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Background: Somalia is one of 13 countries in Africa with stillbirth rates of more than 30 per 1000 total birth. To our knowledge no study in Somaliland has focused on the mother-baby dyad regarding risk factors for stillbirth. The objective of this study was to identify frequency, causes and beliefs for stillbirth in mothers with life threatening conditions as a pilot for a potential nationwide near-miss study with full coverage in the Somaliland health care system.Method: A prospective cross sectional study using the WHO near-miss questionnaire in a tertiary level hospital with 1.385 deliveries during a five months period in 2015.Results: Out of 138 near miss and death events 22% (n=30) had a stillbirth. Seventy-seven percent (77%) of the mothers (n=23) with stillborn babies survived and 23% died (n=7). They were diagnosed with life threatening conditions, possible to prevent, on arrival at the tertiary hospital. None of them developed the maternal complication/s during the hospital stay. Cesarean sections (43%) were performed within three hours after arrival. Beliefs regarding the stillbirth for the near miss women were that holding the baby born death helps them cope with the loss (74%) and that religious believes helps them cope faster with the loss (91%).Conclusion and clinical implications: The near miss women, their families, TBAs and SBAs might need better information of what causes a stillbirth, how they could prevent it and about the near miss women’s beliefs surrounding stillbirth to enable them to communicate this to pregnant women and prevent delay in admission to the tertiary level hospital. Furthermore, this pilot study suggest that the “Near Miss Questionnaire” could be used in low-and middle income settings to detect a full picture of the situation with stillbirth in a country.

Background: Low maternal awareness of fetal movements is associated with negative birth outcomes. Knowledge regarding pregnant women’s compliance with programs of systematic self-assessment of fetal movements is needed.

Aim: To study women’s experiences using two different self-assessment methods for monitoring fetal movements and to determine if the women had a preference for one or the other method.

Methods: Data were collected by a crossover trial. 40 healthy women with an uncomplicated full-term pregnancy counted the fetal movements according to a Count-to-ten method and assessed the character of the movements according to the Mindfetalness method. Each self-assessment was observed by a midwife and followed by a questionnaire. A total of 80 self-assessments was performed; 40 with each method.

Results: One of the 40 participants did not find at least one method for monitoring fetal movements suitable. Twenty of the total of 39 reported a preference, fifteen of the 39 participants reported a preference for the Mindfetalness method and five for the Count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby. They said they felt calm, relaxed, and mentally present and focused during the observations.

Conclusions: In the 80 assessments all but one of the women found one or both methods suitable for self-assessment of fetal movements and they felt comfortable during the assessments. More women preferred the Mindfetalness method compared to the Count-to-ten method.

Clinical implications: For women who prefer systematic self-assessment methods of their unborn baby’s movements, both Count-to-ten and Mindfetalness can be presented as options. However, the methods need to be better evaluated concerning their potential to prevent pre-hospital delay when the unborn baby’s health is at stake before they can be implemented in antenatal care as a routine.

OBJECTIVE: To investigate the association between the magnitude of foetal movements and level of prenatal attachment within a 24h period among women in the third trimester of pregnancy.

DESIGN: a prospective population-based survey.

SETTING: A county in central Sweden.

PARTICIPANTS: Low risk pregnant women from 34 to 42 weeks gestation, N=456, 299 multiparous and 157 primiparous women.

MEASUREMENTS: The revised version of the Prenatal Attachment Inventory (PAI-R) and assessment of the perception of foetal movements per 24h in the current gestational week.

FINDINGS: A total of 81 per cent of the eligible women completed the questionnaire. The overall sample of women found that the majority (96%) felt their baby move mostly in the evening. More than half of the respondents (55%) stated that they perceived frequent foetal movement on two occasions during a 24h period, while almost a fifth (18%) never or only once reported frequent foetal movement in a 24h period. Just over a quarter (26%) of respondents perceived frequent movement at least three times during a 24h period. Perceiving frequent foetal movements on three or more occasions during a 24h period, was associated with higher scores of prenatal attachment in all the three subscales.

KEY CONCLUSION: Perceiving frequent foetal movements at least during three occasions per 24h periods in late pregnancy was associated with prenatal attachment.

IMPLICATIONS FOR PRACTICE: encouraging women to focus on foetal movements may positively affect prenatal attachment, especially among multiparous women >35 years.

Objective: To study women’s description of fetal movements in full-term pregnancy. Further to investigate if their descriptions could be sorted with regard to intensity and type of movements, using a matrix under development to be a tool for evaluating fetal movements in clinical praxis.

Methods: Data were collected by distributing questionnaires including an open question: “Please describe your perception of the baby’s movements during this gestational week.” A matrix listed seven categories of movements divided into powerful and non-powerful movements, was used for the content analysis.

Results: 393 (78%) women responded to the open question. The movements were split into two domains: Powerful movements and Non-powerful movements. Altogether, 383 (96%) women perceived fetal movements that were sorted as powerful movement: firm, slow stretching, large and side to side. Ten (4%) women described movements exclusively, i.e. movements that did not include any of the movements in the powerful domain. Most women perceived movements that corresponded to more than one type of category, and all movements described by the women could be referred to at least one of the categories in the matrix.

