Tuesday, June 08, 2010

Ultrasound, Doppler, Fetoscope & Pinard Horns


Ultrasound during pregnancy

The administrator of the Facebook group, I gave birth at home. Not brave. Not crazy. Just educated. recently posted this question, "With more and more information coming out regarding the danger of ultrasound, I'd like to hear your comments regarding the use of a doppler in pregnancy and labor. Doppler vs. Fetoscope? I'm interested to hear the perspectives of midwives that may or may not use them, and everyone else."

We thought this was a good question to open up to our readers as we have a number of midwives, birth advocates, women's health researchers, obstetricians and pediatricians who regularly contribute to and read DrMomma.org.

Your thoughts?

Hand held fetal doppler
(these are commonly purchased for at-home use in the United States as well)


Above: Midwife listens to baby with a fetoscope
Below: Mom listens to her baby with the fetoscope

In case the subject of questionable ultrasound safety is new to you, here are several places to begin an investigation:

Dr. Marsden Wagner's Ultrasound: More Harm than Good?

Dr. Sarah Buckley's Ultrasound: Cause for Concern

Gloria Lemay's Ultrasound Precautions

Green Health Watch News: Ultrasound - just looking can hurt

Midwifery Today: Questions about ultrasound and the increase in autism

Midwifery Today: Ultrasound: Weighing the Propaganda Against the Facts

AIMS: Who says ultrasound is safe?

ASRT: Potential dangers of ultrasound on development

Safety and Usefulness of Ultrasound

Book: Ultrasound? Unsound by Beech & Robinson

Gloria Lemay's 7 Step Recipe for scrambling the brain of a baby

AIMS: Ultrasound: Powerful, Dangerous, Unethical


Wooden Pinard Horns
A Midwifery tool from years past for listening to baby's heartbeat.
Pinard Horns are still used today, especially among skilled midwives who do not use other means of ultrasound interventions, and among birth workers traveling to various remote locations around the world.


30 comments:

  1. I use a Pinard Horn during pregnancy (as a midwife). I like it better than either. I give mamas a choice in labor, explaining that the doppler is quick and easy and may be more conducive to her laboring needs, but that of course I cannot guarantee no risk to the doppler, so if she wants to use the Pinard Horn or a fetoscope then she has to commit to periods of her labor in which she can be still, quiet, and in a position that allows auscultation. Most choose the doppler. I also give them the option to not have heart tones taken during labor, explaining the potential risks and benefits. Full informed consent. I think women and families should have that option for every single procedure they may experience.

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  2. I only allowed the doppler to be used during labor. If I am ever pregnant again, I would consider refusing it altogether. My midwives are skilled enough to use a fetoscope during prenatal visits. I have my own fetoscope and loved to use it in the mornings before I got out of bed to listen to my baby and play with him. He loved to kick at the light touch of it.

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  3. I didnt do any monitoring for my home birth. I had one here to use during labor but I was so involved with being in labor it didn't even cross my mind to use it. In my birth center birth they used it twice once when I got there and once during transition. It was quick and didn't interfere with my being in the water.

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  4. I use the doppler, parents like to hear the heartbeat too. They request it. Fetoscope is great when I just am not sure on baby's position, or if it sounds like there are two!!

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  5. my midwife always used a fetoscope during prenatals. she did use a doppler during my labor. in my case that was a good thing. my labor was incredibly fast, and his heart rate kept dropping and wasn't rebounding well. she was able to stay hands on when i was pushing (when she REALLY needed to be hands on) without worrying about trying ot find heart tones with a fetoscope. I think there is a time and place for technology.there are times when benefits DO outweigh risks. but technology should never replace for the sake of progress.

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  6. my midwife used both, but I can tell that she preferred using the doppler. she is skilled with both, and i wanted her to use both. she has the waterproof doppler which was very useful in the tub. for me, hearing my baby's heartbeat a couple times during active labor reminded me that i needed to keep on with my deep abdominal breathing. when i held my breath in pain, i could hear the baby's heart rate change. this was useful to me to keep focus on what i needed to do during labor. (that's not the reason why she used the doppler, but that is what it came to be, for me.)

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  7. My babies don't like the Doppler.

    I vividly remember when my second son turned completely posterior in an attempt to get away from the Doppler (at 39 weeks) and I had to work to turn him anterior again.

