Home fetal dopplers "strongly discouraged"

Government and professional bodies in the UK strongly advise against the use of fetal dopplers by parents in the home. The Medicines & Healthcare Regulatory Agency (MHRA) have published updated guidelines on this, which are supported by a statement from the Royal College of Obstetricians and Gynaecologists.

Fetal dopplers are hand-held ultrasound devices that use soundwaves to listen to a baby’s heartbeat. They have been used for years by health care professionals to listen to a baby’s heartbeat. But, over the past few years, companies have been advertising and selling them to parents for home use. Some companies also hire out ultrasound machines, which is also of concern.

The advice follows growing concerns from some midwives, doctors and others about the safety of this technology. The RCOG focus on the concern that home use of fetal dopplers can lead to false reassurance. If parents are concerned about a baby, they should seek advice from a midwife or doctor rather than attempting to use this technology to try to listen to the baby’s heartbeat.

What are the concerns?

This isn’t an attempt to ‘protect’ professional knowledge. The concerns about the at-home use of fetal dopplers are very real.

First, there exist concerns about the safety of ultrasound, especially in untrained hands. The US Federal Drug Administration has previously warned that ultrasound heats up the baby’s tissue. One needs to know how to use it to reduce the risk of that. Evidence also shows that ultrasound affects the brain. And concerns about this sit alongside wider concerns about the increased use of sonic technology to gather knowledge about babies.

Doppler ultrasound can be very useful when employed judiciously. However, we don’t know enough about whether frequent use or overuse is harmful to babies. So it should be reserved for times of genuine medical benefit (and even then only with the mother’s informed consent, because some women don’t want it used at all) and certainly not used routinely or recreationally. This is a key reason why some midwives, doctors and others are concerned about the sale of hand-held dopplers and the hiring of ultrasound machines to parents-to-be for home use or even entertainment. Safety information is not always in line with current evidence and babies are being unnecessarily exposed to technologies that may cause harm, especially if not used correctly.

The second concern is that, in untrained hands, fetal dopplers may give false reassurance. In other words, they can lead parents to think that all is well when it might not be. There are a number of ways in which false reassurance may occur. The machine may pick up the mother’s heartbeat rather than the baby’s. The placenta may also be heard. In the case of multiple pregnancy (which may or may not be known about; surprise twins do still occur!) then this can further confuse the situation. And, as is often the case in midwifery and medicine, one test or technology may not be enough to get a full picture of wellbeing. Childbirth educator Vicki Hobbs has written an in-depth blog post about this here. In summary, as the RCOG spokesperson noted:

“We recommend that women monitor their baby’s movements during pregnancy as a reduction or pattern change in movement can indicate that the baby is unwell.” (RCOG)

There is an additional concern about the undermining of parents’ knowledge and confidence. Some of the advertising for these products shows happy actors claiming that owning such a device made them feel reassured. In reality, some parents find that having a fetal doppler at home actually makes them feel more anxious. Some parents have said that they found they wanted to listen in more and more frequently. Others said they became concerned about the tiniest change. This can undermine people’s trust in their own bodies and cause unnecessary worry.

As a midwife, I see women develop amazing ways of being in touch with their bodies and their babies. But this can be undermined by the use of such technologies. Professor Emerita Mavis Kirkham has also been concerned about the at home use of fetal dopplers for some time. As an expert researcher, she points out that we have never really paid much attention to researching the communication between a mother and her unborn baby. “Having the machine is a really crude diversion from developing your own skills and intuition,” she says.

The key issue, as the RCOG explain in their statement, is that seeking professional advice from a qualified midwife or doctor is best. This sentiment is echoed by professional and government bodies in other countries too.