VIEWS AND EXPERIENCES OF PREGNANT WOMEN, PARTNERS, AND CLINICIANS OF REDUCED FETAL MOVEMENTS: A GROUNDED THEORY STUDY IN ZIMBABWE

Abstract

ABSTRACT Background and aim Globally there are two million stillbirths annually, 98 % of which occur in low-income settings (LICs). Although the majority of data exist in high-income countries (HICs). Stillbirth may be associated with the maternal perception of reduced fetal movements (RFM) in LICs. However, little is known about maternal experiences of RFM and subsequent engagement with health services in LICs. Zimbabwe has a high stillbirth rate of 21/1 000 births. The study aimed to explore views and experiences of pregnant women, partners, and clinicians of RFM in Zimbabwe, and to develop a theory to influence practice, education, policy, and research in maternity care. Methodology and methods A qualitative study informed by the constructivist grounded theory methodology was conducted. Data were collected using in-depth interviews from fifteen women, three partners, and ten clinicians. A total of ten non-participant observations were conducted through observing clinicians as they attended to women and partners. Data analysis followed the constant comparative analysis by Charmaz. Results Three major categories were found. The first category, ‘Fetal movements as a unique experience’ comprised three subcategories, ‘Communicating through fetal movements’ ‘Learning individual normal patterns and recognising abnormal patterns’, and ‘Catalyst to family bonding’. The second category, ‘Factors that impact on RFM’ comprised two subcategories, ‘Socio-cultural factors’ and ‘Knowledge of RFM’. The third category, ‘Support rendered for RFM’ comprised two subcategories, ‘Inconsistent health care’ and ‘Influence of family support’. The Core category ‘Being interactive’ underpinned the three major categories. The grounded theory combined elements of the Health Belief Model and Ecological Systems model to help understand the women’s health-seeking behaviour for RFM. Conclusion RFM is a concerning symptom and needs to be treated promptly. Women need to be encouraged to listen to their instincts when perceiving RFM and to seek health care early to avoid unnecessary delays. In Zimbabwe, there is a need for formulating national and local practice guidelines to standardise care for women to avoid management inconsistencies. The Ministry of Health and Child Care should institute a policy for immediate investigating and management of a woman with RFM to reduce perinatal mortality and morbidity. Further qualitative research should be conducted in various high and low-resource maternity settings to substantiate the findings. Keywords Women; Partners; Clinicians; Reduced Fetal Movements; Grounded Theory; Qualitative Research.

Date of Award	31 Dec 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Alexander Heazell (Supervisor), Tina Lavender (Supervisor) & Rebecca Smyth (Supervisor)