    However, it is nice to hear that heartbeat when there's a concern. I think that if it is used infrequently and only as indicated, the Doppler can be a useful tool.

    I cringe at mamas who use one every day though, just because I know how much my babies hate it.

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  8. After reading what Tami wrote above, and thinking back to my pregnancy, I wonder if THIS is the reason my baby stayed posterior and 'scrambled' away each time a doppler or ultrasound was used during pregnancy? We must have had one or the other (doppler or u/s) at least 15 times over the course of an otherwise normal pregnancy. He would kick violently when it was turned on and it seemed to me that he was trying to get away from it. I was always just assured that it doesn't hurt, and he doesn't know the difference between having one on him or not... Now I am not so convinced. And I wonder if this contributed to our very difficult birth DUE to poor positioning. Next time around, no interventions - and especially no ultrasound. Maybe even no dopplers!!

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  9. I do not like ultrasound or doppler. Unfortunately, we are not able to get FHT with a fetoscope (anterior placenta), so we use the doppler. It is used only to get the 15sec reading and then put away. When I start practicing as a midwife, I will use a fetoscope for prenatals and doppler for labors - simply because doppler is quicker and easier to hear and I prefer to let moms do what they need to with minimal interference.

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  10. It is seductive to rely on technology rather than experience because it is so easy. Ultrasound is not safe enough to use as often as they use it.

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  11. Hmm, the links you provided are excellent, but they only offer one perspective.

    I admit I had WAY too much u/s in my last pregnancy (with twins). I don't think it helped one bit other than to ease my mind regarding the health of my pregnancy and babies. In fact, it did NOT any any way accurately assess growth concordance. And considering that both babies turned breech at 33 and 37 weeks, one DURING a high level u/s, I'd say that in hindsight perhaps that contributed to the late change in position. I'm living and I'm learning, often the hard way . . .

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  12. I prefer to have one ultrasound in mid-pregnancy to look for any issues that might impact birth (fetal defects and placental position). I don't like excessive use of ultrasound or Doppler and would never be comfortable with a home Doppler. Fetoscope or stethoscope are totally fine with me.

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  13. all four of my babies have all tried to hide from the doppler too so if i have another i think i will have to think long and hard about the whole thing.

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  14. My mw used a fetoscope during my pregnancy and a doppler when I was in labor because it is waterproof. I liked the fetoscope because it was not an amplified as with the doppler and seems to sound more real

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  15. @Tania--Why do you say that you will use a doppler at births as a midwife? You imply that it is for the sake of the mother, but it avoids informed consent for you to make that choice. I was willing to lift my belly out of the birth tub to avoid a doppler. I also had midwives who did very little monitoring by the time I had my third homebirth, so it was minimally annoying. I would have been angry as hell though if a midwife told me it was not my choice as to which tools she used on my baby!

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  16. None of my younger children liked scans...they swam away from the sonographer!
    In my sons pregnancy, he hated the doppler and would try to move away...didn't help that the doppler kept shocking me though!

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  17. labortrials - We included the links we did because the common consensus in U.S. birth culture is to tell parents that u/s is safe and that it poses no risk (although this has never been tested or shown to be the case). The justification is similar to that which we used to claim x-ray was safe not so long ago... The other perspective is that all of these articles, research, etc., are bunk. The big 'pop' parenting magazines and books ("What to expect..." etc.) will tell parents u/s is fine, expected - necessary - beneficial. We wanted to make sure parents do have the other side of this often untold story.

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  18. I would only use a fetoscope. We actually used a home made pinard horn. Not really though, as it wasn't needed. It was really quite simple to feel her and know she was okay. *shrug* I'm sure that's not enough of a response for some people, but it was something I *knew.*

    I would not be comfortable with a doppler unless indicated b/c it has stronger waves than an US, and I'm already wary of ultrasounds. I think maybe kinda I will get one very quick scan around 26/27 weeks. Maybe. We are still going back and forth but I'm pretty sure one scan is not enough for direct harm.

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  19. After doing some reading when I found out I was pregnant with our first baby, my husband and I decided not to have any ultrasounds done since the safety is not known. My midwife had the option of a fetoscope available, but we chose to use a Doppler instead so that I could hear the heartbeat as well and I didn't know there were risks associated with the Doppler. I scanned most of the articles in the links, but they all seemed to be focusing on ultrasounds...can someone point me to some good articles about the safety (or lack thereof) of Dopplers? Thank you so much!

