Tools of the Trade - Doppler
homebirth, labor and delivery, maternity, Midwife, pregnancy, prenatal

Tools of the Trade – Doppler

Can you listen to the baby’s heartbeat?  How do you do that without lugging around those big old machines like the hospital has?  These are some of the questions that I get asked pretty frequently.  There are several different types of devices to listen to baby’s heart rates during pregnancy and birth.  The hand held Doppler in the above picture is the topic that I am going to talk about today.

It is believed that the first fetal heartbeat was heard in the 17th or 18th century by placing one’s ear to the pregnant woman’s abdomen.  In 1816,  René Théophile Hyacinthe Laënnec developed the first fetal stethoscope because he was too embarrassed to touch a woman’s abdomen with his ear.  It wasn’t until the 1970’s that the electronic fetal monitoring like you see in hospitals today was invented.  Even though it wasn’t originally invented or tested for that purpose, it was heavily marketed to predict fetal distress and end cerebral palsy.  It was noticed that as the use of these machines increased, so did the Cesarean rate from 5% to 32%.  It is believed that these two are correlated.  “Non-reassuring fetal heart tones” is the 2nd most common reason for C-sections today.

Evidenced Based Birth did an excellent article on the differences in continuous electronic fetal monitoring and hand held monitoring.  It included the different types of devices used for hand held monitoring.  Pros and cons to hand held monitoring are also discussed.

The Pros:

  • It is linked to fewer Cesareans and vacuum-/forceps-assisted births.
  • Continuous labor support is required, so there is more contact between the care provider and the birthing woman.
  • Birthing woman are able to have more movement and the ability to use many positions for labor and birth.
  • Many are waterproof, so can be used during water births, in the bath or shower.
  • These devices are relatively inexpensive and easy to maintain.

Many of the cons listed were more specific to hospitals:

  • Hand held monitoring is linked to a higher rate of newborn seizures (about one seizure in 325 births with hands-on listening vs. one in 650 births for people with continuous EFM; long-term effects are unknown).
  • It may not be appropriate for people with pregnancy or birth complications.  Many of these people would either already be risked out of a Homebirth situation or these may be a consideration for transporting to a hospital.
  • Care providers may not be well trained in current best practices for hands-on listening.  Fortunately, this is a huge part of what Homebirth midwives are trained in.
  • It can take a while to develop the skills needed to listen with a fetal stethoscope.  This is very true.  I own a fetal stethoscope.  It was a huge learning curve.  It needs to be practiced on a regular basis.  If you desire for your midwife to use fetoscope, make sure that she has experience in its use.
  • Devices for hands-on listening are not available in all birth settings.  Many hospitals and doctors do not carry hand held devices.
  • It requires hands-on care, which is not possible in busy hospitals.
  • They may require the care provider to get in awkward or uncomfortable positions while in close physical contact with the laboring person.  As a Homebirth midwife, I view this as par for the course.  It is not unusual to see me or my students twist upside down to reach underneath a woman laboring on her hands and knees.  This kind of thing is pretty unheard of in most hospital settings.
  • There is often no record of the fetal heart rate readings (the exception is some Doppler monitors that can store data), which can cause uncertainty in lawsuits.

Conclusion:

The American College of Obstetricians and Gynecologists recommends intermittent listening to heart tones as long as the birthing woman is considered low risk here.  The American College of Nurse-Midwives also recommends the same in several places on their site including here.  So this is one way that Homebirth midwives monitor birthing women.  Read more about monitoring with handheld devices in my post on the fetal stethoscope here.

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Mercy Eizenga LM, CPM

Mercy Eizenga LM, CPM is the head midwife and owner of Comforts of Home Midwifery. Mercy was first exposed to homebirth when she witnessed the birth of her little brother at the age of 7. Her interest in natural childbirth grew with the birth of her first child and then attending Bradley Natural Childbirth classes with a friend a year and a half later. Attending her first birth as a doula verified that she was called to be a midwife. Mercy attended the Association of Texas Midwives Training Program and completed an apprenticeship with what is now the Corpus Christi Birth Center. She holds a Texas state license, is listed with the state of Oklahoma, and holds her Certified Professional Midwife with the North American Registry of Midwives.

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