A few days ago I got a social media message containing a video of a woman using a doppler. She wanted me to confirm she could hear her baby’s heart rate and that all was well.
I know many of us would be concerned and maybe even a bit angry at receiving this kind of message. After all, it’s not a safe situation.
But with so many dopplers on the market, it being a busy time of year, and reduced fetal movements being a major prompt for anxiety and not so clear thinking, I can put myself in her position.
Of course, I wrote back immediately and let the woman know she needed to see her midwife asap.
I tried to explain in a way that made her feel listened to.
Midwives believe that women have an innate intuition about their baby’s well-being. But in our society, we don’t often embrace our intuition and therefore women sometimes don’t trust themselves.
I wanted to avoid making her feel undermined, which is all too easy to do when it's busy.
With the maternity services as stretched as they've ever been, to make things easier in this post I've put some facts together for you on reduced fetal movements.
The UK stillbirth and neonatal death rate has fallen by 1/5 in the last decade. This is amazing, though we still have some of the highest rates in Europe (report).
There is a government initiative to reduce stillbirth by 50% by 2030, which is something we can all get behind.
This has prompted the ‘Saving Babies Lives Care Bundle’, by NHS England, which is a piece of guidance that concentrates on four main areas.
- Aiming to reduce women smoking in pregnancy
- Aiming to pick up on more fetal growth restriction
- Raising awareness of reduced fetal movements
- Effective fetal monitoring in labour
You can read the about whole bundle here but we’ll concentrate on reduced fetal movements today.
The Royal College of Obstetricians and Gynaecologists (RCOG), in one of their ‘Green Top’ Guidelines that help inform practice, note that women who are busy and spend lots of time upright notice fetal movements less.
If women are worried they should contact their midwife, but lying down for 2 hours on their left-hand side is recommended to help women pick up on movements if they're unsure *Post edit: great point from Julia commenting below, if you're at all worried, midwives and mums are best off going in as time could be lost lying in left lateral if a baby is in trouble.
This sounds like sensible advice (left-lateral is often a recommended position as a big vein called the inferior vena cava is on the right, and relieving pressure on this makes good physiological sense).
However, if a woman is at all worried she should go straight in to be monitored.
RCOG have details on CTG monitoring and the evidence behind this in the guideline and they also go through the history that should be taken and some other recommendations.
The MBRRACE report on antepartum stillbirth found reduced fetal movements that were not followed up were ‘missed opportunities’ to prevent poor outcomes.
Women should also be offered this reduced fetal movements awareness leaflet at 24 weeks to try and encourage them to make contact.
And though there used to be the 'count to ten' fetal movements advice, this isn't recommended anymore. Women should be aware of their baby's normal movements and get in touch if there are any changes.
The charity 'Kicks Count', which aims to reduce stillbirth by promoting awareness of fetal movements, used to be called 'Count The Kicks' but it's changed its name to reflect this newer recommendation.
It is a bit of a problem that women can get anxious when we talk to them about fetal movements. Like screening or any other aspect of care that hints at the fact not every pregnancy is straightforward and ends happily, it can cause stress.
This is an ethical difficulty as stress is not something we want to be causing for women who are pregnant.
I think a good midwife/mother relationship, ideally based on continuity of care, could go a long way to reducing this kind of stress. In fact, a recent Cochrane review on midwife-led continuity models showed that this kind of care reduced stillbirth, which is of course what identifying women with reduced fetal movements is supposed to be about.
Also, making sure women know they are the most important way of monitoring their baby is an empowering experience for many.
This is something I want to praise the RCOG Green Top Guideline for. It says ‘women intuitively view their experience of fetal activity as normal’.
I love the fact women’s intuition has made it into the guideline, as it makes for a good blend of midwifery and medical philosophies.
Finally, if you’ve come across a woman using a home doppler, like I did, you can refer them to the excellent ‘Kicks Count’ charity information on the subject.
They have a great analogy about dopplers: if you were concerned about someone’s wellbeing, perhaps unsure about whether they were conscious, would you be happy and stop worrying just because you felt their pulse?
Of course not. In the same way, a snapshot listen-in to a fetal heart shouldn't be taken as reassurance, especially if it's done by a lay person.
I think this analogy is something all midwives should have in their verbal toolkit.
I hope this is helpful!
Now I’d love to hear from you:
- Have you any tips to make sure women feel comfortable getting in contact with concerns about fetal movements?
- Have you come across women with home dopplers? What do you say to help them access good education on the subject?
Wishing you a very merry Christmas and huge thanks if you are working over the holiday.