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  20. With our first child, we had u/s and doppler. The u/s was for dating and was very, very wrong and also caused a lot of stress since it 'showed' the possibility of brain abnormalities (because the dating was so wrong!). It took having yet another one later on to confirm that there was nothing wrong with our son's brain.

    But he was born very premature and by c/s for frank breech because of that dating error. He would otherise have had a lot of time to turn.

    I also had u/s and doppler for our second baby and he hated it and resisted every attempt that midwife, OB, or tech made to 'see' or 'hear' him.

    Our third had one u/s and one doppler listen for a few seconds when I told the OB to turn it off. I then never went back to that OB for reasons I won't get into here, but that baby also hated the doppler and u/s and was very uncooperative.

    I should add that u/s's caused my body such distress that it took me days- usually four- to recover from them. They completely wiped me out in all ways. I was a vegetable for the four days following.

    I didn't have any more interference for my babies- at all once I walked out of that last OBs office. Baby #3 was freebirthed and so was baby #4 and any day now, so will be baby #5.

    I have done no "monitoring" during labour. My babies have been active, alert, and responsive to me the whole time, so there has not been any need or concern.

    I think that because I have only my communication to rely upon with my babies, I am so much more aware of their needs and their expressions while they are in my womb than I was during those times when I had someone else monitor them. The doppler for hearing the heartbeat was not even nearly as reassuring to me as my baby responding to my voice and touch afterward to confirm that he was okay. Now a doppler or u/s would be so foreign that I would feel that we were both being violated.

    My previous experience with u/s and doppler was that they caused unnecessary c/s's, and undue stress and exhaustion at worst and
    at best, they didn't in any way contribute to the health and well-being of me or any of my babies.

    Btw, I find that throughout the course of my pregnancy, the position of the placenta becomes very obvious. U/s for finding its location is unnecessary for me or anyone else who deliberately or just naturally gets to know and understand her body intimately. I see no benefit to handing over such responsibility to techs and their machines.

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  21. I've just met a family who had twins two years ago. They went for an ultrasound on the twins at 24 weeks and during the u/sound exam, the mother felt a "shock". While the transducer was on her belly, the technician said "One of your baby's hearts has just stopped beating". It was beating when the exam started and the mother believes she got an electric shock and it killed one of her twins.

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  22. The ASRT link that you posted is a good link... With ALL imaging, risk vs. benefit must be thought about. I am a registered x-ray tech. I ONLY x-ray people if needed and with a doctor's order. It is much better to know if a bone is broken and how--minute risk of radiation compared to making sure the bones are healing. This also applies to ultrasound. To date, there is NO actual evidence that US causes any harm to people. The ASRT (and every tech and radiologist you will meet) will tell you that medically necessary scans can provide vital information. The ASRT is warning against use performed by untrained and/or unregistered people and for uses such as "keepsake books". The ASRT took a hard look at these "novelty" types of imaging done at malls and whatnot after Tom Cruise and his wife Katie decided to purchase a scanner so they could do it anytime they wanted at home. This is wrong. I am currently pregnant and will have an US done in 3 weeks. My daughter had the exact same thing done, and she is a wonderfully healthy 19 mth old.

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  23. I allowed my midwife to use the doppler at my first prenatal visit (15 weeks), as she could not hear the baby's heartbeat yet with the fetoscope (generally you can hear FHT by 20 weeks with a fetoscope). At my 19-week visit she was able to ascultate the FHT and I have only had the fetoscope used since then. I am willing to have the doppler 2-3 quick times during labor if I am too much "in the zone" to lay down and let her hear with the fetoscope.

    Thanks for putting this info out there---several of the articles I had read already, but they are not normally "out there" for the majority of new moms.

    Jessica

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  24. India has published many articles on the dangers of using doppler/ultrasound in pregnancy, but the USA does not teach this research to our residents because the consumer demand is out there, and the damage is not readily apparent. Many years ago I remember a study where they passed the ultrasound wand over a petri dish of cells that were dividing- the chromosomes immediately mutated. Several hours later the cells seemed to be repairing the damaged chromosomes...My questions is this. If you are ultrasounding a baby GIRL, who's ovaries are forming all the ovums she will have for the rest of her life, and chromosomal damage is done to THOSE dividing cells, which then "freeze" until years later when they are released each month... Who will link any rise in female infertility or "damaged" offspring to having had their ovums ultrasounded when they were still in their mother's womb twenty years ago?
    I prefer to use fetalscope over doppler until after the 2nd trimester, and not to use ultrasound unless there is a medical indication- but I let the parents make the choice after I tell them my preference.

