Use of Home Fetal Heart
Rate Monitors - Doppler’s
The home use of fetal heart rate monitors is becoming more common with an increased availability of the medical devices through online retailers. Parents describe being excited at the prospect of being able to hear their babies heart beats whenever they like, explaining that they feel it also increases bonding with the baby, and with some considering the purchase of the device as an insurance policy for the babies’ wellbeing.
While it is tempting to see this as a harmless exercise health professionals are raising serious concerns regarding the home use of fetal heart rate monitors. As a Midwife, I find this trend alarming for several reasons.
Dangers of overuse of ultrasound – do we know what we are doing?
Doppler’s produce ultrasound; ultrasound is as yet an untested science in that we do not yet know the long-term effects of exposure to developing babies from ultrasounds. Due to this ‘unknown’ the American College of Obstetrics and Gynecology (ACOG) state that while no reported evidence of harm from ultrasound has been reported to date, “it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care professionals. Casual use of ultrasound during pregnancy should be avoided.” The idea of women using a Doppler, therefore exposing their babies to unneeded ultrasound, possibly daily, makes the clinician in me extremely concerned about future outcomes. Remember when we gave out Thalidomide? Remember when all little boys had a circumcision? ACOG,2017. https://www.acog.org/Patients/FAQs/Ultrasound-Exams#Doppler
Untrained ears: what are you hearing? Opportunity for false reassurance and false distress?
False, or unneeded distress is possibly the best outcome here. You think your baby has passed because you cannot identify a fetal heart rate, you see your midwife and thankfully there is a wonderful strong, reassuring heart rate heard. However; as a Mumma myself I can only imagine the absolute horror I would feel if I was untrained and attempting to hear my baby and could hear nothing that sounded like a baby. I would be frantic. Driving to the hospital or waiting for your midwife to arrive would be torture. Just don’t do it to yourself. Monitor movements, not fetal heart rate.
Unfortunately, the other side of this is the false reassurance. This is the one that gives maternity staff nightmares. The woman knows her baby has not been moving as much as usual, she is worried and feels as though something is not right. She does not want to be a problem and anyway, she has a Doppler her friends gave her at her baby shower. She decides to have a go and listen to her baby, she can even look online and see other women using a Doppler so confident in doing it. She hears what sounds to her very much like what the midwives hear when she is assessed in clinic and decides that the anxious feeling is all in her head and that the baby is ok, she heard the heart beat after all, right? She even posts in an online group. She explains that she has a Doppler and has heard the heartbeat and is reassured by the group members that it is normal for babies to slow down movements at the end of pregnancy, and that if she heard the heartbeat it is fine. This Mumma does not seek medical assessment for her baby…………………………………… There are reported cases of stillbirths and significant neonatal morbidity (seriously sick babies, some with long term neurological issues) associated with the use of home dopplers.
Bonding with your baby
Instead of hearing your baby to increase bonding, work on your baby hearing you. Babies in-utero can hear from 26 weeks; talk to your baby, read to your baby. Massage your belly or your partner's belly and get to know that little one. If you talk to this little one now, when they come earth side, they will know you intimately. They will know the tone in your voice, they will know your happy, your sad, your excited; they will know you. And that is bonding.
How to safely monitor your babies’ wellbeing:
If at any time you have any concerns about your baby’s movements, either reduced or increased, if you are feeling anxious, have a sense that something is not right, seek medical care immediately. Do not wait until the next day, or after work, or for your next appointment; reduced movement, maternal instincts saying something is wrong or a suddenly over active baby can all be possible signs of an unwell baby and delay could be life threatening.
As a midwife, I can assure you that I would rather see you for review 100 times and find a well-baby and well Mumma than be the midwife who has to tell you your baby has passed, knowing you did not come in for days. It also breaks our hearts when we find out a woman has been at home worrying herself sick about something and has not come in because she is afraid of being a problem or putting someone out. You are never a hassle. Always come in.
When you come in, someone highly trained in fetal heart rate monitoring will assess your baby. Fetal heart interpretation is an advanced skill, midwives are trained to assess for many complex variations in fetal including, for example; accelerations, rate, reactivity, baseline, decelerations, bradycardia and tachycardia. These variations are used to develop an overall assessment of fetal welfare along with all other relevant assessments and testing required to give a comprehensive overview of fetal welfare, something that simply cannot be achieved by listening to what may, or may not be, a fetal heart rate, by an untrained person.
Still-aware (Stillaware.org) and kickscount (kickscount.org.uk) are two, amid many professional services, advising women to consider the following ways to assess fetal wellbeing rather than using a fetal heart rate monitor:
3 characteristics of wellbeing:
1. Frequency of movements
2. Strength of movements – a baby doesn’t slow down, it is a myth that babies stop moving at the end of pregnancy and babies do not ‘run out of room’ to the extent that they cannot move – the movements may be different but remain presen
3. Pattern of movement– your baby will have a regular pattern of movements you will come to know and anticipate during the day or night, you are the absolute best judge of this – no machine can replace your instincts.