOGC Clinical Practice Guideline no. 197, September 2007.
      Women considered low risk needed as a minimum to be paying attention generally to fetal movement and, if feeling less than normal amounts of movement, to start a “kick count.” Women considered high risk needed to be paying attention generally to fetal movement and performing daily kick counts. Women at low risk who also stated they were also doing daily kick counts in addition to being generally aware were still considered to have “Right Surveillance” as these women are not at increased risk of missing decreased fetal movement.
      The goal of fetal movement monitoring is timely presentation to a health care provider so that there is a possibility for intervention in cases of preventable stillbirth. For a woman to be able to make this decision, she requires an understanding of normal movement, a method of paying attention to it, and the knowledge to contact a health care provider about it in a timely fashion. These three components create a “chain of safety”: if one component is missing, there is a possibility that a woman who has decreased fetal movement will not seek help from a care provider within a reasonable time frame. The designation “Safe Baby” is used to describe respondents who demonstrate all three of the above components.
      Completed surveys were placed in an opaque, locked drop box at the clinic’s registration desk. If a participant wished to complete the survey at a different time or location, stamped self-addressed envelopes were available. A total of 440 surveys were distributed, and 306 were returned into the drop boxes. There were no returns by mail. Two surveys were excluded for not meeting the gestational age inclusion criteria.
      Descriptive statistics of questionnaire response data were used to illustrate the participants’ understanding of normal fetal movement, the importance of detection, the ease with which movement is perceived, and, ultimately, the proportion of women who have the knowledge needed to seek help from a health care provider when decreased fetal movement is apparent. The relationships among demographics, health care provider information, and participant responses were evaluated with chi-square analyses. Analyses were carried out using SPSS v.14 (IBM Corp., Armonk NY).
      Ethics approval for the study was obtained from the IWK Research Ethics Board.

      RESULTS

      Three hundred four surveys were available for data analysis. Within this group, 99.7% of respondents were able to feel fetal movement, and 93.3% were able to feel it easily. Slightly over 5% stated it was “somewhat easy” to feel fetal movement and 0.7% felt it was not easy. As well, 88.8% of respondents felt that fetal movement was “very important.”
      When asked where they had acquired information about fetal movement, 69.5% of respondents stated “doctor,” 47.3% stated “nurse,” 33.4% stated “family or friend,” 25.8% stated “internet,” 43.7% stated “reading” and 44.3% stated “I thought of it myself” Multiple responses were permitted.
      As shown in Figure 1, when respondents were asked specifically if their physician or nurse talked about fetal movement (Discussion), the majority checked “yes.” Less than one half of respondents indicated that they had received some form of specific instruction that enabled them to perform fetal movement monitoring (Education), and less than one fifth stated that they had received a piece of paper regarding fetal movement monitoring (Handout).
      Figure thumbnail gr1
      Figure 1Patient recollection of education
      Number of respondents receiving information about fetal movement monitoring.
      As shown in Figure 2, three questions were used to determine patients’ understanding of normal fetal movement. The first question was “Why is it important to pay attention to the baby’s movements?” The majority of women answered correctly “because less movement might mean that the baby is sick,” but almost one quarter of participants answered incorrectly. The second asked participants whether the statement “When I am close to my due date, it is normal if I don’t feel my baby move” was true. More than one third responded incorrectly that this statement was true. The third asked participants whether the statement “It is normal to not feel the baby move on some days” was true; approximately one third of respondents incorrectly indicated that fetal movement is not felt every day. The understanding of fetal movement was evaluated in the “Right Knowledge” questions illustrated in Figure 2.
      Figure thumbnail gr2
      Figure 2Knowledge base
      Women’s responses to questions regarding knowledge of normal fetal movement and common misperceptions. “Right Knowledge” is the percentage of participants who answered all three questions correctly.
      In Figure 3, Right Knowledge indicates the percentage of women who answered all three knowledge questions correctly.
      Figure thumbnail gr3
      Figure 3If a woman experiences decreased fetal movement, will she present to a health care provider in a timely fashion?
      Safe Baby concept. To present to a health care provider in a timely fashion, a woman requires correct knowledge surrounding normal fetal movement (right knowledge) an understanding of fetal movement surveillance (right surveillance), and know how to respond to decreased fetal movement (right action).These three components create a “safe baby chain”.18.5% of respondents had all three components.
      It was found that 47.9% of respondents had Right Surveillance (as described in the methods) in accordance with the SOGC guidelines.
      Contacting a health care provider in a timely fashion was evaluated with to the completion of the statement, “If I felt the baby was not moving as much as usual, I would . . .” A correct response indicated timely contact with a health care provider and included “Call the hospital,” “Call my doctor,” or “Go to the hospital/doctor’s office.” Incorrect responses indicated significant delays or lack of contact with a health care provider. Fifty-four percent of women responded correctly, and this data point is labelled “Right Action.”
      As shown in Figure 3, 18.5% of respondents had all three components needed for a Safe Baby.
      The relationships of demographics to Right Action and Safe Baby are shown in the Table. Right Action correlated with BMI < 30, gestational age > 32 weeks, having graduate level education or higher, classifying fetal movement as “very important,” and finding fetal movement easy to feel. Safe Baby correlated with age > 20 years, being a non-smoker, having a gestational age > 32 weeks and having a level of education greater than graduate school.
      Discussion, Education and Receiving a Handout, as previously described, were related to the designation of Safe Baby. All of these educational interventions increased the likelihood of a Safe Baby designation significantly. Similarly, each of these interventions significantly increased the likelihood of knowing the Right Action.

