AFFIRM – can promoting awareness of baby’s movements in pregnancy help reduce stillbirths?

The AFFIRM trial explored whether the stillbirth rate would change if maternity staff and pregnant women were made more aware of their baby’s movements, and a new package of care was offered to any women who reported concerns.

In pregnancy, a baby’s movements can be a sign of their health. This study, part-funded by Sands, took place across 33 hospitals in the UK and Ireland, involving over 400,000 women. The study aimed to find out if stillbirths are reduced by promoting awareness of baby’s movements among pregnant women, and introducing a package of care when women report a change in movements.

Researchers found there was an 11% drop in the stillbirth rate after the care package was introduced. However, this reduction was too small to prove the benefits of this new approach, which was also associated with an increase in induction of labour and caesarean sections.

These findings are being considered alongside other research and have not caused fetal movement advice to change in the UK.

Women are encouraged to pay attention to their baby’s movements and immediately share any concerns with their midwife or maternity service.

Our Safer Pregnancy website provides further advice.

More Information

Why do we need this research?

There is a clear link between reduced fetal movement, stillbirth, and the underlying causes of stillbirth (for example, problems with the placenta or a baby that is not growing well). Up to half of women whose pregnancies end in stillbirth report that their baby moved less the week before he or she died. Fetal movement is an important focus for research aiming to reduce stillbirth. However, there is little evidence about what type of care can reduce the risk of stillbirth following reduced fetal movements.

What were the aims of this study?

The study aimed to test whether the stillbirth rate would change if maternity staff and pregnant women were made more aware of fetal movements, and a standardised ‘care package’ was offered to any women who reported concerns.

What did the researchers do?

In the trial, pregnant women who had concerns about fetal movement could choose between routine care or the AFFIRM care package, which included:

educating maternity staff about the link between reduced fetal movement and stillbirth
raising women’s awareness about the importance of monitoring movements and immediately reporting any concerns
more monitoring and scans for babies who might be at risk
early delivery of babies when the benefits were likely to outweigh the risks

Researchers compared the outcomes of mothers and babies who received standard care and the care package, looking at baby deaths, how babies were born, and other complications.

What did the study find?

Previous research had suggested that encouraging women to pay attention to their babies’ movements, combined with additional checks and early delivery of babies at risk, might help cut rates of stillbirth by 30 per cent (Tveit et al., 2009).

In this study, the stillbirth rate dropped from 44 in 10,000 births after standard care to around 41 in 10,000 births. This means there was an 11% fall in the stillbirth rate after introducing the care package. However, this reduction was too small to prove the benefits of this new approach, which was also associated with an increase in induction of labour and caesarean sections. Because of this, the results need to be analysed alongside other research before recommendations can be made about how best to care for women with reduced fetal movement.

Impact of the study

The study was published in The Lancet and was initiated and funded by the Scottish Government’s Chief Scientist Office. The research was also part-funded by Teddy’s Wish and Tommy’s.

Further analysis of the research can be found on the NIHR Dissemination Centre.

A related Sands-funded study has also been published which examines the cost effectiveness of the AFFIRM package of care.

Additional information:

Lead researcher – Professor Jane E Norman

Institution – Tommy's Centre for Maternal and Fetal Health

Funder – Scottish Government’s Chief Scientist Office, Sands, Teddy’s Wish, Tommy’s

Duration – Jan 2014 to Dec 2016

Publications:

Camacho, E.M. et al. (2022) ‘Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial’, BMC Pregnancy and Childbirth, 22(1), p. 235. Available at: https://doi.org/10.1186/s12884-022-04563-9.

Norman, J.E. et al. (2018) ‘Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a stepped wedge, cluster-randomised trial’, The Lancet, 392(10158), pp. 1629–1638. Available at: https://doi.org/10.1016/S0140-6736(18)31543-5.