DOI: https://doi.org/10.14710/nmjn.v16i1.68244

Bonding from Womb: A Mixed Method Study of Pregnant Women’s Knowledge, Attitude, and Experiences on Fetal Movement

*Restuning Widiasih orcid scopus  -  Department of Maternity Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
Khoirunnisa Khoirunnisa orcid  -  Departement of Paediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
Lilis Mamuroh  -  Department of Maternity Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
Windy Natasya Al Baihaqi  -  Hasan Sadikin Hospital, Indonesia
Tosin Popoola orcid scopus  -  School of Nursing and Midwifery, University of Newcastle, Australia
Open Access Copyright (c) 2026 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Fetal movement is an important indicator of fetal life and well-being and contributes to maternal–fetal bonding. However, evidence on pregnant women’s knowledge, attitudes, behaviors, self-efficacy, and experiences in self-monitoring fetal well-being remains limited.

Purpose: This study aimed to comprehensively examine pregnant women’s knowledge, attitudes, behaviors, self-efficacy, and experiences related to fetal movement monitoring.

Methods: A mixed-methods study with a concurrent triangulation design was conducted. Quantitative and qualitative data were collected simultaneously through a survey of 216 respondents from two districts and interviews with 18 participants drawn from the survey pool. Comparative analysis was used to assess differences in knowledge, attitudes, behaviors, and self-efficacy between the two districts using the Mann–Whitney test for survey data, while thematic analysis was applied to the interview data.

Results: Overall, the majority of pregnant women demonstrated low knowledge (64.4%), negative self-monitoring behaviors (52.7%), and low self-efficacy (56.0%), while attitudes toward fetal movement self-observation were slightly more favorable (53.7%). Statistical analysis indicated significant differences in knowledge, attitudes, and behaviors related to fetal movement self-observation (p < .05), whereas self-efficacy was not statistically significant (p > .05). Thematic analysis identified four themes: (1) Bonding since in the womb; (2) Emotional responses; (3) Actions when sensing abnormalities; and (4) Culture and beliefs.

Conclusion: The findings suggest that mothers and fetuses form a strong emotional bond from the womb, as reflected in maternal experiences and behaviors. There is a need for nursing interventions in fetal monitoring, particularly to improve pregnant women’s knowledge, attitudes, behaviors, and self-efficacy. Furthermore, this study strengthens the evidence base for maternity nursing practice, enabling nurses and midwives to design targeted educational and monitoring interventions that promote pregnant women’s autonomy in observing fetal health and responding appropriately to early warning signs.

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Keywords: Fetal well-being; maternal-fetal attachment; mixed-methods research; pregnancy
Funding: Universitas Padjadjaran

