Could fetal movement ‘initiatives’ cause harm?
Surprisingly, the incidence of RFM presentations is largely unreported4,5. Yet the ‘performance’ of a risk factor is related
not just to sensitivity but to its specificity. In 2021 Turner1 reported an increase in presentations from 4% of
total births to 18% over a ten-year period in Australia. Bhatia et al
in 2019 7 reported a figure of 22.6% in the UK, with
nearly half of women presenting more than once. Oxford data
(unpublished) now suggest a figure of 40%. This massive increase almost
makes RFMs a ‘new normal’. The consequent ‘emergency’ assessment
requires considerable resource: yet this and staff shortages are
repeatedly cited as contributory to adverse outcomes. Intervention,
induction and caesarean section, also increased 1,4,6,
further contribute to this. In the UK, where an offer of induction from
39 weeks is mandated for recurrent episodes (with financial penalties),
indications such as pre-eclampsia and postdates pregnancy with a better
evidence base and probably greater individual risk, ‘compete with’ RFMs
for induction on busy labour wards.
One common recommendation 4 is ultrasound. This can
determine if movements are occurring and if these are perceived. Whilst
identification of FGR may occur, an apparently normally grown baby may
still be very unwell, from anaemia or even FGR. A false sense of
reassurance could follow.
There are also direct consequences. Infant mortality11, cerebral palsy and special educational needs are
increased after even early term birth. The AFFIRM trial4 recommended induction at 37 weeks in some
circumstances and reported a possible increase in death up to one year
and longer neonatal unit admission (aOR 1.12; 1.06-1.18). Maternal
anxiety is not consistently reported in trials 4.
Although most studies report no worsening of psychological outcomes, it
would be disingenuous to suggest that the high rate of presentation is
not a manifestation of anxiety.