This article has Open Peer Review reports available.
Fetal movement in late pregnancy – a content analysis of women’s experiences of how their unborn baby moved less or differently
© The Author(s). 2016
Received: 4 February 2016
Accepted: 25 May 2016
Published: 1 June 2016
Pregnant women sometimes worry about their unborn baby’s health, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently.
Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 – 31/12 2014. The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women’s responses to, “Try to describe how your baby has moved less or had changes in movement”.
Four categories and six subcategories were identified: “Frequency” (decreased frequency, absence of kicks and movement), “Intensity” (weaker fetal movements, indistinct fetal movements), “Character” (changed pattern of movements, slower movements) and “Duration”. In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.
Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.
It is widely acknowledged that a pattern of regular movements is associated with fetal wellbeing . Fetal movements can be defined as any discrete kick, flutter, swish or roll and are normally first perceived by the mother between 18 and 20 weeks of gestation . The frequency of fetal movements reaches a plateau in gestational week 32 and stays at that level until birth . There is normally a variation in fetal movements with a wide range in the number of movements per hour . The movements are normally absent during sleep and occur regularly throughout the day and night, normally lasting for 20–40 min. The sleep cycles rarely exceed 90 min in the normal and healthy fetus . Although the movement pattern of the individual fetus is unique, it is general knowledge that decreased fetal movement is associated with adverse outcome, including stillbirth .
The character of the movements changes when the pregnancy approaches delivery due to limited space in the uterus, but the frequency and intensity will not normally decrease . In an interview study, 40 term pregnant women with an outcome of a healthy baby described fetal movements during the past week. Almost all experienced fetal movements as “strong and powerful”. Half of the women also described the movements as “large” (involving the whole body of the fetus). Another common description was “slow” as in “slow motion” and “stretching” or “turning”. Some of the women stated that they were surprised how powerfully the fetus moved .
Several maternal factors may impair the ability to recognize fetal movement . Amniotic fluid volume , fetal position , having an anterior placenta [10, 11], smoking, being overweight  and nulliparity [6, 12] have been reported as such factors. Maternal factors which may enhance the ability to recognize movement are the opportunity to focus on the fetus and the absence of distracting noises . About 50 % of the pregnant women in a study from Norway were sometimes worried about decreased fetal movements . In a review article, it was found that between four and fifteen percent of pregnant women consult health care because of a decrease in fetal movement in the third trimester . The aim of the present study was to examine how women, who consulted health care due to decreased fetal movements after gestational week 28, describe how the baby had moved less or differently.
Settings and participants
Age, level of education and country of birth among the 876 women in the study
Age, level of education and country of birth among the 876 women in the study
College or university
Country of birthc
Europe (excluding Sweden)
The questionnaire used in the study was developed from a web survey, an interview study [7, 15] and clinical experience. The questionnaire was face-to-face validated with ten women who consulted health care due to reduced fetal movements, not included in the study. The final version of the questionnaire included a total of 22 questions with multiple-choice or open-ended response alternatives (Additional file 1). This study comprises the women’s responses to the request: “Try to describe how your baby has moved less or had changes in movement”. The women were asked to describe their experiences in the space provided but could also, if necessary, continue on the back of the questionnaire.
The women’s descriptions (n = 876) of how their unborn baby had moved less or differently were analysed using a modified content analysis . The material consisted of concise descriptions of movements, which were used without editing. The analysis was performed in three steps. Firstly, all the answers were read and re-read three times to gain a sense of content in the data. Codes were then revealed in accordance with Malterud. Every quotation was read and sorted into codes. In the second phase of the analysis the material was organized. Units, the quotations, with the same code were divided into defined main categories and categories. When appropriate the categories were divided into subcategories  The quotations could be placed in more than one category. However, each statement was only placed in one subcategory. During the whole process the findings were continually discussed in the research group in order to reach agreement. To validate the results, a sample of 50 quotations was randomly selected and re-analysed from the beginning of the analysis process. After consensus had been reached some of the quotations were transferred to other subcategories and three quotations were deemed irrelevant and removed. Those carrying out the analysis did not know the gestational week.
Women descriptions of fetal movement*
N = 876
Gestational week 28–32
Gestational week 33–36
Gestational week 37+
n = 190 (22)
n = 263 (30)
n = 423 (48)
Decreased frequency of fetal movement
Absence of fetal movement
Weaker fetal movements
Indistinct fetal movements
Changed pattern of movements
The most commonly experienced deviation of fetal movements concerned frequency, which was described in 746 (85 %) of the questionnaires. This category was divided into two subcategories; “Decreased frequency” and “Absence of kicks and movement”.
