Evidence of the importance of listening to women

A research study which described and explored women’s ‘gut instincts’ during pregnancy has provided further support for the idea that it is vital to listen to women and to pay attention to other ways of knowing such as intuition (Warland et al 2018).

The authors of the case-control study used web-based questionnaires to ask mothers of live and stillborn babies about their gut instincts during pregnancy. They concluded that practitioners need to be alert to women’s intuitive feelings, to actively talk to women about how they feel and to respond appropriately when women report feeling concerned.

The study found a significant difference in the responses to one question by women who had given birth to stillborn babies compared to women who had given birth to live babies. The question was, “During this pregnancy did you ever have a “gut instinct” that something was not right?” Of the women who had a stillborn baby, 75% answered yes to this question, compared to 12% of the women who gave birth to live babies.

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One key thing that we need to bear in mind is that women answered this question after they had had their baby. There is a possibility of negativity bias in this kind of research, and for this reason we need further prospective research to confirm the findings and assess the strength of any difference. It would be ideal to also conduct more qualitative research to explore this with women and care providers, and I know from my own research on midwifery knowledge that this is a complex issue. The authors of this paper offer some insight into negativity bias for those who might not have encountered this term:

“This bias causes humans to respond more strongly to negative than to positive or neutral stimuli, such that negative events are remembered more strongly than positive ones. It is therefore possible that the controls may also have had these intuitive feelings and ‘forgotten’ them prior to completing the survey because of their recent positive birth experience. While this is certainly possible, it is unlikely to entirely account for the stark difference between the cases and controls recollections. While it is true that both the cases and controls completed this question within 30 days weeks of the baby’s birth/death we consider it unlikely that large numbers of controls would have forgotten this “feeling” so soon after the birth especially as pregnancy and birth is such a memorable event in any woman’s life.” (Warland et al 2018)

A couple of other things are important here. We always need to remain aware of the potential for over-interference. It is important to bear in mind that 12% of the women who gave birth to live babies reported having a worry that something was wrong and yet went on to have a live, healthy baby. So, as the authors of this study highlight, we need to dig deeper into the notion of intuition itself and be able to distinguish intuition from anxiety, especially in our modern world in which women who engage with the maternity services have to deal with so much emphasis on risk. The study also highlights the value of continuity of care, and the issue of relationship comes up over and over again when we look at topics like this.

Here’s the abstract for anyone wishing to look further into the study…

The Research

Objective: To describe and explore ‘gut instinct’ that something was wrong in women who identified that they experienced gut instinct during pregnancy.

Method: A case-control study utilising an international web-based questionnaire. Stillborn cases (n=146) and liveborn controls (n=234) answered the gut instinct question within 30 days of the pregnancy ending. Of those, 84 cases and 27 controls also provided qualitative comment data. Descriptive statistics were used for the question, with a fixed option and summative content analysis was used to analyse the comment data.

Findings: In all, 110 (75%) of the stillborn cases answered “yes” to the gut instinct question vs only 28 (12%) of the controls who had a livebirth meaning the risk of stillbirth was 22.5 fold higher in those who experience “gut instinct” than in those who don’t experience this feeling. Four themes were identified from the comment data namely: When the gut instinct occurred; How the gut instinct made the woman feel; Dreams and other related phenomena; Reassured by someone or something. Conclusions. Women who had a stillborn baby reported a “gut instinct’ that something was wrong more frequently than mothers of a live born baby. Our findings may be influenced by recall negativity bias, and a prospective study is needed to confirm or refute our findings. The possibility that “maternal intuition” exists during pregnancy and responds to changes in fetal or placental health merits further exploration.

Implications for practice: Maternity care providers should be alert to the woman when she expresses intuitive feelings, as well as asking her to report her concerns and act appropriately to assess and manage fetal wellbeing.