Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were:  to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week.  (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion:  In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero.

Aim: To explore how pregnant women experience fetal movements in late pregnancy. Specific aims were:  to study women’s experiences during the time prior to receiving news that their unborn baby had died in utero (I), to investigate women’s descriptions of fetal movements (II), investigate the association between the magnitude of fetal movements and level of prenatal attachment (III), and to study women’s experiences using two different self-assessment methods (IV). Methods: Interviews, questionnaires, and observations were used. Results: Premonition that something had happened to their unborn baby, based on a lack of fetal movements, was experienced by the participants. The overall theme “something is wrong” describes the women’s insight that the baby’s life was threatened (I). Fetal movements that were sorted into the domain “powerful movements” were perceived in late pregnancy by 96 % of the participants (II). Perceiving frequent fetal movements on at least three occasions per 24 hours was associated with higher scores of prenatal attachment in all the three subscales on PAI-R. The majority (55%) of the 456 participants reported average occasions of frequent fetal movements, 26% several occasions and 18% reported few occasions of frequent fetal movements, during the current gestational week.  (III). Only one of the 40 participants did not find at least one method for monitoring fetal movements suitable. Fifteen of the 39 participants reported a preference for the mindfetalness method and five for the count-to-ten method. The women described the observation of the movements as a safe and reassuring moment for communication with their unborn baby (IV). Conclusion:  In full-term and uncomplicated pregnancies, women usually perceive fetal movements as powerful. Furthermore, women in late pregnancy who reported frequent fetal movements on several occasions during a 24-hour period seem to have a high level of prenatal attachment. Women who used self-assessment methods for monitoring fetal movements felt calm and relaxed when observing the movements of their babies. They had a high compliance for both self-assessment methods. Women that had experienced a stillbirth in late pregnancy described that they had a premonition before they were told that their baby had died in utero.

Bakgrund: Hur mödrar knyter an till sitt väntade barn, vad det påverkas av och vad det kan få för konsekvenser samt hur de lär känna sitt barn under graviditeten innefattas av prenatal anknytning. Prenatal anknytning har stor plats inom mödrahälsovården men som begrepp är det relativt odefinierat. Syfte: Syftet var att beskriva begreppet prenatal anknytning genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Begreppet prenatal anknytning resulterar i flera definierade attribut där fosterrörelser har stor del. Andra attribut är interaktion, dela med sig, fantasier och känslor. Referensramen för begreppet bestäms av dess förutsättningar och konsekvenser. Slutsats: Prenatal anknytning kan ses som ett komplext begrepp som anpassas till varje graviditet utifrån de definierade attributen. / Background: Mothers prenatal attachment, what it is influenced by and what the consequences might be and how the mothers experience their child during pregnancy are included in prenatal attachment. The concept is lacking clear definitions. Prenatal attachment has a great part within maternal health care but as a concept it's relatively undefined. Aim: The aim was to describe the concept of prenatal attachment through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed, earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: The concept of prenatal attachment results in defined attributes. Fetal movement was a significant attribute. Other attributes were interaction, sharing, fantasies and emotions. The frame around the concept is set due to its conditions and consequences. Conclusion: Prenatal attachment can be identified as a complex concept adapted to each pregnancy based on the defined attributes.

Bakgrund: Fosterrörelserna ses som ett friskhetstecken. Fostrets rörelser ändrar karaktär under graviditeten, men det är en myt att de ofta blir svagare i slutet av graviditeten. Minskade fosterrörelser är ett viktigt kliniskt tecken som kan föregå intrauterin fosterdöd (IUFD). Kvinnan tar telefonkontakt när hon är orolig då hon upplever ett ändrat rörelsemönster. Socialstyrelsens nya riktlinjer finns till för korrekt handläggning, undersökning utan fördröjning kan förebygga livshotande tillstånd hos fostret. Syftet var att beskriva barnmorskors erfarenheter av telefonrådgivning till gravida som kontaktar förlossningsavdelningen gällande minskade fosterrörelser.Design: Studien har utgått ifrån en kvalitativ design med deskriptiv ansats. Datainsamlingen utfördes med semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys.Deltagare och omgivning: Tio barnmorskor som arbetade vid en förlossningsavdelning i norra Sverige.Resultat: I studien framkom två huvudkategorier, försöka bemöta oron samt komma till ett beslut och sju kategorier. Barnmorskorna är medvetna om vilka riskfaktorer som föreligger för minskade fosterrörelser och IUFD samt kring andra faktorer som kan ha betydelse för fosterrörelserna. Barnmorskorna ger “handgripliga” råd till kvinnan innan hon återkommer och i vissa fall erbjuds undersökning direkt. Telefonrådgivning förekommer dagligen och barnmorskorna belyser vikten av att vara lyhörd och ta kvinnans oro på allvar. Det ses som svårt att bedöma fostrets välmående över telefonen. Kommunikationen och erfarenhetsutbyte mellan kollegor anses värdefullt, men det upplevs även som en svårighet att ta del av nya riktlinjer på kliniken. Slutsats: Telefonrådgivningen är en komplex uppgift där en korrekt handläggning som grundar sig på evidens är avgörande för fostrets överlevnad. Riktlinjer och PM måste utformas för att barnmorskorna ska kunna handlägga minskade fosterrörelser på likartat sätt. Kliniska implikationer: Gravida kvinnor bör få information om fosterrörelser på mödravården för att öka medvetenheten. Ett nationellt utformat PM för rådgivning vid minskade fosterrörelser bör upprättas för kvinnors lika vård på lika villkor. Ökad medvetenhet hos vårdgivare om att undvika avvaktande råd då dessa saknar evidens. Nyckelord: Barnmorska, minskade fosterrörelser, IUFD, telefonrådgivning, rådgivning

