My Baby’s Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy

Background: Maternal concern of decreased fetal movements (DFM) and the optimal care provided by clinicians are associated with stillbirth. The My Baby’s Movement (MBM) Trial was a stepped wedge cluster randomised control trial, which evaluated the impact of the MBM package of interventions on stillbirths at 28 weeks or more, across 26 maternity facilities in Australia and New Zealand between Aug 2016 and May 2019. The MBM package of interventions consist of 1) a mobile phone program (a purpose-built app or SMS messages for those without a smartphone) for women to increase maternal awareness of fetal movements (FM) and reduce delay in reporting of DFM, and 2) an education program for clinicians on the management of women presenting with DFM, based on the clinical practice guideline published by Gardener et al. (2017).

To assess the effects of the MBM package, compared to routine antenatal care alone on: 1) stillbirth at 28 weeks or more; 2) neonatal morbidity; 3) maternal psychosocial outcomes and health services utilisation; 4) women’s and clinician’s knowledge and perceptions of FM and the acceptability of MBM; and 5) cost.

Sub-studies

An audit tool on the management of women presenting with decreased fetal movements

Kristen Haakons leads this sub-study.

This audit tool aimed to investigate whether the MBM intervention has had influence on the maternal care for women presenting with DFM. To assess change using purpose-built clinical audits of presentations for DFM conducted by one month prior and six months post implementation of MBM intervention. Women’s behaviours and clinical characteristics at presentation with DFM were collected.

Surveys of women to elicit psychosocial outcomes, knowledge and acceptability of the DFM information

Surveys of women were undertaken over a four week period immediately before commencement of the intervention and again at 6 months post intervention, staggered per cluster. Women were asked to complete a survey (1a) when attending a routine antenatal visit at ≥35 weeks gestation or up to one week after giving birth. Survey 1a aimed to collect the women’s knowledge and acceptability of DFM information. A follow-up survey (1b) was undertaken at 6 months, aimed to determine psychosocial outcomes, quality of life, and health services utilisation since discharge.

Women’s experience of the MBM App

Mu Cheng leads this sub-study.

This sub-study aimed to investigate women’s perception of the MBM App, including user-friendliness, accuracy of the information about FM and the impact on maternal behaviour change with DFM concerns, via an in-built survey completed after birth.

Economic evaluation

Emily Callander leads this sub-study.

This sub-study aimed to collect all Australian women completed the surveys as well as all women experiencing a stillbirth Medicare claim data from the federal government via the Health Insurance Commission.

Research Team: Vicki Flenady, Glenn Gardener, David Ellwood, Billie Bradford, Michael Coory, Philippa Middleton, Caroline Crowther, Christine East, Emily Callander, Jane Norman, Frances Boyle, Frederic Froen, Adrienne Gordon, Mu Cheng, Kristen Haakons, Jessica Sexton

Publications:

Flenady V, Gardener G, Boyle FM, Callander E, Coory M, East C, et al. My Baby’s Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol. BMC Pregnancy Childbirth. 2019;19(1):430.

Flenady V, Gardener G, Ellwood D, Coory M, Weller M, Warrilow KA, et al. My Baby’s Movements: a stepped-wedge cluster-randomised controlled trial of a fetal movement awareness intervention to reduce stillbirths. Bjog. 2022;129(1):29-41.

Skalecki S, Lawford H, Gardener G, Coory M, Bradford B, Warrilow K, et al. My Baby’s Movements: An assessment of the effectiveness of the My Baby’s Movements phone program in reducing late-gestation stillbirth rates. Aust N Z J Obstet Gynaecol. 2023;63(3):378-83.