Conclusion: The matrix was useful for identification of the women’s perceptions of fetal movements in full-term pregnancy. Further studies are needed in order to develop the tool and its potential to evaluate the well-being of the fetus before it is to be used in clinical praxis.

Background: Low maternal awareness of fetal movements is associated with negative birth outcomes. Knowledge regarding pregnant women's compliance with programs of systematic self-assessment of fetal movements is needed. The aim of this study was to investigate women's experiences using two different self-assessment methods for monitoring fetal movements and to determine if the women had a preference for one or the other method.

Methods: Data were collected by a crossover trial; 40 healthy women with an uncomplicated full-term pregnancy counted the fetal movements according to a Count-to-ten method and assessed the character of the movements according to the Mindfetalness method. Each self-assessment was observed by a midwife and followed by a questionnaire. A total of 80 self-assessments was performed; 40 with each method.

Results: Of the 40 women, only one did not find at least one method suitable. Twenty of the total of 39 reported a preference, 15 for the Mindfetalness method and five for the Count-to-ten method. All 39 said they felt calm, relaxed, mentally present and focused during the observations. Furthermore, the women described the observation of the movements as safe and reassuring and a moment for communication with their unborn baby.

Conclusions: In the 80 assessments all but one of the women found one or both methods suitable for self-assessment of fetal movements and they felt comfortable during the assessments. More women preferred the Mindfetalness method compared to the count-to-ten method, than vice versa.

When a baby has died during pregnancy, the first encounter between mother and child occurs when the baby is already dead. Despair, emptiness, and grief characterize the encounter, which is also a gradual farewell to the child and the planned future for the family. This study describes mothers' experiences of the farewell of their stillborn baby at discharge from hospital. Twenty-three mothers from different parts of Sweden, who suffered stillbirth, were interviewed. Semi-structured questions were used and the replies were analyzed using content analysis. The mothers describe the separation from the child when leaving hospital as unnatural and that the separation ruins the motherhood they felt during pregnancy. Five categories were identified: unnatural to leave the baby; going home empty-handed; access to the child; security and insecurity in the separation; to let go. The overarching theme that we recognized from these responses we have formulated as: You don't leave your baby. Leaving the baby at the hospital goes against the biological instinct to care for and protect the offspring. Routines for a dignified goodbye including designating a deputy guardian into whose arms the mother can place the baby can help to facilitate the separation. The possibility of leaving the baby in the arms of someone known to the parents should be an option for parents who choose to take farewell of the child at the hospital. The place and time for the farewell should be decided on by the parents, taking the baby home for a personal farewell could be an alternative.

Objective: To explore mothers' experiences of the confirmation of ultrasound examination results and how they were told that their baby had died in-utero.

Design: In-depth interviews.SettingSweden.

Participants: 26 mothers of stillborn babies.

Measurement: Narratives were analysed using a qualitative content analysis with an inductive approach.

Findings: The mothers experienced that silence prevailed during the entire process of confirming the ultrasound results. Typically all present in the ultrasound room were concentrating and focusing on what they observed on the screen, no one spoke to the mother. The mothers had an instinctive feeling that their baby might be dead based on what they observed on the ultrasound screen and on their interpretation of the body language of the clinicians and midwives. Some mothers reported a time delay in receiving information about their baby's death. Experiencing uncertainty about the information received was also noticed.

Conclusion: Mothers emphasised an awareness of silence and feelings of being completely alone while being told of the baby's death.Implication for practicethe prevalence of silence during an ultrasound examination may in certain cases cause further psychological trauma for the mother of a stillborn baby. One way to move forward given these results may be to provide obstetric personnel sufficient training on how difficult information might be more effectively and sensitively provided in the face of an adverse pregnancy outcome.

Bakgrund: Det finns begränsad kunskap om hur kvinnor upplever fosterrörelser i slutet av graviditeten. Ökad kunskap om fosterrörelser kan bidra till bättre möjligheter att identifiera foster som riskerar att dö intrauterint. Syfte: Att utforska hur gravida kvinnor upplever fosterrörelser i slutet av en okomplicerad graviditet samt hur mammor som mist ett barn i livmodern upplevt kontakten med barnet tiden före beskedet att barnet hade dött. Metod: Delstudie I, djupintervjuer med 26 mammor vars barn dött före födelsen, efter 28 fullgångna graviditetsveckor. Delstudie II, frågeformulär till 393 kvinnor med okomplicerad graviditet som besvarades i graviditetsvecka 37 till 42. Svaren analyserades i båda studierna med kvalitativ innehållsanalys. Resultat: 22 mammor i delstudie I beskrev att de hade haft en föraning om att något kunde ha hänt deras barn innan de fick besked att barnet dött intrauterint. Föraningen grundades på att mammorna hade upplevt minskade eller uteblivna fosterrörelser. Det är något som inte stämmer; formulerades som ett sammanfattande tema på mammornas föraning. Processen mot insikten om att deras barn dött beskrivs i olika steg; Inte känna kontakt med barnet; Känna oro; Känna att något är fel; Inte begripa det ofattbara; Vilja få besked; Vara säker på att barnet har dött. I delstudie II beskrev 383 (96 %) kvinnor i fullgången okomplicerad graviditet olika rörelser som klassificerades som kraftfulla rörelser. De flesta kvinnorna beskrev flera typer av rörelser, tio (4 %) kvinnor beskrev fosterrörelser som inte inkluderade någon rörelse i kategorin kraftfulla rörelser. Konklusion: Mammor som mist sitt barn före födelsen hade känt en föraning om att deras väntade barn kunde må dåligt, de hade upplevt att de tappat kontakten med barnet innan de fick besked att barnet hade dött i livmodern men normaliserade känslan. De flesta kvinnor med okomplicerad, fullgången graviditet, beskriver att barnet rör sig med kraft och tryck, få kvinnor beskriver rörelser som inte kan kategoriseras som kraftfulla. Implikationer: Blivande mammor bör uppmanas att lita på sin upplevelse av att det är något som inte stämmer och kontakta sjukvården direkt om de är bekymrade över sitt ofödda barns rörelser. Bedömning av fosterrörelser i fullgången graviditet kan inkludera: förekomst, frekvens och intensitet.

