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Doppler Use or an Ultrasound, which should I consent to? Going to have to give on something :(

post #1 of 12
Thread Starter 
In the past, I have declined routine ultrasounds but allowed Doppler use at prenatal visits. The more I research, though, I don't want either this time around. However, my midwife is heavily pushing an ultrasound, refuses to use a fetoscope and is insistent on Doppler use.

I have read that just one minute of Doppler is the equivalent exposure of 30 minutes of ultrasound use, which makes me feel foolish for allowing Doppler while avoiding ultrasound. So I am wondering if consenting to one ultrasound and asking to forgoe Doppler in return would make sense.

I can't seem to find much information on this, most of what I find focuses on the risks of ultrasounds and doesn't really elaborate on the statement that each Doppler listen is a much higher exposure anyway. If US is less exposure, why don't providers use a short ultrasound at appts to check on baby instead of Doppler? Confused.

Can anyone enlighten me? Links? I hate feeling like I have to negotiate, but UP/UC is not an option for me and other providers around here have the same requirements. Thank you!
post #2 of 12

Ultrasounds and dopplers aren't really substitutes for each other.  Ultrasounds are much more expensive machines to buy, maintain, and run, and the information you get from an ultrasound (a picture) requires more skill and training to interpret then the results you get from a doppler (usually just the heartbeat).  Lots of insurance companies are reluctant to pay for repeated ultrasounds, and they really are more expensive.

 

An ultrasound can get you a lot of information, but a single ultrasound won't substitute for what the provider is looking for when they whip the doppler out, which is confirmation that the baby's heart is beating a reasonable number of beats per minute at each appointment. 

 

I don't know what your midwife's rationale is on preferring the doppler to the fetoscope.  There may be a solid reason for it, but whatever that reason is, it probably doesn't address your concern about ultrasound exposure.  I'm sorry I don't have an answer for that one either.

post #3 of 12

It doesn't take a minute on the doppler to check the heartbeat in pregnancy, more like 15 seconds. If they can be quick I allow it. It's a shame your midwife won't even try a fetascope, that's a real shortcoming in my eyes. After I mentioned Doppler bothered my middle child (he would kick and struggle and his hb would spike in response to it), mine always tried fetascope or a pinard horn and offered doppler if they couldn't pick the hb up.

post #4 of 12
Thread Starter 
Thanks for the responses. Realizing the Doppler was such high exposure was a surprise to me considering how much they are used. The midwife says fetoscopes aren't fast and reliable enough in a busy practice and she has very little experience using one.

I agree with you, her attitude is arrogant and dismissive in my eyes, especially considering I take none of her time asking basic questions or getting other testing done; I'm an in-and-out patient.

Thinking I will ask for Doppler use to be as brief and limited as she will agree to.

ETA: the more I think about it, I don't really see the medical necessity of hearing the heartbeat at each visit although I would find it reassuring.....I'll be interested to hear her reason for needing it. I suspect it will be something along the lines of, 'why are you here if you want me to do nothing?'
Edited by neycie - 10/26/13 at 3:46pm
post #5 of 12

I actually made an account just to comment here...!

I think you are mixing up handheld dopplers (the kind that midwives and OBs use to routinely check heartbeat) and doppler ultrasounds. Doppler ultrasounds use pulsed-wave doppler to measure bloodflow. You would usually only get something like this if you were referred to have a "level 2 ultrasound" to check things like bloodflow to the placenta or heart conditions... Only really in certain "high risk" scenarios. You wouldn't be given an exam with one of these machines at a routine prenatal appointment, you would be referred to a specialist. These are the "dopplers" associated with research which suggests they might not be totally safe for prolonged use. Handheld dopplers use a much much lower frequency/gentle sound-wave and are considered safe for prolonged use, although most of the time they aren't used for longer than a minute. Doppler ultrasounds use a different kind of sound wave than hand-held dopplers. Most pregnant women are not examined with doppler ultrasounds. 

post #6 of 12
Thread Starter 
Yes, although I am a little confused, I do realize there is a difference between Doppler sonography and hand-held Doppler use. I believe the research I am referring to is comparing hand-held Doppler use to routine ultrasound use, not to a Doppler ultrasound. My midwife did not dispute the comparison either, she just didn't care to modify her usual care.

"Normal" ultrasounds are of some concern to me as well (although I realize they do not concern most moms), so my question pertained to comparing hand-held Doppler with routine ultrasound exposure.

However, obviously I am far from an expert in this and any information is much appreciated! I guess I'm wondering if you have read or are interested in the exposure and risk/benefit information I was referring to or were basing your comment only on my post?
Edited by neycie - 10/30/13 at 3:38pm
post #7 of 12

I'm 29 weeks pregnant right now, but at 6 weeks, I had a misdiagnosed miscarriage. I think probably a combo of implantation bleeding and a subchorionic hematoma that was later discovered. The ER docs definitively told me I lost my baby, though. So it was understandably traumatic and difficult, and in order to confirm, first that it was a miscarriage, and then that it wasn't, and then a usual dating ultrasound and to make sure an issue with the gestational sac measuring a bit small was resolving, I had to have an ultrasound at weeks 6, 7 and 8. 

I am in midwifery care (in Canada, BC to be exact).