      DISCUSSION

      In this study population, 18.5% of respondents were able to demonstrate the knowledge needed to identify and respond to a decrease in fetal movement. Fifty-four percent knew to contact a health care provider if a decrease in fetal movement was noted.
      Table 1Relation of patient demographics to Right Action and Safe Baby
      DemographicsRight ActionSafe Baby
      %P%P
      Age
      Statistically significant for Safe Baby
      0.080.04
       < 2035.30
       ≥ 2056.919.9
      BMI, kg/m20.0360.122
       ≤ 3059.320.8
       > 3045.813.1
      Smoking status
      Statistically significant for Safe Baby
      0.1770.012
       Non-smoker56.420.6
       Smoker45.24.7
      Pregnancy risk level0.8770.478
       Low55.621.3
       High56.816.8
      Gestational age, weeks
      Statistically significant for Safe Baby
      0.0010.003
       ≤ 3241.67.8
       > 3262.923.7
      Parity0.4930.644
       Nulliparous53.617.6
       Multiparous57.519.7
      Care provider0.5710.156
       Family physician60.926.1
       Obstetrician56.315.2
       Both50.623.5
      Education
      Statistically significant for Safe Baby
      0.0030.017
       Graduate level71.428.6
       < Graduate level50.215.5
      Important to feel movement0.0020.131
       Very important60.320.5
       Somewhat/not31.39.4
      Easy to feel movement0.0350.630
       Easy57.319.4
       Somewhat/not31.312.5
      * Statistically significant for Safe Baby
      This study demonstrates that women who recall receiving information regarding fetal movement from a health care provider are more likely to know how to detect and react to a decrease in fetal movement. As shown in Figure 4, a discussion with a health care provider provides the greatest increase in this knowledge, from 3.6% to 26.3% of respondents. Providing written material has the greatest overall effect, with 38.8% of those receiving a handout having the designation of a Safe Baby. When only the reaction to a decrease in movement is evaluated (Right Action), the same relationship is demonstrated (Figure 5). This relationship has been mirrored in a study by Saastad et al. in 2010, who found that the percentage of primiparous women who reported having received information on fetal movement monitoring was negatively associated with fetal mortality rates.
      • Saastad E.
      • Tveit J.V.H.
      • Flenady V.
      • Stray-Pedersen B.
      • Fretts R.C.
      • Børdahl P.E.
      • et al.
      Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women—a clinical quality improvement.
      Figure thumbnail gr4
      Figure 4Health care interventions: effect on Safe Baby
      Discussion, Education, and receiving a Hand Out and its effect on Safe Baby. *P < 0.05 **P < 0.01
      Figure thumbnail gr5
      Figure 5Health care interventions: effect on Right Action
      Discussion, Education, and receiving a Handout and its effect on Right Action. *P < 0.05 **P < 0.01 ***P < 0.001
      Importantly, receiving a handout from a health care provider was the least common type of interaction reported by respondents (16.3%), as seen in Figure 1. The act of writing on the handout did not have any significant effect on the proportion of respondents with a Safe Baby. This demonstrates that there is significant room for improvement in education about fetal movement.
      Fetal movement monitoring is easy and feasible, as illustrated by the fact that 99.7% of women reported that they could feel movement and 93.3% said that it is easy to feel.
      Eighty-nine percent of women felt it was very important to feel fetal movement, suggesting that women are motivated to feel and record fetal movement and that education about fetal movement monitoring may be well received.
      Demographics also have an effect on the rates of Safe Baby and Right Action, as seen in the Table; however, education from a health care provider had a greater effect on Safe Baby rates than any individual demographic factor. It is of concern that certain groups of women with a higher baseline risk for stillbirth, such as adolescents
      • Arkan D.C.
      • Kaplanoglu M.
      • Kran H.
      • Ozer A.
      • Coşkun A.
      • Turgut E.
      Adolescent pregnancies and obstetric outcomes in southeast Turkey: data from two regional centers.