Nyckelord: Innehållsanalys, fosterdöd, fosterrörelser, fullgången graviditet, upplevelser

Bakgrund: I en tidigare genomför intervjustudie beskrev 40 kvinnor med okomplicerad graviditet hur de upplevde fostrets rörelser i slutet av graviditeten.  Starka rörelser delades in i kategorierna: kraftfulla-; stora-; långsamma-; stretchande rörelser samt rörelser då barnet rörde sig från sida till sida. Icke kraftfulla rörelser, delades in lätta och ryckiga rörelser. För att undersöka om denna kategorisering kunde användas i en större population, testades kategorierna i föreliggande studie.

Syfte: Att studera kvinnors upplevelse av fosterrörelser i fullgången graviditet och om rörelserna som beskrevs kunde kategoriseras utifrån intensitet och typ av rörelse med hjälp av en matris som utvecklats i en förstudie.  Metod: Samtliga kvinnor i fullgången graviditet som ingick i mödrahälsovårdens basprogram under perioden 1 mars 2011 till 31 oktober 2011 i ett mellansvenskt län, inbjöds till deltagande i studien. Data samlades in genom att distribuera enkäter som innehöll en öppen fråga: " Beskriv hur du uppfattar att ditt barns rörelser vanligtvis varit under den nuvarande graviditetsveckan”. Analysen genomfördes med innehållsanalys och en matris med sju definierade kategorier av rörelser indelade i två domäner: kraftfulla rörelser och icke-kraftfulla rörelser. Resultat: 393 (78 %) kvinnor svarade på den öppna frågan. Sammanlagt 383 (96 %) kvinnor beskrev fosterrörelser som sorterades som kraftfulla, långsamma, stretching, stora och rörelser från sida till sida. Tio (4 %) kvinnor beskrev endast lätta och ryckiga rörelser det vill säga rörelser som inte kunde sorteras till någon av rörelserna i den kraftfulla domänen. De flesta kvinnor beskrev rörelser som motsvarade fler än en typ av rörelser och alla rörelser relaterade till minst en av kategorierna i matrisen. Slutsats: Matrisen var användbart för att sortera fostrets rörelser såsom de beskrevs av kvinnorna i fullgången graviditet. Ytterligare studier behövs för att utveckla hjälpmedlet och för att undersöka dess möjlighet att utvärdera fostrets välbefinnande.

Background: Decreased and weak fetal movements in late pregnancy are associated with adverse neonatal outcomes. Enhanced knowledge about the women’s perception of the movement may improve the possibilities for identifying fetuses at risk.  It has previously been established that there is a risk for stillbirth if fetal movements are reduced or weak. It has also been generally understood that frequent and strong fetal movements during the last three months of pregnancy are signs of satisfactory health of the fetus.  Since observation of fetal movement depends on the mother’s perception, it is important to study these perceptions more carefully.  Objective: To investigate the perceptions of fetal movements among women in full term pregnancy. Design: A population- based study. Setting: All antenatal clinics in one of the counties in Sweden March 1, 2011 to October 31, 2011. Population: Altogether 505 pregnant women were eligible and fulfilled the inclusion criteria for this study.  Methods: Data were collected by distributing questionnaires including an open question: “Please describe your perception of the baby´s movements during this gestational week” to be answered in writing.  A protocol, listing seven types of movements was used for the content analysis. Main outcome measures: Perception of fetal movements among women in full term singleton pregnancy. Results: 393 (79%) women responded to the open question. Altogether, 383 (96%) women perceived five different types of fetal movements that were sorted as powerful: strong (78%), (24%), stretching (23%), from side to side (18%), and large (18%). Most women described movements that corresponded to more than one type of movement. Fifty three (13%) women also described light movements and seven (2%) startled movements, categorized as non-powerful. Only ten (4%) women described movements that did not include any of the movements in the powerful category. Conclusion: In full-term pregnancy, fetal movements are usually recognized as powerful.