Women’s experiences of monitoring fetal movements…

medium_8600180515Researchers have looked at women’s experiences of two different self-assessment methods for monitoring fetal movements in full-term pregnancy and, although the study was relatively small, it would appear that more of the Swedish women who participated, having tried both methods, prefer the mindfetalness approach over the count-to-ten method.  I’m delighted to see the publication of this research, which is in an area that I have previously explored (see Evolution of the Theses: monitoring fetal movement to assess fetal well-being), and which I know will be close to a lot of peoples’ hearts.

This study was carried out as a crossover trial, which means that the 40 women tried one method and then the other, with half the women beginning with the count-to-ten method and half beginning with the mindfetalness approach.  This was to remove any chance that the order in which they tried the approaches might affect the woman’s views.  The women carried out self-assessment while in the same room as a researcher, who made notes on their position, behaviour and any comments they made during the exercise.

The results are really interesting:

  • Of the 40 women who were studied, only one did not find at least one of the methods suitable.
  • Twenty of the 39 women who found one or both methods suitable reported a preference
    • 15/20 preferred the Mindfetalness method
    • 5/20 preferred the Count-to-ten method
  • All of the 39 women who found one or both methods suitable said they felt calm, relaxed, mentally present and focused during the observations.
  • The women also described the observation of the movements as safe and reassuring and a moment for communication with their unborn baby.
medium_5076609629It is always important in studies such as this one to consider whether the participants are representative of all women, or whether there is a chance that the methods of approaching or selecting women or even the nature of the study question might have attracted a particular type of woman. It’s not necessarily a bad thing if that happens, as it is often the case in practice that certain kinds of women are more likely to choose some things than others, but looking closely at such elements of a research study means that we can be clear about the implications of the results.  In total, 78 women were approached by their midwives about joining the study, and 38 of these – almost half – chose not to participate for one or more reasons.  This seems like quite a high number, especially as the intervention could be considered ‘mild’.  A closer look at table 1, which shows us who decided not to participate and why, gives us a little bit of information on why a few of the women declined to participate, but most did not give a specific reason for this.

As the researchers themselves acknowledge, this means that “we cannot exclude the potential difference between participants and those who declined participation regarding the experienced negative emotions during the observations. It is possible that women who did not want to participate did so because of  stressful emotions related to the situation.” (Malm et al 2014: 7)  This doesn’t negate the value of the findings at all, but it raises some interesting questions about how the women who chose not to participate might have felt about the two methods.

The authors declare that they have no competing interests, but I think it is worthy of note that the second author, Ingela Rådestad, was responsible for developing the Mindfetalness approach.  I am not highlighting this because I think it is necessarily a problem, and to some extent all researchers test their own ideas on a daily basis, but because I think it is an important element of the context of this research, which offers the next step forward in our understanding about this important topic.

Malm M-C, Rådestad I, Rubertsson C et al. Women’s experiences of two different self-assessment methods for monitoring fetal movements in full-term pregnancy – a crossover trial. BMC Pregnancy and Childbirth 2014 14:349
photo credits: bench by Ian Sane and couple by bortescristian via photopin cc

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