The effect of formal fetal movement counting on maternal psychological outcomes: A systematic review and meta-analysis

Abstract

INTRODUCTION Formally counting fetal movements in pregnancy is one of the oldest methods to assess fetal well-being. Although not routinely recommended in contemporary maternity care, due to a lack of evidence of its effectiveness, formal fetal movement counting is still practiced in many birth settings. Requesting women to formally count their fetal movements in a structured, objective way that can potentially improve maternal subjective outcomes such as worry or concern. The aim of this study was to evaluate the effect of formal fetal movement counting versus no formal counting, on maternal worry, concern or anxiety, and maternal-fetal attachment (MFA). Secondary outcomes were compliance with the intervention (counting method) and hospital admission/attendance for fetal activity concerns. METHODS CINAHL, MEDLINE and EMBASE were searched systematically for eligible studies from inception dates to June 2020, supplemented by searches of trial databases, grey literature and the reference lists of included studies. Randomized controlled and quasi-randomized trials were included in the review. RESULTS Nine studies reported across 15 publications were included involving 70824 pregnant women. The results showed that MFA levels were significantly higher in women who formally counted fetal movements than those who did not (standardized mean difference=0.72; 95% CI: 0.10-1.33, five studies, 1565 women). There were no differences between the groups in maternal anxiety or worry/concern outcomes. Attendance or admission rates for reduced fetal movements, or concern for fetal activity, did not differ between the groups (OR=1.36; 95% CI: 0.97-1.91, three studies, 1947 women). Compliance in completing fetal movement charts varied, ranging 45-90%, although definitions of compliance differed across studies, which may have affected rates. CONCLUSIONS This review has found that formal fetal movement counting in pregnancy has no detrimental effects on maternal psychological or emotional status and positively affects maternal-fetal attachment. Although current evidence does not support the use of formal fetal movement counting for improving perinatal outcomes, such as stillbirth and neonatal death, the results of this review are helpful for clinicians in discussing fetal movements in pregnancy and in discussing the optional methods available to women who may be advised to or choose to objectively assess fetal movements using a formal fetal movement counting method.

F-KiCo (Fetal-Kick Count) Innovation Needs Analysis for Monitoring Fetal Well-Being and Maternal-Fetal Attachment

“…The movement of the fetus that is felt gives the mother confidence that the fetus exists and is alive, will instinctively stimulate the mother to move, stroke, talk so that the fetus responds with further movements. This maternal-fetal emotional connection has a positive impact on the uteroplacental circulation so that the fetus is maintained healthy (Delaram et al, 2018;AlAmri & Smith, 2022). The results of a study were also reported which stated that counting fetal movements affects the attitudes and actions of mothers who pay more attention to the fetus which has an impact on the development of the fetus to the baby (Yani et al, 2021).…”

“…Pregnancy is an important situation in a mother's life that requires physiological and psychological adaptation. Pregnancy adaptation is an important basis for the mother to build a relationship with the fetus during pregnancy (AlAmri & Smith, 2022;Berthelot et al, 2020). Maternal-Fetal Attachment (MFA) is a bond of attachment between mother and baby with love and affection, plays an important role in the health of the mother and fetus and influences the mother's decision to behave healthily during pregnancy, this was revealed in research (Wahyuntari & Puspitasari, 2021;Purwati et al, 2023).…”

“…Fetal movements can be felt by the mother as a result of pressure behind the abdominal wall by the movement of the fetal limbs. These movements can be felt from the 20th week of gestation, getting clearer and stronger with advancing gestation (Güney & Uçar, 2019;AlAmri & Smith, 2022). Fetal movement was measured using the Cardiff Count of Ten technique, namely the fetus is said to be healthy and prosperous showing 10 series of movements in less than 12 hours.…”

“…Fetal movement was measured using the Cardiff Count of Ten technique, namely the fetus is said to be healthy and prosperous showing 10 series of movements in less than 12 hours. If less than 10 sets of movements last more than 12 hours, there is a risk to fetal well-being (AlAmri & Smith, 2022;Paiss et al, 2023). Decreased fetal movement as a sign of fetal health problems, initiated by a lack of placental perfusion originating from oxygenation of the mother, causing hypoxia.…”