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)