Decreased frequency of fetal movement
“Less frequent during the day”
“From being very active and kicking a lot to very few movements during some days”
Absence of kicks and movement
“I haven't felt any kicking for about 12 hours”
“Have not felt any movement during the whole day”
A total of 343 (39 %) responses were perceptions that the movements had altered in intensity. Two subcategories were formed: “Weaker movements” and “Indistinct movements”.
Weaker fetal movements
“From obvious, strong movements and nudging to feathery tickling a few times a day”
“… The movements of the baby felt weaker the few times I have felt my baby”
Indistinct fetal movements
“…The only thing I felt was non-specific movements deep inside my tummy…”
“Have previously felt apparent kicks which can be both felt and seen distinctly. Since yesterday evening only small occasionally twisting movements”
This category comprised 252 (29 %) statements describing experiences of the fetal movements changing in character. The category revealed two subcategories: “Changed pattern of movements” and “Slower movements”.
Changed pattern of movements
“Not the same pattern of movements as before and not active at the same time”
“The baby has not moved at the times that she had moved earlier, following the pattern that she had previously. This has been going on for about 2 days. When she has moved, the movements felt weaker the past two days compared to before.”
“Calmer more tired movements as if it were tired…”
“Slow and smoother movements”
“… the periods when it has moved have been shorter”
“No more lively periods.”
Differences according to gestational age
Women in gestational weeks 33–36 experienced changes more often than women at term regarding the category Frequency (92 % vs. 81 %), the subcategory Decreased frequency (75 % vs. 67 %), and the category Intensity (42 % vs. 35 %). Compared to women at term, those in gestational weeks 28–32 expressed changes to a lesser extent within the category Character and the subcategory Slower movements (5 % vs. 15 %) (Table 2).
Four percent, 32/876, of the total number of women in this study only stated a change in the character of the movements, not included in any other category. The distribution regarding length of pregnancy was; gestational week 28–32, 1/190 (0.5 %), 33–36, 1/263 (0.4 %) and gestational weeks 37+, 30/423 (7 %). There were no statistically significant differences in the other categories (Not in table).
In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.
Stimulation due to less movement
“No pushes” back when I am pulling on the tummy, no reaction when drinking a glass of lemonade. Otherwise he has been quite active and you have been able to see my tummy moving”
“Even if I touch my tummy, eat, drink, there is not much difference. He is moving considerably less”
Difficult to distinguish fetal movements from contractions
“Not felt any movements since the contractions became more intensive”
“It has been more difficult to perceive movements. Difficult to distinguish movements from contractions… previously the movements have been very distinct”
Worry due to incidents related to changed pattern of fetal movements
“Used to move a lot during both day and night. Have been ill with fever for three days and then there have been movements 4–5 times every twenty-four hours”
“Not as often as before but I still feel him daily. We’re extremely worried as we lost our first child in gestational week 33 in utero so it may be imagination”
We are not aware of any studies that have categorized how women describe the changes they have perceived concerning fetal movements when they seek health care due to worry about their unborn baby.
Women who consulted health care due to decrease fetal movements described changes in frequency, intensity, character and duration of the movements. However, all women in this study were reassured after an examination of their unborn baby. In Norway, as many as 51 % of women reported that they were concerned about decreased fetal movements once or more in pregnancy . In different populations, between four and 15 % consulted health care facilities because of decreased fetal movements in the third trimester . There are several factors which may impair the ability to recognize fetal movements . However, we have no data concerning amniotic fluid volume, fetal position, placenta position, smoking, overweight and nulliparity among the women participating in this study. These factors may explain some of the women’s perceptions of decreased fetal movements. Also, the plateau in gestational week 32  may be perceived as a decrease. In a study by Sheikh and colleagues (2014), 729 women counted and registered fetal movements for one hour three times per day. Eight percent of the pregnant women in the third trimester, who in the end gave birth to a healthy child, experienced reduced fetal movements. Further, the researchers found that among women who consulted health care for reduced fetal movements but later gave birth to a healthy child, more of them were working than those who did not perceive reduced fetal movements . We do not have data as to work status among the women participating in our study.
Placental dysfunction is one main reason for decreased fetal movements in late pregnancy . It is thus important for the pregnant women to recognize the pattern of movement. A change may be a sign of asphyxia due to the redistribution of the circulation which gives priority to the brain over peripheral parts . All fetuses in the present study were examined and no symptoms of asphyxia or placental dysfunction were identified at the time when the woman consulted health care. The women’s worry about their unborn baby’s health due to decreased fetal movements in this study did not result in a diagnosis or actions to induce the delivery.
