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Doula--Fetal Doppler?

post #1 of 19
Thread Starter 
Hi,

I am a birth doula pending certification through DONA. I am wondering if it would be bad to buy a fetal doppler to use on clients. I'm pretty sure that I shouldn't do it because I am not a medical person, but I have to ask.

When they're having contractions at home, the only thing I worry about slightly is how the baby is handling contractions and I feel like I would know how the baby was doing if I could intermittently use the fetal doppler on a client. I feel like that could possibly help some nervous clients relax too. I worked in a midwife's office for a year, and I know how to use a fetal doppler...I'm just wondering if it's alright for a doula to have one.

Thanks in advance!
post #2 of 19
Doing anything clinical like that is outside of DONA's scope of practice, so if you really want to do it, I would drop the DONA certification.
post #3 of 19
And if you do decide to use it, you may wish to fully research the risks and benefits so your clients can have informed consent
post #4 of 19
It's out of DONA's scope and it would make me uncomfortable to do something like that.
What if you were using it and didn't get a heartbeat?
What if you get some really low or really high heart tones?
There's too many what if'f for me.
post #5 of 19
Thread Starter 
Yeah, I totally see all of your guys' point. And I totally get that it's out of DONA's scope of practice.

I just have a slight fear that I'll have a client laboring at home who's baby will have low heartbeat and be giving in distress and I won't know about it...But there are lots of doula's out there that don't use them...so I guess it's alright?
post #6 of 19
I think you need to try to remember which hat you're wearing when you're with laboring mamas.

Because you have experience as a midwife's assistant - you know that FHTs are important in assessing labor - but your role as a doula is not to make clinical assessments. It's hard to let go have having that information.

Most hospitals - if they are interested in supporting a woman's desire to have an unmedicated birth, will discourage the laboring mother to come into the the hospital until active labor has started - they are not assessing heart tones.

Other thoughts to remember:

Most of the time - an overwhelming majority of the time: birth works, and mother and baby are fine.

Most of the time when FHTs are "non-reassuring" the baby is fine. This is published over and over again in medical research - that non-normal heart rate patterns are more likely indicative of a well-oxygenated baby than not.

I'm not saying we shouldn't assess heart tones in labor, but as a doula, remember that birth works, that the heart tones are usually just fine, and that the likelihood that a baby would be in true distress during an unmedicated labor in a healthy mama is very very small.

Providing the service of auscultating heart tones in labor may be a service that some mothers would want from a doula - but I would ask myself what would be the value in providing this service, what practice guidelines I would choose to follow, and if I could really call my services 'doula' services at the point I am making fetal assessments and clinical judgments based on those assessments.
post #7 of 19

fetal doppler

If you want to include that in your doula practice you may want to look into other organizations that it is within the scope of practice for the doula. I believe ALACE may allow for that.
post #8 of 19
you might not want to get the dona cert - if you have experience with taking heart tones and you are trying to keep moms home as long as possible it makes perfect sense. But if you do listen and try to keep that cert eventually they will find out you will probably loose that certification
post #9 of 19
You could check into CAPPA as another option also.

Plus, there's no rule that says that a doula has to be certified. You may want to consider not carrying any certification.
post #10 of 19
I have to say that I understand the concern here. Something that comes up a lot in my circle of birth workers is that people who are encouraging moms to stay at home as long as possible are not necessarily doing it to keep help them have a natural birth, but to limit liability...if the woman doesn't seek medical help, the provider can't be held responsible for it. Encouraging a VBAC to stay home as long as possible but then saying that she shouldn't have her baby with a midwife at home is just silly...at home her MW would be checking on mother and baby starting at 4-6cm or so but in the hospital, they're wanting her to stay home until 8-9cm? Whatever...that's kind of an aside.

What you are talking about providing is actually called "montrice service" and it seems to fall into a pretty gray area. There are at least a few organizations that provide montrice certification and teach you to assess dilation and check fetal heart tones. I think it is definitely beneficial for someone wanting to stay home as long as possible because really, how can you know how long to stay home if you're thinking maybe something's wrong with the baby or maybe you're 9cm when you're only 2, ya know? And we all know that these things don't matter, but when women are taught that babies have to be monitored and dilation is the gold standard of labor progress, it's hard to undo that!
post #11 of 19
Quote:
Originally Posted by phathui5 View Post
You could check into CAPPA as another option also.

Plus, there's no rule that says that a doula has to be certified. You may want to consider not carrying any certification.
It would be out of scope for a CAPPA doula as well. I think overall, having a doppler as a doula for use in labor wouldn't be helpful. Its a false sence of safety really. I know I would hate to advise a client all seems well, based on what appears to be a good healthy heart tone and there be a problem. Or advise her that there seems to be a problem, rush to the hospital to find nothing wrong and put her through stress for a poor doppler read? JMO
post #12 of 19
Honestly I wouldn't call myself a doula if I was checking FHT. That isn't a doula's role. I would make sure to call myself something else, because you are just going to screw over all of the other doula's that are practicing with the scope. (I am not cerifited any longer and am also apprenticing to be a midwife. I do this so that I can talk about more than regular doula things at prenatals. I really get where you are coming from.)