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  25. @Anon - Tom + Katie purchased it for the use of their OB/GYN, not personal use. Pretty well known fact, published in vanity fair after Suri was born :)

    Next time... I would do things totally differently. I've had 2 children. Both have had extensive US (about 7 for one, 9 for the other) for differing reasons. They're now 2 1/2 and 10 months. One was a CS, he was breech. The other was a VBAC with no scan for 'growth' thankfully.
    I would probably have 2 US next time (12 weeks, and 18 - 20 weeks) and utilise whichever way my middie preferred to listen to HB towards the end of my pregnancy and in labour (in a water-friendly manner that is ;) )

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  26. When I had my first child, the doctor's office had to search for the fetoscope when I asked for it - no one had for years and years. But my FP was amazing and she brought one with her from her main office whenever she was visiting the small clinic because she knew I preferred it (it was kept on the wall in the main office - more like decoration! When I mentioned it to a young OB I saw one time, she said they weren't even taught how to use it in med school - "they're antiques."). My doc taught her students how to use it on me (with my permission) during my second pregnancy.

    Now that I'm pregnant again and seeing a midwife, she always seems rather uncomfortable using the doppler for heart rate. She has successfully used the fetoscope once, and the baby kept turning away from it the last time and she apologized for using the doppler. I'm thankful for her concern, but throwing a couple of miscarriages into the mix between #2 and this one... I am more than happy to take the 10-15 second risk to actually hear a heartbeat.

    We've never had an ultrasound done in pregnancy. I'll admit that I get pangs of wanting to know what MY baby looks like when I see other friend's u/s pictures (2D - the 3D are creepy). But that's not reason enough to have one done. I did consider having one done this time because this will be my first homebirth and we're at least a half hour from the closest hospital - 1.5 from the hospital of my choice. But I truly believe that this imposed fear has no place in my labor and birth, I have a skilled attendant, and enough can be told by palpation and where sounds can be heard to let go and trust things are okay. After all, my doctor never pushed for an ultrasound when I was having hospital births - why needlessly worry myself now?

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  27. “Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.”
    Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.”
    Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary.
    “That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.”
    Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on toll free: 888-419-6855.

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  28. Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike "differentiated" cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus.
    Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it. For example, neural cells in the spinal cord, brain, optic nerves, or other parts of the central nervous system that have been injured can be replaced by injected stem cells. Various stem cell therapies are already practiced, a popular one being bone marrow transplants that are used to treat leukemia. In theory and in fact, lifeless cells anywhere in the body, no matter what the cause of the disease or injury, can be replaced with vigorous new cells because of the remarkable plasticity of stem cells. Biomed companies predict that with all of the research activity in stem cell therapy currently being directed toward the technology, a wider range of disease types including cancer, diabetes, spinal cord injury, and even multiple sclerosis will be effectively treated in the future. Recently announced trials are now underway to study both safety and efficacy of autologous stem cell transplantation in MS patients because of promising early results from previous trials.
    History
    Research into stem cells grew out of the findings of two Canadian researchers, Dr’s James Till and Ernest McCulloch at the University of Toronto in 1961. They were the first to publish their experimental results into the existence of stem cells in a scientific journal. Till and McCulloch documented the way in which embryonic stem cells differentiate themselves to become mature cell tissue. Their discovery opened the door for others to develop the first medical use of stem cells in bone marrow transplantation for leukemia. Over the next 50 years their early work has led to our current state of medical practice where modern science believes that new treatments for chronic diseases including MS, diabetes, spinal cord injuries and many more disease conditions are just around the corner. For more information please visit http://www.neurosurgeonindia.org/

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  29. Can anyone explain to me the sounds of the placenta, heartbeat, and fetal movement, when using a fetoscope? I am 19w3d and believe that I have found the heartbeat, and placenta sounds, and am hearing the baby kick as well, but I am unsure. I have listened to audio clips of the doppler, but know that these sounds will probably sound a little different with the fetoscope. Please help me to understand what I am hearing. Thanks.

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  30. A watch ticking through a pillow. You hear and feel the rhythm of the vibration more than you hear the beat. It is really quite amazing and beautiful.

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