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  1. Ahmed, S. K., Mohammed, R. A., Nashwan, A. J., Ibrahim, R. H., Abdalla, A. Q., M. Ameen, B. M., & Khdhir, R. M. (2025). Using thematic analysis in qualitative research. Journal of Medicine, Surgery, and Public Health, 6, 100198. https://doi.org/10.1016/j.glmedi.2025.100198
  2. Akselsson, A., Georgsson, S., Lindgren, H., Pettersson, K., & Rådestad, I. (2017). Women’s attitudes, experiences, and compliance concerning the use of mindfetalness: A method for systematic observation of fetal movements in late pregnancy. BMC Pregnancy and Childbirth, 17, 359. https://doi.org/10.1186/s12884-017-1548-5
  3. Arikunto, S. (2014). Prosedur penelitian suatu pendekatan praktik [Research procedures: A practical approach]. Jakarta: PT Rineka Cipta
  4. Bellussi, F., Poʼ, G., Livi, A., Saccone, G., De Vivo, V., Oliver, E., & Berghella, V. (2020). Fetal movement counting and perinatal mortality: A systematic review and meta-analysis. Obstetrics & Gynecology, 135(2), 453–462. https://doi.org/10.1097/aog.0000000000003645
  5. Berndl, A. M. L., O’Connell, C. M., & McLeod, N. L. (2013). Fetal movement monitoring: How are we doing as educators? Journal of Obstetrics and Gynaecology Canada, 35(1), 22–28. https://doi.org/10.1016/s1701-2163(15)31044-6
  6. Boerma, T., Campbell, O. M. R., Amouzou, A., Blumenberg, C., Blencowe, H., Moran, A., Lawn, J. E., & Ikilezi, G. (2023). Maternal mortality, stillbirths, and neonatal mortality: A transition model based on analyses of 151 countries. The Lancet Global Health, 11(7), e1024–e1031. https://doi.org/10.1016/S2214-109X(23)00195-X
  7. Bowen, J. H. (2018). Pregnant women’s knowledge about fetal movement counts [Honors Undergraduate Theses, University of Central Florida]. https://stars.library.ucf.edu/honorstheses/282
  8. Castro, F. G., Kellison, J. G., Boyd, S. J., & Kopak, A. (2010). A methodology for conducting integrative mixed methods research and data analysis. Journal of Mixed Methods Research, 4(4), 342–360. https://doi.org/10.1177/1558689810382916
  9. Creswell. (2022). Research design: Qualitative, quantitative, and mixed methods approaches (6th ed.). SAGE Publication
  10. Dibazari, Z. A.-, & Abbasalizadeh, F. (2024). Evaluation of childbirth readiness and its associated factors and consequences in pregnant women referring to health centers in Tabriz , Iran and providing strategies to promote childbirth readiness : A sequential explanatory mixed method study protocol. BMJ Open, 14, e087038). https://doi.org/10.1136/bmjopen-2024-087038
  11. Elsayed, W., & Sinha, A. (2019). Umbilical cord abnormalities and pregnancy outcome. Journal of Fetal Medicine, 06(04), 183–189. https://doi.org/10.1007/s40556-019-00217-7
  12. Gregory, E. C. W., & Valenzuela, C. P. (2021). User guide to the 2021 fetal death public use file. https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-04.pdf
  13. He, Y., Liu, X., & Yang, X. (2024). Effects of multidimensional exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus. Frontiers in Physiology, 15, 1407569. https://doi.org/10.3389/fphys.2024.1407569
  14. Heazell, A. E. P., Warland, J., Stacey, T., Coomarasamy, C., Budd, J., Mitchell, E. A., & O’Brien, L. M. (2017). Stillbirth is associated with perceived alterations in fetal activity - Findings from an international case control study. BMC Pregnancy and Childbirth, 17(1), 369. https://doi.org/10.1186/s12884-017-1555-6
  15. Hunter, L. J., Da Motta, G., McCourt, C., Wiseman, O., Rayment, J. L., Haora, P., Wiggins, M., & Harden, A. (2019). Better together: A qualitative exploration of women’s perceptions and experiences of group antenatal care. Women and Birth, 32(4), 336–345. https://doi.org/10.1016/j.wombi.2018.09.001
  16. Jabir, H. N. (2020). Faktor yang mempengaruhi perilaku ibu hamil dalam pemeriksaan kesehatan di UPT Puskesmas Lamurukung [Factors that influence pregnant mother behaviorin health examination in the Public Health Center of Lamurukung]. Jurnal Ilmiah Kesehatan Sandi Husada, 9(1), 548–553
  17. Karlina, L. (2018). Gambaran pengetahuan suami tentang suami siaga dalam masa kehamilan di Puskesmas Matakali Kecamatan Matakali Kabupaten Polewali Mandar [Overview of husbands’ knowledge about being a supp.ortive husband during pregnancy at the Matakali Community Health Center]. Bina Generasi: Jurnal Kesehatan, 8(1), 107–117. https://doi.org/10.35907/bgjk.v8i1.56
  18. Kc, A., Wrammert, J., Clark, R. B., Ewald, U., & Målqvist, M. Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: A case-referent study in Nepal. BMC Pregnancy Childbirth, 19(16), 233. https://doi.org/10.1186/s12884-016-1034-5
