Home Doppler use has increased over the years. With affordable home dopplers available for under $100, many are intrigued by their use. Often used either for reassurance due to concerns over miscarriage or to utilize as a method for bonding.
As a doula, you are likely to be asked if home dopplers are safe.
Pregnancy can be an extremely exciting time, but it can also bring anxieties. One in four pregnant people will experience a pregnancy or infant loss at some point in their life. Even if you have not personally experienced loss, you likely know someone who has. Looking at the numbers, you will inevitably have clients who are pregnant after a previous loss.
There is also a desire to bond early in pregnancy, leading to pregnant people wanting to learn more about or use at home Dopplers.
While they are available, is there a benefit to use? Are they safe? As with all pregnancy choices, it comes down to benefit vs risk.
A Home Doppler Cannot Prevent Miscarriage
A miscarriage is a devastating experience. Many pregnant people who experience one wonder if there was something they could have done to prevent it.
However, most early miscarriages are due to chromosomal issues and thus the pregnancy could not progress beyond a certain point. Most chromosomal losses also occur around or prior to ten weeks. This is often well before a home Doppler can.
Early Doppler use (some people can use one around 8 weeks, while many are unable until 10-14 weeks) can only offer a certain amount of information. If it can pick up a heartbeat, you will be able to determine the heartrate.
However, inability to pick up a heartbeat prior to 14 weeks is generally deemed inconclusive due to the limitations of Dopplers in early pregnancy. This can create unnecessary stress and anxiety for some unable to catch the heartbeat at home.
If one can pick up a heartrate and it is low or concerning and the same is confirmed by a healthcare provider, an ultrasound might be ordered. Unfortunately, even if an ultrasound can confirm a concern, early miscarriages are rarely preventable.
Aside from concerns picked up incredibly early, such as low progesterone due to hormonal imbalances (treated with progesterone supplements) or a thyroid issue (treated with thyroid medications), there’s not much treatment available for first trimester concerns.
Neither progesterone or thyroid issues can be detected by Doppler use, they can only be tested for and treated by a healthcare provider. It is also important to note that low progesterone can be caused by an unviable pregnancy, meaning even tracking progesterone cannot always prevent a loss. Most early losses are because the pregnancy is not viable.
Home Dopplers Use The Same Technology As Ultrasounds
Hand held Dopplers utilize the same high frequency sound waves as the ultrasounds used to make a picture on a screen. Ultrasound technology has never been proven safe during pregnancy, nor has it been proven dangerous. For this reason, ACOG (the leading obstetrical organization in the US) recommends only one to two routine ultrasounds during pregnancy unless others are truly medically necessary.
The FDA also advised against keepsake ultrasound imaging as they are not medically necessary.
Being that hand held home Dopplers utilize the same technology, one might assume it is a good idea to limit their use. The FDA also advises against home Doppler use. While hand held Dopplers are utilized by a midwife or OB during prenatal appointments, it is likely used for less than a minute or two every 2-6 weeks.
For a trained healthcare provider, the information gained likely outweighs any potential risk. They can assume a pregnancy is progressing well with a proper heartrate (along with checking other things such as fundal height). If they are concerned, they are able to refer for a picture ultrasound.
Utilizing one at home does not necessarily provide a medical benefit and could carry potential risks. One risk is unnecessary concerns which could lead to unnecessary and expensive interventions. If a client is unable to find a heartbeat or interpret heartrate, they are likely to be concerned and reach out to their provider.
If one is unable to locate and heartbeat and it is confirmed by their care provider, the only benefit would be shortening the length of a missed miscarriage. This possible benefit, however, may not outweigh other possible risks in most circumstances.
Midwives And OBs Receive Training For Proper Home Doppler Use
On one hand it seems that a home Doppler is simple to use. While it looks easy, it is important to remember midwives and OBs receive training and likely have years of experience locating fetal heartbeats. It is helpful to remind clients of this.
It can be easy to accidentally pick up the blood flow of the placenta or the pregnant person’s own heartrate. Also, it is easy to miss a heartbeat. This could lead to unnecessary concern and intervention. For this reason, most midwives and OBs advise against home Doppler use.
There are a small number of providers who even avoid Doppler or home doppler use all together as they have concern over the safety of ultrasound technology; or they simply prefer other methods. These providers utilize another method to check heartrate, a device called a fetoscope.
This is essentially a stethoscope shaped differently to pick up a fetal heartbeat. These can be used starting at 18-22 weeks gestation.
Kick Counts Are More Important Later In Pregnancy
For clients beyond the first half of pregnancy, they may have less concerns about miscarriage. That said, it is still not uncommon to have other concerns. This is especially common among parents who have experienced late miscarriages or stillbirths.
Home Dopplers might sound ideal, but lack of professional training can mean they are not the most effective when catching concerns later in pregnancy. Once a heartbeat stops, it is unfortunately too late to prevent anything. As someone without medical training, if a client is able to find a heartbeat but they’re unsure how to interpret heartrate, the information could provide false security.
For this reason, healthcare providers recommend parents use kick counts to monitor their pregnancy between prenatal visits. Abrupt changes in fetal movement can indicate fetal distress. If this happens, your client’s healthcare provider would have you come in for more monitoring. Often baby is simply resting. However, if a concern is found, their midwife or OB will determine what steps to take, including inducing labor or giving birth via c-section so baby can receive treatment.
There Are Many Ways To Bond With Baby
For many parents, hearing the heartbeat at each prenatal visit brings excitement. This experience can help parents connect with their pregnancy and feel as though they are already bonding with their little one.
Recreating this feeling on a regular basis is appealing. This may be especially true for parents with previous losses who are hesitant to connect; or those facing really difficult pregnancies (such as hyperemesis gravidarum). When one faces a challenging pregnancy, it can be really hard to remember they are also carrying a baby and that they’re not just ill.
While a home Doppler is tempting to help with bonding, there are many other ways to bond with baby. Some parents find prenatal exercise and yoga great for bonding. Journaling about pregnancy and/or writing to baby is another way to connect. Taking a childbirth class, going for a prenatal massage and other activities that focus on relaxation and pregnancy can help.
It is important to remember that many parents do not feel a bond or connection with baby until after birth. How one feels during pregnancy is not necessarily a correlation between how they will feel about baby once born. It is completely within the realm of normal to take time to bond and connect with baby, just like any other relationship.
As with all pregnancy choices, home Doppler use comes down to benefit vs risk. If your clients have concerns about pregnancy, they need to discuss them with their midwife or OB. While home Doppler use is quite appealing, it is important to understand and acknowledge the limitations of use. Also, potential risks (e.g., unknown concerns about repeat ultrasound exposure, concerns leading to unnecessary intervention). Do this before making a decision about use.