Anyway, I had a really really difficult time becoming excited about the pregnancy again because I was completely gutted by the miscarriage "diagnosis" and then having to get on board with being pregnant again after I had kind of come to terms with losing the pregnancy. I found that the time I felt the best about the pregnancy was at my 16 week appointment when I heard the baby's heartbeat for the first time with the doppler. I did a bit of research and decided to get a home doppler to mitigate the extreme level of worry and anxiety I was feeling, or to help me become more attached to the pregnancy. from weeks 16 to 24 or something, I would check in daily for a moment or so. I became really good at finding the heartbeat right away and eventually I would just click it on enough to hear a few beats and then turn it off. Once I started feeling the baby more (I have an anterior placenta, so this was kind of delayed), I stopped using it regularly.

Earlier on, my mother in law had guilt-tripped me over the "excessive" ultrasounds I had earlier on in the pregnancy (I've had five over all, three in early pregnancy and two anatomy scans because my son was too low to properly examine in the first one -- I declined genetic testing so I felt the anatomy scan was a good idea -- if everything continues to go as well as it is now I probably won't need another one for the entire pregnancy), so I decided to do some research. I have found that in a lot of natural/attachment parenting literature that most of the doppler research is for the doppler ultrasounds, and not handheld dopplers. I have found that it seems like people often conflate the two and it amounts to (what I feel is) misinformation. 

I would be slightly curious to read the information you're citing -- because as far as I know, based on everything I've read (which is quite a bit, but I'm obviously not an expert), a handheld doppler is considerably less powerful than an ultrasound, and the most troubling findings have been with the doppler ultrasound, which as far as I know is quite rarely used and only for diagnostics when serious problems are suspected. When I enquired with my midwife, she seemed to support the idea that a lot of the negative findings were with pulsed-wave doppler ultrasounds, NOT the handheld devices. 

post #8 of 12

The biggest issue for me wouldn't be the Doppler, ultrasound, etc, but you feeling like your midwife can't respect your wishes. Are you comfortable advocating for yourself in this scenario?

post #9 of 12
Why dont you UP/UC? If you dont find the need to have any of this stuff done, why go to a place or use someone who finds these things a necessary part of their practice? The reason to hear the heart rate during pregnancy is to determine if there could be a heart problem. You cant fix a heart problem while pregnant but if you know about it ahead of time it can save your baby's life by delivering someplace that can be prepared to operate immediatley after birth. Ultrasounds can also make a difference in outcome of the baby. The chance of doppler or u/s harming your baby, especially after your first trimester is incredibly small but it can make a huge difference in your baby's life. I say consent to both if not only once in your last trimester. Not trying o shame you but if you didnt consent to one of these for fear of a minute possible risk but then ended up missing a problem that could have been no big deal had it been planned for, how bad would u feel? Birth defects, etc., are not something that just happen to other people who dont do things the right way.
post #10 of 12

How far along are you? Would she be all right with skipping the Doppler after you are feeling the baby move regularly? I think it's nice at the early visits to be able to verify everything is still okay in there, but once the baby is bigger you can tell that for yourself. 

 

If she doesn't feel competent with the fetoscope I wouldn't try to make her use it. Do you really want her doing an exam she doesn't feel like she's very good at and doesn't think she can get accurate results with? I'd save your energy to advocate for yourself on other things. 

post #11 of 12
Thread Starter 
This CMN practice is by far the best there is within hours of me, other than a DEM homebirth. Not a natural birth friendly area. They don't respect all my wishes, but I do realize the need to compromise if I want to use them. And yes, I sure don't want her using a fetoscope if she doen't know how!

Sure I could UP/UC or homebirth, but personally I don't want to, and honestly, as long as I am low-risk and not having concerning symptoms, I don't understand why asking for an ultrasound-exposure free pregnancy and still being able to birth in a hospital is viewed as unreasonable....??sometimes by both the HB and the medical community. Routine US has not been shown to statistically improve birth outcomes. In fact, it harmed my first child by providing incorrect information that led to unecessary intervention.

Bailey, I do think about potential birth defects and I certainly don't blame the parents! I know people with those situations and it is one of the reasons I prefer to deliver in a hospital. It is a major medical center that could treat an emergency quickly. So in my situation, I don't feel sure that any US risk is incredibly small compared to the risk of not screening for heart problems, since US safety is not proven and we know it causes cellular changes. It's really about your individual situation and the medical community seems to make little allowance for that. If I was planning a homebirth or a UC, or I would consider having one.
post #12 of 12

I personally don't see a problem skipping dopplers at each appointment, I don't see why the midwife would. I know my midwives ask at the end of each appointment "would you like to hear your baby?" and I don't think there would be a problem with me saying no. I do find it reassuring to hear that first time though. We typically go ahead and listen for DH's sake as I know he has trouble relating to the baby since he can't feel it moving or anything (esp. with my anterior placenta).

 

They have never presented the 20 wk. ultrasound as related to appointment doppler checks so I'm not sure why your midwife would give you such an ultimatum. It sounds to me like she is not skilled with using a fetascope (but perhaps doesn't want to say so) and that's why she's refusing it. With my last pregnancy we did as the midwife to try the fetascope and although it took longer she did find it (we wanted DH to know how it sounds so he could try it himself at home). I hope you are able to find something that you feel comfortable with.

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