      and smokers,
      • Flenady V.
      • Koopmans L.
      • Middleton P.
      • Frøen J.F.
      • Smith G.C.
      • Gibbons K.
      • et al.
      Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis.
      were at increased risk of not achieving the Safe Baby data point, and women with a BMI > 30 (who are also at increased risk for stillbirth
      • Flenady V.
      • Koopmans L.
      • Middleton P.
      • Frøen J.F.
      • Smith G.C.
      • Gibbons K.
      • et al.
      Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis.
      ) were less likely to have responded with Right Action. Not surprisingly, women who feel that it is important to feel fetal movement and find it easy to detect are more likely to have Right Action.
      This study further demonstrates that there are some current popular misunderstandings that have the potential to interfere with and delay a woman’s decision to seek attention from a health care provider if decreased fetal movement is detected. For example, 32.1% of women did not think that decreased fetal movement could mean that the health of the fetus was at risk.
      • Frøen J.F.
      • Tveit J.V.
      • Saastad E.
      • Børdahl P.E.
      • Stray-Pedersen B.
      • Heazell A.E.
      • et al.
      Management of decreased fetal movements.
      Even more worrisome is the finding that 38% of women surveyed thought it normal for the fetus to stop moving near the due date, which is untrue in a healthy fetus,
      • Rayburn W.F.
      Monitoring fetal body movement.
      and 30% thought it normal for movement not to be detected every day.
      A prospective cohort study by Tveit et al.
      • Tveit J.V.H.
      • Saastad E.
      • Stray-Pedersen B.
      • Børdahl P.E.
      • Flenady V.
      • Fretts R.
      • et al.
      Reduction of late stillbirth with the introduction of fetal movement information and guidelines—a clinical quality improvement.
      found that universal provision of prenatal information about fetal movement decreased the stillbirth rate in women presenting with decreased fetal movement by almost 50%, from 4.2% to 2.4%. In the absence of such universal provision of information, “old wives tales” have the potential to take validity away from this intuitive and common sense approach to monitoring of fetal well-being. If misconceptions are addressed and accurate information is provided, women will be better equipped to care for themselves during pregnancy. The findings of the present study have been used to create an educational booklet that aims to increase awareness of the importance of fetal movement, to empower women to react appropriately to it, and to dispel myths.
      Our study has a number of weaknesses. Although the survey was validated first by accepting suggestions from experts in the field and then by a pilot study involving obstetric nurses, the survey itself was not validated by pregnant women before its distribution. This survey relied on patient recall and honesty for all aspects of data collection, and the responses were not confirmed by chart information. The study did not address the optimal timing to provide education about monitoring fetal movement. In addition, although a standard kick count chart is available at our hospital, it is unknown how often it is provided to patients and to what extent the purpose of the chart is discussed with them. This study did not directly evaluate the education provided, but rather the recollection and understanding of the patients. It is unknown what information the patients actually received; rather, the study identified what they learned. Linking patient knowledge levels with an educational intervention would be a reasonable next step in this area of study.

      CONCLUSION

      Pregnant women who recall receiving information about fetal movement from health care providers are more able to describe normal healthy fetal movement patterns and would be more likely to seek help promptly if fetal movements were to decrease. Many women do not recall receiving information, either verbal or written, about fetal movement from their health care providers. There is room for improvement in this area of patient education.

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