  19. Lengkong, G. T., Langi, F. L. F., & Posangi, J. (2020). Faktor-faktor yang berhubungan dengan kematian bayi di Indonesia [Factors associated with infant mortality in Indonesia]. Kesmas: Jurnal Kesehatan Masyarakat Universitas Sam Ratulangi, 9(4), 41–47. https://ejournal.unsrat.ac.id/index.php/kesmas/article/view/29482
  20. Ma, Y., Gao, Y., Li, J., Sun, A., Wang, B., Zhang, J., Dill, S. -E., Medina, A., & Rozelle, S. (2020). Maternal health behaviors during pregnancy in rural Northwestern China. BMC Pregnancy and Childbirth, 20(1), 745. https://doi.org/10.1186/s12884-020-03444-3
  21. Mangesi, L., Hofmeyr, G. J., Smith, V., & Smyth, R. M. D. (2015). Fetal movement counting for assessment of fetal wellbeing. The Cochrane Database of Systematic Reviews, 2015(10), CD004909. https://doi.org/10.1002/14651858.CD004909.pub3
  22. Maryuni, M., Prasetyo, S., Martha, E., Devy, S. R., Pardosi, J. F., Anggraeni, L., & Subu, M. A. (2024). Local cultural perspectives of birth preparedness: A qualitative study in a rural subdistrict of Indonesia. British Journal of Midwifery, 32(8), 412–420. https://doi.org/10.12968/bjom.2024.32.8.412
  23. McArdle, A., Flenady, V., Toohill, J., Gamble, J., & Creedy, D. (2015). How pregnant women learn about fetal movements: Sources and preferences for information. Women and Birth: Journal of The Australian College of Midwives, 28(1), 54–59. https://doi.org/10.1016/j.wombi.2014.10.002
  24. Ministry of Health of the Republic of Indonesia. (2020). Pedoman pelayanan antenatal terpadu 2020 [Integrated antenatal care guidelines 2020]. https://repository.kemkes.go.id/book/147
  25. Ministry of Health of the Republic of Indonesia. (2024a). Laporan akuntabilitas kinerja instansi pemerintah (LAKIP) Direktorat Gizi Kesehatan Ibu dan Anak tahun anggaran 2023 [Government agency performance accountability report of the Directorate of Maternal and Child Health Nutrition, fiscal year 2023]. Ministry of Health of the Republic of Indonesia. https://ppid.kemkes.go.id/wp-content/uploads/2025/03/Lakip-2024_compressed_compressed.pdf
  26. Ministry of Health of the Republic of Indonesia. (2024b). Agar ibu dan bayi selamat [For the safety of mothers and babies]. Ministry of Health of the Republic of Indonesia
  27. Modde Epstein, C., Houfek, J. F., & Jones, L. P. (2023). Deep health: A qualitative, woman-centered perspective of health during pregnancy. Midwifery, 120, 103628. https://doi.org/10.1016/j.midw.2023.103628
  28. Mutawtah, M. Al, Campbell, E., Kubis, H. P., & Erjavec, M. (2023). Women’s experiences of social support during pregnancy: A qualitative systematic review. BMC Pregnancy and Childbirth, 23, 782. https://doi.org/10.1186/s12884-023-06089-0
  29. Nafisah, N. Z., Widiasih, R., & Mamuroh, L. (2025). Overview of knowledge, attitude, and behavior of pregnant women in self-monitoring of fetal movement. Indonesian Journal of Nursing and Health Sciences, 6(1), 11–18. https://doi.org/10.37287/ijnhs.v6i1.5699
  30. Niu, C., Xie, Y., Zhou, W., Ren, Y., Zheng, Y., & Li, L. (2024). Effect of social support on fetal movement self-monitoring behavior in Chinese women: A moderated mediation model of health beliefs. Journal of Psychosomatic Obstetrics and Gynaecology, 45(1), 2291632. https://doi.org/10.1080/0167482X.2023.2291632
  31. Norman, I. D., & Norman, B. M. A. (2016). Juxtaposition of Hohfeldian rights, principle-based ethics, functionings, and the health-seeking behavior of Sub-Saharan Africa. Advances in Applied Sociology, 6, 344–362. https://doi.org/10.4236/aasoci.2016.610026
  32. Novrianto, R., Marettih, A. K. E., & Wahyudi, H. (2019). Validitas konstruk instrumen general self-efficacy scale versi Indonesia [Construct validity of the Indonesian version of the general self-efficacy scale instrument]. Jurnal Psikologi, 15(1), 1–9
  33. Ogland-hand, C., Biroscak, B., Kim-mozeleski, J., Williams, S. M., & Hovmand, P. S. (2025). Social norms structure underlying health behaviors: Developing a feedback theory of social norm adoption for public health. Social Sciences & Humanities Open, 12, 102165. https://doi.org/10.1016/j.ssaho.2025.102165
  34. Peat, A. M., Stacey, T., Cronin, R., & McCowan, L. M. E. (2012). Maternal knowledge of fetal movements in late pregnancy. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 52(5), 445–449. https://doi.org/10.1111/j.1479-828X.2012.01462.x
  35. Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Wolters Kluwer
  36. Pollock, D., Ziaian, T., Pearson, E., Cooper, M., & Warland, J. (2020). Breaking through the silence in antenatal care: Fetal movement and stillbirth education. Women and Birth: Journal of the Australian College of Midwives, 33(1), 77–85. https://doi.org/10.1016/j.wombi.2019.02.004