Our results indicate that some women at term seek health care due only to a change in the character of the fetal movements. Although these women were asked to describe how their baby had moved less or differently, they did not mention a decrease in frequency in the fetal movements or a change in intensity. Slow, as in slow motion, stretching and turning, are descriptions of the character of fetal movements used by women in full term pregnancy, pregnancies that resulted in a healthy child . The women in our study who consulted health care merely due to a change in the character of the movements and not because of altered frequency and intensity might not have been aware of normal changes in the fetal movement patterns in late pregnancy. The changes they reported as different can be physiological due to limited space in the uterus at term . There is no routine in Swedish antenatal health care for giving information about fetal movements but women are recommended to consult health care if they experience decreased fetal movements . However, pregnant women ask for information about fetal movements in general and for information about the number and type of fetal movements they can expect, as well as how the movements are supposed to change over time in pregnancy .
There were no stillbirths among the women in this study. Thus, we can only speculate that it is possible that women who consult health care due to decreased or changed patterns of fetal movement may be aware of the importance of detecting fetuses at risk as early as possible. Detection of decreased fetal movements can improve the outcome and reduce delay in consulting health care [23, 24]. Further, the fetuses in this study who could be at risk were examined and risk factors such as placental abruptions, growth retardation or malformations  may have been detected. The primary reason for consulting health care due to decreased fetal movements is worry about the health of the baby . None of the women in our study consulted health care without cause, but their worry was obviously unfounded from a medical perspective in the short term.
Strengths and limitations
Women in this study had a normal CTG before they completed the questionnaire. However, aside from no stillbirths among the participating women, we have no data regarding the health status of the baby after birth. This is a major limitation of the study. There is also only sparse information about the women’s’ sociodemographic background.
One strength of the study is the large number of participants. Another strength is that all delivery wards in Stockholm participated in the study. However, all women came from the capital city in Sweden where women in generally are older and well educated compared with women outside the capital. Further, the number of those who declined to participate and their reasons for doing so are not known.
The wording of the request, “Try to describe how your baby has moved less or had changes in movement” might have influenced the responders to use the words “decreased” and “differently” in their descriptions of their experiences. The results may have yielded even more if the initial request had been broader or more open, for example, “Try to describe how your baby has moved”. However, the context in which the women completed the questionnaire was one of already perceived decreased fetal movements.
Increased knowledge about the normal changes in the fetal movement patterns in late pregnancy can be one way to lessen the number of visits to obstetric clinics from women over concerns that turn out to be unnecessary from a medical perspective. The challenge from a clinical perspective is to inform and advise pregnant women about fetal movements with the goal of diminishing the length of pre-hospital delay if the fetus is at risk and at the same time reduce worry leading to unnecessary consultation. Reducing the pre-hospital delay when the intrauterine environment is a threat to the unborn baby’s life will provide a window of opportunity to save a greater number of children from death or compromised health. Further, fewer visits to obstetric clinics, over concern that turns out to be unnecessary from a medical perspective, will have health economic benefits. Before giving definitive advice that can reduce unnecessary controls at the end of the pregnancy, distinct differences must be identified regarding how women who lost their child intrauterine or have given birth to a hypoxic or anaemic child, report the changes in character of movements as only symptoms when they seek care for decreased fetal movements. Future studies are needed.
Women reported changes in fetal movement concerning frequency, intensity, character and duration; they described decreased, absence, weaker, slower and changed pattern of the movements.
The Little Child’s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation funded this study.
Availability of data and materials
The data will not be made available in order to protect the participant’s identity.
AL, KP and IR participated in the design of the study. AL, SG and IR performed the qualitative analyses. SH and EN carried out the first and main part of the analysis. KP contributed to the discussion of the analysis. AL, SG, KP and IR drafted all versions of the manuscript. AL, SG, KP, SH, EN and IR commented on the draft. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
The women gave consent to participate and permission to access supporting data when receiving information about the study. The data will not be made available in order to protect the participant’s identity. The study was approved by the Regional Ethical Review Board in Stockholm: DNR: 2013/1077-31/3.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Froen JF. A kick from within--fetal movement counting and the cancelled progress in antenatal care. J Perinat Med. 2004;32(1):13–24. doi:10.1515/JPM.2004.003.View ArticlePubMedGoogle Scholar
- Neldam S. Fetal movements as an indicator of fetal wellbeing. Lancet. 1980;1(8180):1222–4.View ArticlePubMedGoogle Scholar
- RCOG. Green-top guideline No.57: reduced fetal movements. London: Royal College of Obstetricians and Gynaecologists; 2011. http://www.rcog.org.uk/womens-health/clinical-guidance/reduced-fetal-movementsgreen-top-57. Accessed 17 May 2016.
