Management of abnormal maternal perception of fetal movements
During pregnancy, women said they would eat, rest, massage the abdomen and wait if they get worried about the way their baby was moving. For how long they would wait before seeking health care differed from a few hours (22.2%, n=4), to more than 24 hours (44,4%, n=8) or up to two weeks (27.8%, n=5). All women who said they would present within a few hours had received health education in peripheral ANC clinics. Twenty-two percent (n=4) of the ANC women mentioned they had a history of seeking medical help because of abnormal FMs and wanted a fetal ultrasound. One woman in the ANC said she went to a midwife in her community for an abdominal massage.
When the baby will stop moving or I’m worried about it, I will not directly come to the hospital. First, I will wait and see what the situation is. If it’s still not moving after 2 days, I will come to the hospital. I’m afraid to directly come to the hospital because maybe I will get shocking information or they will send me home because it was nothing. I prefer to wait and see.’ (Antenatal)
Asking for advice from relatives, their husband, friends or neighbors in case of worrisome FMs was mentioned by 10/18 (55,6%) of women in the ANC.
I was concerned on admission, but actually 3 days before already, my baby had stopped moving. I asked my neighbor about this, she told me it was normal for the baby to stop moving towards term. So, I didn’t worry that much. I also asked my mom whether it was normal for the baby to stop, but she didn’t remember it anymore because it was too long ago she was pregnant herself. She could not advise me on this.’ (Postpartum, delivered a stillborn baby)
Midwives stated that they will first assess a mother’s mental, physical and social health and lifestyle because these all can contribute to abnormal FMs. All health providers stated they advise women to stimulate their baby with various means in case of absence of FMs: to exercise, drink cold water, eat something (sweet), change position or rest. Moreover, the staff unanimously responded that women should go to nearby clinic or hospital ‘immediately’ or ‘as soon as possible ’, ‘even during the night ’ in case of worrisome changes in FMs.
You can save a baby or lose a baby in 1 hour, so why waste any time? Why wait?’  (Healthcare provider)
Management of decreased or absent FMs at the clinic or hospital consisted of auscultation of fetal heart rate (FHR) and performing fetal ultrasound. Nurse-midwives commonly evaluated the mother and fetus to rule out problems and reassure mothers while registrars doctors usually suspected intrauterine fetal death. Women were advised and reassured if fetal viability was confirmed or they proceeded to further management in case of a intrauterine death or other complications.
First, I will ask the mother what happened before I can think of what caused the changes in FMs. Then we do an ultrasound and advise the mother to change position, especially if the ultrasound is normal. If it is abnormal we have to take action accordingly.’  (Healthcare provider)
'When a woman for example comes to the hospital in the evening and complains about reduced fetal movements or that the movements have been absent for a couple of hours: you check FHR and you confirm [fetal] death.’  (Healthcare provider)
‘…we check FHR and if it’s there and there are no other danger signs, we tell her to come back in 2 weeks…. Why not observe her here if there’s any change in fetal movements?’   (Healthcare provider)