  37. Samutri, E., & Endriyani, L. (2021). Education of fetal movement counting: An effort to increase knowledge and compliance of pregnant women to do self-assessment of fetal wellbeing. Jurnal Ners dan Kebidanan Indonesia, 9(1), 68−75. https://doi.org/10.21927/jnki.2021.9(1).68-75
  38. Shorey, S., Chan, S. W.-C., Chong, Y. S., & He, H.-G. (2015). Predictors of maternal parental self-efficacy among primiparas in the early postnatal period. Western Journal of Nursing Research, 37(12), 1604–1622. https://doi.org/10.1177/0193945914537724
  39. Smith, V., Muldoon, K., Brady, V., & Delaney, H. (2021). Assessing fetal movements in pregnancy: A qualitative evidence synthesis of women’s views, perspectives and experiences. BMC Pregnancy and Childbirth, 21(1), 197. https://doi.org/10.1186/s12884-021-03667-y
  40. Stahl, N. A., & King, J. R. (2020). Expanding approaches for research: Understanding and using trustworthiness in qualitative research. Journal of Development Education, 44(1), 26–28
  41. Statistics Indonesia (BPS). (2020). Peraturan Kepala Badan Pusat Statistik Nomor 120 Tahun 2020 tentang klasifikasi desa perkotaan dan perdesaan di Indonesia tahun 2020 [Regulation of the Head of the Central Statistics Agency Number 120 of 2020 concerning the classification of urban and rural villages in Indonesia]. Statistics Indonesia
  42. Statistics Indonesia (BPS). (2023). Angka kematian bayi (AKB)/infant mortality rate (IMR) hasil long form SP2020 menurut provinsi/kabupaten/kota, 2020 [Infant mortality rate (IMR) results from the 2020 population census long form by province/regency/city]. Statistics Indonesia. https://www.bps.go.id/en/statistics-table/1/MjIyMCMx/angka-kematian-bayi-akb--infant-mortality-rate-imr--hasil-long-form-sp2020-menurut-provinsi-kabupaten-kota--2020.html
  43. Suryaningsih, E. K., Alvianty, F. N., & Wantonoro, W. (2022). Maternal-fetal attachment and family support among pregnant women in Yogyakarta. International Journal of Health, Science and Technology, 4(1), 93–99. http://dx.doi.org/10.31101/ijhst.v4i1.2504
  44. Szubert, M., Ilowiecka, M., Wilczynski, J., & Bilinski, P. (2020). Health-related behaviors of pregnant women residing in urban and rural areas in Poland. International Journal of Environmental Research and Public Health, 17(12), 4395. https://doi.org/10.3390/ijerph17124395
  45. Tassi, W. D., Sinaga, M., & Riwu, R. R. (2021). Analisis faktor-faktor yang mempengaruhi perilaku ibu hamil dalam pemanfaatan pelayanan antenatal care (K4) di wilayah kerja Puskesmas Tarus [Analysis of factors affecting the behavior of pregnant women in the use of antenatal care services (K4) in the work area of the Tarus Public Health Center]. Media Kesehatan Masyarakat, 3(2), 175–185. https://doi.org/10.35508/mkm.v3i2.3251
  46. Wawan, A., & Dewi, M. (2019). Teori dan pengukuran pengetahuan, sikap dan perilaku manusia dilengkapi contoh dan kuesioner [Theories and methods for measuring human knowledge, attitudes, and behavior, complete with examples and questionnaires]. Nuha Medika
  47. Weller, K., Housseine, N., Khamis, R. S., Meguid, T., Hofmeyr, G. J., Browne, J. L., & Rijken, M. J. (2023). Maternal perception of fetal movements: Views, knowledge and practices of women and health providers in a low-resource setting. PLOS Global Public Health, 3(3), e0000887. https://doi.org/10.1371/journal.pgph.0000887
  48. Wensu, Z., Xidi, Z., Shaojie, L., Baohua, Z., Yunhan, Y., Huilan, X., Zhao, H., & Xiyue, X. (2021). Does the presence of anxiety and depression symptoms mediate the association between family functions and self-efficacy in pregnant women in the third trimester?: A community-based cross-sectional survey. Frontiers Psychiatry, 12, 726093. https://doi.org/10.3389/fpsyt.2021.726093
  49. World Medical Association. (2001). World Medical Association declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization, 79(4), 373−374. https://iris.who.int/handle/10665/268312
  50. Wulandari, R. D., Laksono, A. D., & Rohmah, N. (2021). Urban-rural disparities of antenatal care in South East Asia: A case study in the Philippines and Indonesia. BMC Public Health, 21, 1221. https://doi.org/10.1186/s12889-021-11318-2
  51. Yani, F., Adila, D. R., & Roslita, R. (2021). Tingkat pengetahuan ibu tentang pemantauan gerakan janin pada ibu hamil dengan preeklampsia [Mothers’ knowledge level about fetal movement monitoring in pregnant women with preeclampsia]. Jurnal Cakrawala Promkes, 3(1), 33–41. https://doi.org/10.12928/promkes.v3i1.2848
  52. Yuan, F., Qian, D., Huang, C., Tian, M., Xiang, Y., He, Z., & Feng, Z. (2015). Analysis of awareness of health knowledge among rural residents in Western China. BMC Public Health, 15, 55. https://doi.org/10.1186/s12889-015-1393-2

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