Abstract
Abstract
Background
Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women’s awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care.
Methods
In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks’ gestation. We applied the intention-to-treat principle.
Results
The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87–0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90–0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85–0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62–1.97). The differences remain after adjustment for potential confounders.
Conclusions
Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies.
Trial registration
ClinicalTrials.gov (NCT02865759). Registered 12 August 2016, www.clinicaltrials.gov.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology
Reference20 articles.
1. Flenady V, Ellwood D, Bradford B, Coory M, Middleton P, Gardener G, et al. Beyond the headlines: fetal movement awareness is an important stillbirth prevention strategy. Women Birth. 2019;32(1):1–2 PubMed PMID: 30563769. Epub 2018/12/20. Eng.
2. Walker KF, Thornton JG. Encouraging awareness of fetal movements is harmful. Lancet. 2018;392(10158):1601–2 PubMed PMID: 30269875. Epub 2018/10/03. Eng.
3. Norman JE, Heazell AEP, Rodriguez A, Weir CJ, Stock SJE, Calderwood CJ, et al. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial. Lancet. 2018;392:1629 PubMed PMID: 30269876. Pubmed Central PMCID: PMC6215771. Epub 2018/10/03. Eng.
4. Vårdgivarguiden. Behandlingsstöd barnmorskor [cited 2020 0407]. Available from: http://www.vardgivarguiden.se/behandlingsstod/barnmorskemottagning/.
5. Graviditetsregistret. Årsrapport 2017.
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献