OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.

DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.

SETTING: The study was conducted in Sweden.

PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.

FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.

KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.

IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.

PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.

BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.

AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.

METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.

FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.

DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.

CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.

Background: The Covid-19 pandemic has posed challenges to maternal healthcare systems worldwide, impacting women’s access to and utilisation of reproductive healthcare services, particularly highlighting health inequities among minority populations. Maternal awareness of fetal movements is a measure to evaluate fetal well-being. In Sweden, women are encouraged to contact healthcare if they experience decreased fetal movements. It is unknown whether women in Sweden faced greater challenges accessing such care during the Covid-19 pandemic. The objective of this study was to examine whether the proportion of healthcare contacts for decreased fetal movements changed during the Covid-19 pandemic, and if this varied according to women’s demographic characteristics.

Methods: This retrospective population-based cohort study included 18,791 who contacted healthcare due to decreased fetal movements before (1 January 2017 to 31 December 2019) and after (13 March 2020 to 31 March 2022) the onset of the Covid-19 pandemic in Region Stockholm. Women with a singleton pregnancy from gestational week 22 were included. Data were retrieved from the Swedish Pregnancy Register and the National Patient Register.

Results: There was no significant difference in healthcare contacts for decreased fetal movements before compared to during the Covid-19 pandemic (17.3% vs. 17.7%). Subgroup analyses showed an increase in healthcare contacts for decreased fetal movements after the onset of the pandemic among women born in Sweden, women with a university-level education, and students. In contrast, healthcare contacts among women with BMI ≥ 30.0 kg/m² significantly declined during the pandemic period.

Conclusions: Overall, contacts with healthcare due to decreased fetal movements remained consistent before and during the Covid-19 pandemic. However, variations were observed among specific subgroups, defined by BMI, region of birth, occupation, and educational level. These findings underscore the complex interplay between sociodemographic factors and maternal healthcare utilisation. To ensure equitable access to essential prenatal care during future health crises, healthcare services and communication strategies must be adapted to reflect the needs and circumstances of all demographic groups.

Background: Women born in Somalia who have migrated to Sweden have increased risks of complications related to pregnancy and childbirth. Swedish-Somali women are, compared to women born in Sweden, less likely to contact healthcare for decreased fetal movements, which can be a sign of fetal distress. This study aimed to evaluate the effect of a Mindfetalness-based intervention in increasing awareness of fetal movements and its impact on birth outcomes among Swedish-Somali migrant women.

Methods: An intervention study with a non-randomised control group, encompassing Swedish-Somali migrant women, with a singleton pregnancy, giving birth from gestational week 32 + 0 between June 2022 and June 2024. Data was collected from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. The intervention group consisted of 1,251 women who, in addition to routine information about fetal movements, also received information about Mindfetalness, a concept supporting women to become familiar with the baby’s movement pattern. The control group consisted of 1,555 women who only received routine information about fetal movement. Outcome measures included Apgar score at five minutes after birth, birth weight, neonatal intensive care unit admission, fetal death, onset of labour, mode of birth, and gestational age at birth. Log-binomial regression analyses were applied to assess associations between the intervention and selected outcomes.

Results: There was a statistically significant increase in spontaneous vaginal births in the intervention group (RR 1.06, CI 1.01–1.11). No statistically significant differences between the intervention and control groups were observed for any other outcomes. Nearly one-third of women in both groups experienced a prolonged or post-term birth, while two-thirds were overweight or obese. The overall stillbirth rate ranged between 0.3% and 0.4%.

Conclusions: The Mindfetalness intervention was associated with an increased incidence of spontaneous vaginal births, but no effect on other birth outcomes was observed. Implementing health interventions in a high-quality healthcare setting present challenges. When designing interventions to improve birth outcomes, it is essential to consider demographic data and the prevalence of risk factors within the target population. Further research involving stakeholders representing Swedish-Somali women is needed to understand the implications of this intervention.

Trial registration: Retrospectively registered at ClinicalTrials.gov: NCT05540639, 30/06/2022.