Randomised trials and ‘impact’ studies have assessed either self-monitoring or clinical advice for management of RFM, or both. The impact studies of combined packages of awareness and intervention are complex, but benefits have been concluded. However, the most recent and therefore applicable, with 8821 women with RFMs, reported no reduction in perinatal mortality ¹. Indeed, excluding the pregnancies where RFMs was the presentation of stillbirth, they reported no increased risk of stillbirth with RFMs.

The interventions in recent trials, Saastad et al ²and the Swedish Mindfulness trial ³ encouraged self-monitoring only. By contrast, both this and a clinical ‘package’ were implemented in the UK AFFIRM study ⁴ and the Australasian My Babies Movements ⁵, stepped wedge cluster randomised trials of over 400 000 and nearly 300 000 participants respectively. None of these trials reported reduced perinatal mortality. Systematic review and metanalysis⁶ including smaller trials (but not the Australasian study), reported a possible reduction in stillbirth (RR 0.92; 0.85-1.00), but increased intervention rates. But any policy, which increases intervention to expedite birth at or near term should reduce perinatal mortality: routine induction of labour from 37 weeks does just that (RR 0.31; 0.15 -0.64).

Of course, these trials did not compare fetal movement monitoring with advice to ignore movements: ‘usual care’ increasingly constitutes a relatively high awareness of RFMs. But the evidence suggests that, barring when RFMs is the actual presentation of stillbirth, RFMs constitute a minor risk factor when compared, say, to other established risk factors such as reaching 42 or even 41 weeks.