Womens perspectives on fetal movement monitoring in high and low stillbirth settings: a qualitative study

IntroductionMaternal fetal movement monitoring during pregnancy is commonly advised to assess fetal wellbeing. However, qualitative research exploring how women perceive and implement such advice is lacking, particularly in regions with the highest burden of stillbirth. This study investigates womens experiences and opinions on fetal movement monitoring during pregnancy across high- and low-stillbirth settings. MethodsWomen from three countries with low-stillbirth rates and five with high rates of stillbirth were surveyed and interviewed regarding their experiences with fetal movement monitoring advice. Open-ended answers from the surveys and interview were analysed using inductive thematic methods, while categorical answers were examined using non-parametric statistical analysis. Results234 women were included in the study. The nature and extent of fetal movement monitoring advice varied considerably by country, encompassing active monitoring methods such as kick counting, pattern awareness and movement presence detection, as well as guidance on responding to fetal movements concerns. Notably, 33% (37/112) of women in high-stillbirth countries and 8% (10/122) in low-stillbirth countries reported a lack of any fetal movement monitoring advice. Globally, half of women rated the advice easy to follow, while one-third experienced difficulty understanding their healthcare providers guidance. Key facilitators of following advice included having an active baby and a clear understanding and confidence in the received advice, whereas barriers included a lack of clarity and understanding, difficulty perceiving movements, competing time demands and challenges in identifying patterns of movements. Maternal anxiety was prevalent, with 78% of participants reporting at least occasional anxiety about fetal movements during pregnancy. ConclusionWide variation in the type and consistency of fetal movement monitoring advice across countries indicates the need for further research into the comparative effectiveness of current recommendations, particularly in high-stillbirth settings. High rates of maternal anxiety worldwide highlight the importance of providing support to women navigating fetal movement monitoring.