Fostrets rörelser kan vara en indikator på den intrauterina miljön, där avtagande fosterrörelser kan tyda på att moderkakan inte fungerar optimalt. När fostret får för lite syre och näring spar fostret energi genom att röra sig mindre. Det finns olika räknemetoder för att registrera fosterrörelser. Metoderna har utvecklats för att identifiera ett foster som är under risk, där förlossningen måste tidigareläggas för att rädda barnets liv. Evidens för räknemetodernas effektivitet diskuteras i en pågående internationell diskurs. Mindfetalness är en ny metod för att observera fostrets rörelser, där fokus är att registrera rörelsernas styrka, kvalité och karaktär utan att räkna varje enskild rörelse.   Syftet var att undersöka barnmorskors upplevelse av att arbeta med Mindfetalness på barnmorskemottagning.   I december 2017 genomfördes en datainsamling, med hjälp av ett webb-baserat frågeformulär, till barnmorskor som arbetar på en mottagning som lottats att dela ut en broschyr till gravida kvinnor. Svaren analyserades med hjälp av en innehållsanalys med induktiv ansats.   Majoriteten av barnmorskorna upplevde att broschyren var lätthanterlig, stödjande och den kompletterade deras muntliga information om fosterrörelser. Barnmorskorna upplevde att kvinnorna var nöjda och kände sig trygga med att få broschyren. I några få fall upplevde barnmorskorna att kvinnorna blev oroliga. Barnmorskorna förmedlade att informationen om Mindfetalness underlättade kvinnornas anknytning till sitt ofödda barn. Att informera om fosterrörelser var enligt barnmorskorna svårt men samtidigt viktigt och betydelsefullt.   Mindfetalness kan vara en lämplig metod för barnmorskor att använda då de informerar och samtalar om fostrets rörelser med gravida kvinnor. Fler studier behövs om metodens effektivitet avseende att identifiera foster under risk. / Fetal movements can be an indicator of the intrauterine environment, where reduced fetal movements may interpret a placenta deficiency. When a shortage of oxygen and nutrition occurs the fetus saves energy by moving less frequently. There are a variety of methods for recording fetal movements. The methods have been created to identify a fetus at risk and the delivery might be put in advance to save the fetus’s life. There is an on-going international discussion whether the counting methods carries enough evidence. Mindfetalness is a new method to observe fetal movements, where the main focus is to record the strength, quality and characteristic of the movements without counting each and every movement.   The purpose was to observe midwives experience working with Mindfetalness at midwifery clinics.   In December 2017 data collection was conducted via a web-based questionnaire including midwives practicing at antenatal clinics, which were randomized to hand out brochures to pregnant women. The responses were analysed based on a content analysis with inductive approaches.   A majority of the midwives experienced the brochure manageable, supporting and complemented the verbal information about fetal movements. The midwives experienced that the women perceived satisfaction and felt secure receiving the brochure. A few women experienced anxiety according to the midwives. The midwives conveyed the information of Mindfetalness facilitate the women’s attachment to their unborn child. To inform about fetal movements was according to the midwives difficult but at same time important and meaningful.   Mindfetalness can be an appropriate method for midwives when informing and talking about fetal movements to pregnant women. Further research focused on the methods efficacy to identify a fetus at risk is necessary.