OB's only hear that a doula is checking FHT. They don't care about where you certified. It would be bad if that happened here, with the potential to harm other doula's if there is an angry OB.

Maybe calling yourself a labor assistant or montrice would be more appropriate?

For me, I don't bring anything other then a doula bag. I have to think veyr clearly about how I am not assessing baby or mom's health. Otherwise the lines get too blurry.
post #13 of 19
FHTs are tricky, there's a lot more to knowing if a baby is doing well than sticking a piece of equipment on the belly and noting the number of beats per minute. As a doula you are not qualified for interpreting FHTs and doing so is not in the best interest of your clients.
post #14 of 19
I am less concerned about what some organization may or may not decide to tell you you are "allowed " to do (can you tell that I don't like arbitrary rules?) and a lot more concerned about your liability and your ability to USE the information you have. What would you do if you had late decels that weren't coming up? Would you call 911? What if you then found out that the baby was fine? That would be a lot of expense and worry for the old "six ways to read the same strip" story. What if you thought everything was fine and you were actually hearing mama's hr, and baby is in distress? (though I was taught to find the clicking of the chambers of the heart working in the baby to avoid that)...and later on they sued you cause you told them it was safe to stay home and they could have been better off at the hospital sooner? I think that much of the reason to NEVER use a doppler as a doula is that, frankly, the client is not paying you enough for that level of responsibility! If they want a homebirth midwife (an expert trained in in-home labor and birth) to listen to heart tones to "safely" stay home, then they need to hire one, with all the assumed "with woman" responsibility that puts on both the family and the midwife. If they want a doula, and are paying a doula fee, they need to understand that you are not paid enough to take on the level of responsibility it takes to listen to and assess heart tones. It's a whole different playing field. Of course you can do what you are comfortable doing, but it's something to think about.
post #15 of 19
Quote:
Originally Posted by courtenay_e View Post
frankly, the client is not paying you enough for that level of responsibility! If they want a homebirth midwife (an expert trained in in-home labor and birth) to listen to heart tones to "safely" stay home, then they need to hire one, with all the assumed "with woman" responsibility that puts on both the family and the midwife. If they want a doula, and are paying a doula fee, they need to understand that you are not paid enough to take on the level of responsibility it takes to listen to and assess heart tones. It's a whole different playing field.
I agree with this. I think it's a "buy the ticket, take the ride" kind of deal. I do think that you can be trained to interpret FHT (obv...I'm a midwife and I check FHT to be assured of fetal well being), but it takes a lot of listening in different situations and a lot of knowing the full picture and so on. In reality a family that isn't trusting you to catch their baby should probably not be trusting you to interpret FHT...they've hired a physician to "ensure the well being" of their baby and you, as a doula (or montrice is really the appropriate term if you're doing any clinical tasks) aren't going to be afforded that level of trust...and probably don't want it.
post #16 of 19
Quote:
Originally Posted by ewilkins_doula View Post
Yeah, I totally see all of your guys' point. And I totally get that it's out of DONA's scope of practice.

I just have a slight fear that I'll have a client laboring at home who's baby will have low heartbeat and be giving in distress and I won't know about it...But there are lots of doula's out there that don't use them...so I guess it's alright?

Why is it your responsibility to know how their baby is doing should they choose to labor at home? Where is the fear of not knowing how the baby is doing coming from?

Frankly you can get yourself into a lot MORE trouble by having and using a doppler than by not having one.
post #17 of 19
Quote:
Originally Posted by nashvillemidwife View Post
FHTs are tricky, there's a lot more to knowing if a baby is doing well than sticking a piece of equipment on the belly and noting the number of beats per minute. As a doula you are not qualified for interpreting FHTs and doing so is not in the best interest of your clients.
Thank you. This is exactly what I was thinking about. Even if you were listening, unless you have been well trained and experienced for what to listen for during labor, you would not at all be qualified to provide that service and could potentially make things even more dangerous by listening and not knowing what you're hearing.
post #18 of 19
Thread Starter 
Thank you all for your input! After reading all of your wise words I see the reasons why I shouldn't use a fetal doppler. I especially appreciate what krst234 had to say, and I do think that my training as a midwife's assistant is what was affecting me there. Thanks!
post #19 of 19
I personally carry a Doppler to VBACs. A particular doctor whose patients I often see is tremendously supportive of VBACs and evidence-based birth practices. He encourages women to stay home as long as possible. However, he insists on reports of fetal heart times during that time laboring at home. I have the Doppler as a resource for these families, but I do not personally monitor or interpret results. My clients educate themselves on how to use a Doppler and they use the Doppler themselves (usually dad or other present) and I just provide the equipment.
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