Why Ditch the Doppler?

Written by Kicks Count CEO, Elizabeth Hutton:

At Kicks Count we have been working for many years to try to reduce the UK’s stillbirth and neonatal death rate, which is the 3rd worst in the developed world. While progress is being made, there is one obstacle that just keeps getting bigger. The rise in the use of home dopplers.

In 2017 we launched an awareness campaign which ran alongside a petition. The aim was to regulate/ban of the sale of home dopplers on the consumer market. Opinion on this tends to be quite polarised. Midwives, doctors, healthcare professionals, and maybe most significantly, many bereaved mothers are in favour of the ban. Mums-to-be who use them are often against it and think I am being a killjoy.

I completely understand the appeal of home dopplers, if they had been around when I was pregnant I probably would have bought one. But that was before I was aware of the risks they pose.

A really important point is that even the manufacturers do not recommend them for mums. They are intended for medical professionals. The general sale of these devices to women implies they are safe and suitable. 

The most significant risk of using a home doppler is that mums may be falsely reassured when they hear a heartbeat, when actually their baby could be in distress. This could lead to life-threatening delays in seeking medical assistance. The best indicator of fetal wellbeing is always the baby’s movements and this is what we should be focusing on – not these cheap imitations of medical equipment.

The most important message we try to get across to pregnant women is that home dopplers are not microphones. They are not amplifying the sound of your baby’s heartbeat. They are sending ultrasound waves into your body that reflects off moving blood vessels and SIMULATE a sound. There are a lot of blood vessels in a pregnant woman's abdomen, the baby’s heart beating being just one. The placenta also pulses at the same rate as the heart and the mother’s main artery runs across the abdomen and that can also be picked up on a doppler. There are so many vessels that can simulate the same sound as a fetal heart. NICE guidelines even highlight the risks to professionals - “Do not rely solely on the CTG trace for fetal wellbeing. Be aware of limitations and artefacts i.e. doubling of the maternal pulse being recorded as the fetal heart.”

Midwives train for 3 years to be able to differentiate these sounds using equipment costing upwards of £400. A £30 device from Amazon does not operate to the same high standard, and a YouTube tutorial can’t possibly hope to offer you the same education and skill that a midwife has. If that was the case, the NHS could save a fortune buying home dopplers instead of the high-quality equipment that they do purchase. I would compare it by saying it would be like checking your friend’s heartbeat with a Peppa Pig stethoscope rather than going to a doctor. The two pieces of equipment just can’t compare.

But putting all that to one side for a moment and just for arguments sake, let’s say these home dopplers pick up the heartbeat perfectly and the mum can pick it out flawlessly, what does that tell us? Absolutely nothing.

If you saw a person collapsed in the street would you check their pulse and walk away? No, you’d probably call an ambulance because this person is clearly unwell, even though they have a heartbeat. It is the same with a baby. If a baby’s movements change, it can be a sign that they are unwell. Just because they have a heartbeat does not mean anything. Everyone has a heartbeat up until the second before they pass away. All a heartbeat tells you is the baby is currently alive, which is the only time something can be done to help a baby in distress. If you wait until you can’t find a heartbeat it’s too late. Picking up the fetal heartbeat is a snapshot in time – 5 minutes later the heart can stop. It is so important that mums do not use the presence of a heartbeat as a sign their baby is well. NICE guidelines also state - “Auscultation of the fetal heart may confirm that the fetus is alive but is unlikely to have any predictive value and routine listening is therefore not recommended.” Even for trained midwives, this is not a reliable determinant of fetal wellbeing.

Fans of home dopplers say that they shouldn’t be banned and there should just be more education about not using them for reassurance. But as a charity, Kicks Count has spent the last 7 years doing this and so far it isn't helping. 

Users say they offer bonding, but there are other ways to bond. If siblings or partners want to hear the fetal heart ask your midwife to record it at your next appointment. The risk of using them for ‘fun’ or bonding is the same – hearing a heartbeat is subconsciously reassuring, however much we tell ourselves they won’t be used for reassurance.

The NHS, The Royal College of Midwives and even the FDA (Food and Drug Administration in America) all warn of their dangers. The NHS choices website says home foetal heart monitors “are potentially dangerous to the mother and baby’s health”, The RCM website says: “Expectant mothers have been warned against the use of home fetal Doppler devices over fears that they may give false reassurances to mothers about the health of their baby.” But these aren’t the sites pregnant women are checking. They see a product in a pregnancy shop that makes some very exciting claims. Who wouldn’t be enticed? We can’t blame pregnant women for being drawn in by these devices when they are marketed so cleverly. This is why we need to ban them from general sale.

It is up to the Government to overrule these companies looking to make a profit and instead put the safety of mums and babies first.

In January 2018, the Department of Health announced a Medicines and Healthcare Regulatory Agency (MHRA) review of fetal dopplers. The Department of Health MHRA Review is ongoing.