FETAL MOVEMENT COUNTING
Condition: the Effect of Fetal Movement Count on Prenatal Attachment and Pregnancy Distress
Study type: Interventional

Summary: 
      Purpose: This study aimed to determine the effect of fetal movement counting on prenatal
      maternal attachment and distress in pregnancy.

      Methods: This is a quasi-experimental study. The population of the study consisted of of 60
      primigravida pregnant women (30 experimental and 30 control groups) being in 28 to 32 weeks
      gestation. The Prenatal Attachment Inventory (PAI) and the Tilburg Pregnancy Distress Scale
      (TPDS) used for data collection. After the pre-tests (28 to 32 weeks gestation), the
      experimental group were trained about fetal movement counting. The experimental group
      performed fetal movement counting for at least four to six weeks. The post-tests were filled
      in 32 to 38 weeks gestation. The control group received only pre-tests and post-test in the
      same weeks gestation with the experimental group.
    

Detailed description: 
      This is a quasi-experimental study.

      The population of the study consisted of pregnant women followed in a State Hospital in the
      capital city of Turkey in 2019. Power analysis (Sample error: 0.01 and power: 95%) was
      performed to determine the sample size of the study. In the power analysis, the mean score of
      the Prenatal Attachment Inventory was 71.88 ± 8.25 [15] and the mean score of the Tilburg
      Pregnancy Distress Scale was 18.86 ± 7.37 [16]. The minimum number of participants required
      for each group was 24 (α = 0.05, 1-β = 0.80). To increase the reliability and validity of the
      study, the study sample consisted of 60 pregnant women (30 experimental and 30 control
      groups). The criteria for inclusion in the research sample were; being in 28 to 32 weeks
      gestation, primigravity, being at least literate, not having any chronic or psychiatric
      disease, not having any communication disability (speech, hearing, mental), non-risky
      pregnancy (preeclampsia, gestational diabetes, advanced age, and adolescent pregnancy, etc.),
      current or recent pregnancy is identified as not having any significant life difficulties
      (loss, illness, accident, etc.). The experimental and control groups were matched to be
      similar in terms of age, education and working status parameters.

      Data Collection Instruments:

      Research data were collected using the Descriptive Information Form, the Prenatal Attachment
      Inventory (PAI), the Tilburg Pregnancy Distress Scale (TPDS) and the Fetal Movement
      Monitoring Card.

      In the Descriptive Information Form, there are five questions including the socio-demographic
      informations of the pregnant women (age, education status, working status, and perceived
      income) and the gestational week.

      The PAI was developed by Mary Muller (1993) to explain the feelings, thoughts, and situations
      of women during pregnancy and to determine their attachment levels to the baby in the
      prenatal period [17]. The scale consists of 21 items in total. In the 4-point Likert scale,
      each item can score between 1 and 4 points (1: Never, 2: Sometimes, 3: Frequent, 4: Always).
      The highest score of the scale is 84, the lowest score is 21, and the high scale score
      indicates the high level of prenatal attachment. The Turkish reliability and validity study
      of the scale was conducted by Duyan et al. (2013) and the Cronbach Alpha reliability
      coefficient was found to be 0.78 [18]. In our study, Cronbach Alpha reliability coefficients
      were; pre-test: 0.851, post-test: 0.811 in the experimental group; pre-test: 0.863,
      post-test: 0.865 in control group.

      The TPDS is developed by Pop et al. (2011) for the diagnosis of distress in pregnancy [11].
      The scale consists of a total of 16 items. The scale has two subscales. Negative Affect
      subscale consists of 12 items including fear, anxiety and negative perceptions regarding
      pregnancy, childbirth and the postpartum period. Partner Involvement subscale consists of 4
      items related to spousal support during pregnancy. The scale is a four-point Likert type and
      each item is scored between 1 and 3 (0: very often, 1: quite often, 2: sometimes, and 3:
      rarely or never). The points 3.5,6,7,9,10,11,12,13,14 and 16 are interpreted by reversing
      them. The highest score of the scale is 48 and the lowest score is 0. A high score from the
      scale indicates that pregnant women are at risk for distress. The Turkish
      validity-reliability study of the scale was conducted by Çapık and Pasinlioğlu (2015) and the
      Cronbach Alpha reliability coefficient was found to be 0.83 [19]. In our study, the
      Cronbach's alpha reliability coefficient of the scale was 0.836 in the experimental group and
      0.826 in the post-test; the control group's pre-test was 0.731 and the post-test was 0.793.

      The Fetal Movement Monitoring Card was prepared by the researchers. The card contains
      instructions on the importance of fetal movement counting and information on how to perform
      the counting. The card also includes a chart to monitor the fetal movement counting process
      performed by pregnant women and record the fetal movement counting process and how many
      movements are counted to check whether the researcher fulfilled the research conditions of
      the pregnant women.

      Procedure:

      Ethics committee approval and hospital permissions were obtained for the study. The
      application was carried out in the pregnant education class of the hospital between
      01.11.2018-18.02.2019. It was determined that the pregnant women who participated in the
      pregnant education class met the research criteria. Written consent was obtained after the
      pregnant women who met the criteria were informed about the study. The pregnant women were
      assigned to the experimental and control groups by the researcher. At this stage of the
      study, all data collection forms were filled out for pregnant women. The forms were completed
      by the pregnant women themselves in a comfortable environment in a quiet part of the pregnant
      education class.

      Control Group:

      When the pregnant women in the control group came to the hospital for follow-up (in 32 to 38
      weeks gestation), they were invited to the pregnant education class and the PAI and the TPDS
      was refilled.

      Experimental Group:

      After completing the data collection tools, pregnant women were trained about fetal movements
      and fetal movement counting was taught. The training was given verbally. Pregnant women were
      asked to perform ten fetal movements by counting once a day after any meal, lying in the left
      side position for one hour. When ten fetal movements could not be reached within the first
      hour, pregnant women were instructed to count the fetal movements for one hour after walking
      for five minutes. When ten fetal movement counts could not be obtained at the end of two
      hours, they were asked to apply to the hospital immediately. Pregnant women were expected to
      perform fetal movement counting after the same meal every day (breakfast, lunch or dinner)
      and record the start and end times of the ten movements on the Fetal Movement Monitoring
      Card.

      In the application of the study, it was ensured that the pregnant women in the experimental
      group performed fetal movement counting for at least four to six weeks. In this context,
      pregnant women were called every week to monitor and to motivate them to continue the
      counting. It was planned to exclude the pregnant women who were informed that they had not
      performed the application for four consecutive days, withdrew from the study voluntarily, who
      could not be followed up by telephone, who had significant life distress (death, illness,
      divorce, accident, etc.), who developed complications in their pregnancy or was diagnosed
      with risky pregnancy. In this context, one pregnant was excluded from the sample because she
      gave birth prematurely and two pregnant women did not answer the phone. New pregnant women
      who met the criteria were included in the sample instead of the pregnant women outside the
      sample.

      When the pregnant women came to the hospital for follow-up (in 32 to 38 weeks gestation),
      they were invited to the pregnant education class. After confirming that the women had
      performed the application by checking the Fetal Movement Monitoring Cards, the API and the
      TPDS were refilled.
    

Intervention name(s): fetal movement counting
Intervention type(s): Other
Intervention description(s): pregnant women were trained about fetal movements and fetal movement counting was taught. Pregnant women were asked to perform ten fetal movements by counting once a day. In the application of the study, it was ensured that the pregnant women in the experimental group performed fetal movement counting for at least four to six weeks. In this context, pregnant women were called every week to monitor and to motivate them to continue the counting.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care