- Nowlan NC. Biomechanics of foetal movement. Eur Cell Mater. 2015;29:1–21. discussion.View ArticlePubMedGoogle Scholar
- Patrick J, Campbell K, Carmichael L, Natale R, Richardson B. Patterns of gross fetal body movements over 24-hour observation intervals during the last 10 weeks of pregnancy. Am J Obstet Gynecol. 1982;142(4):363–71.View ArticlePubMedGoogle Scholar
- Holm Tveit JV, Saastad E, Stray-Pedersen B, Bordahl PE, Froen JF. Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy. Acta Obstet Gynecol Scand. 2009;88(12):1345–51. doi:10.3109/00016340903348375.View ArticlePubMedGoogle Scholar
- Radestad I, Lindgren H. Women’s perceptions of fetal movements in full-term pregnancy. Sex Reprod Healthc. 2012;3(3):113–6. doi:10.1016/j.srhc.2012.06.001.View ArticlePubMedGoogle Scholar
- Hijazi ZR, East CE. Factors affecting maternal perception of fetal movement. Obstet Gynecol Surv. 2009;64(7):489–97. doi:10.1097/OGX.0b013e3181a8237a. quiz 99.View ArticlePubMedGoogle Scholar
- Ahn MO, Phelan JP, Smith CV, Jacobs N, Rutherford SE. Antepartum fetal surveillance in the patient with decreased fetal movement. Am J Obstet Gynecol. 1987;157(4 Pt 1):860–4.View ArticlePubMedGoogle Scholar
- Fisher ML. Reduced fetal movements: a research-based project. Br J Midwifery. 1999;7:733–7.View ArticleGoogle Scholar
- Fried AM. Distribution of the bulk of the normal placenta. Review and classification of 800 cases by ultrasonography. Am J Obstet Gynecol. 1978;132(6):675–80.View ArticlePubMedGoogle Scholar
- Mohr Sasson A, Tsur A, Kalter A, Weissmann Brenner A, Gindes L, Weisz B. Reduced fetal movement: factors affecting maternal perception. J Matern Fetal Neonatal Med. 2015:1–4. doi:10.3109/14767058.2015.1047335.
- Johnson TR. Maternal perception and Doppler detection of fetal movement. Clin Perinatol. 1994;21(4):765–77.PubMedGoogle Scholar
- Saastad E, Ahlborg T, Froen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health. 2008;53(4):345–52. doi:10.1016/j.jmwh.2008.03.001.View ArticlePubMedGoogle Scholar
- Linde A, Pettersson K, Radestad I. Women’s experiences of fetal movements before the confirmation of fetal death--contractions misinterpreted as fetal movement. Birth. 2015;42(2):189–94. doi:10.1111/birt.12151.View ArticlePubMedGoogle Scholar
- Malterud K. Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract. 1993;10(2):201–6.View ArticlePubMedGoogle Scholar
- Malterud K. Kvalitativa metoder i medicinsk forskning. 3rd ed. Lund: Studentlitteratur; 2014.Google Scholar
- Sheikh M, Hantoushzadeh S, Shariat M. Maternal perception of decreased fetal movements from maternal and fetal perspectives, a cohort study. BMC Pregnancy Childbirth. 2014;14:286. doi:10.1186/1471-2393-14-286.View ArticlePubMedPubMed CentralGoogle Scholar
- Scala C, Bhide A, Familiari A, Pagani G, Khalil A, Papageorghiou A, et al. Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome. Am J Obstet Gynecol. 2015. doi:10.1016/j.ajog.2015.07.015.
- Jensen A, Garnier Y, Berger R. Dynamics of fetal circulatory responses to hypoxia and asphyxia. Eur J Obstet Gynecol Reprod Biol. 1999;84(2):155–72.View ArticlePubMedGoogle Scholar
- SFOG. In: Lars-Åke M, editor. Mödrahälsovård, Sexuell och Reproduktiv Hälsa. Stockholm: Svensk Förening för Obstetrik och Gynekologi; 2008. p. 52.Google Scholar
- McArdle A, Flenady V, Toohill J, Gamble J, Creedy D. How pregnant women learn about foetal movements: sources and preferences for information. Women Birth. 2015;28(1):54–9. doi:10.1016/j.wombi.2014.10.002.View ArticlePubMedGoogle Scholar
- Froen JF, Arnestad M, Frey K, Vege A, Saugstad OD, Stray-Pedersen B. Risk factors for sudden intrauterine unexplained death: epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol. 2001;184(4):694–702.View ArticlePubMedGoogle Scholar
- Grant A, Elbourne D, Valentin L, Alexander S. Routine formal fetal movement counting and risk of antepartum late death in normally formed singletons. Lancet. 1989;2(8659):345–9.View ArticlePubMedGoogle Scholar
- Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011;377(9774):1331–40. doi:10.1016/S0140-6736(10)62233-7.View ArticlePubMedGoogle Scholar