Beyond the headlines: fetal movement awareness is an important stillbirth prevention strategy

Stillbirth is a global public health issue affecting over 2.6 million women at or beyond 28 weeks’ gestation each year.1 Raising awareness of decreased or reduced fetal movements (RFM) among pregnant women and clinicians is one existing strategy intended to reduce risk of stillbirth.2, 3, 4 RFM is strongly linked to stillbirth,4 yet suboptimal care for women with RFM is a commonly reported contributing factor to stillbirth.5, 6 Women frequently report that clinicians have not listened to their concerns about RFM and many delay reporting.4, 7 Misinformation about fetal movements is commonplace. For example, women are often told that RFM at term is to be expected due to the baby ‘running out of room’ or that RFM can be corrected by the woman drinking a glass of water. Such information can delay presentation with RFM. Reducing delayed presentation for RFM may increase the window of opportunity for meaningful assessment and intervention. Practice improvement initiatives aimed at raising awareness of RFM are widely accepted as an important prevention strategy for stillbirth.7 The recent AFFIRM trial results show that a package of care targeting women and clinicians did not reduce stillbirth rates, and increased interventions and neonatal admissions.8 The title of the editorial ‘encouraging awareness of fetal movement is harmful' does not accurately reflect the AFFIRM trial findings.9 It is important to look beyond the headlines and try to understand what this well-conducted trial is telling us in this complex area.