Fetoscope help!

[doctorjen]

Okay, I have my first ever client who is declining doppler use during pregnancy. She has her own fetoscope. Can someone please tell me how to use the darn thing so I don't look like an idiot? (Now really, this mama is very patient and knows I'm new at this so she's fine with fumbling and eager to let me play around and try to learn, but I'd like to look a little bit like I have some clue!)
I get so few clients who have any requests of any kind I'm just thrilled to death to have someone who has some ideas, any ideas, of what they want! I'm sure this will be a fun birth for me.

[Defenestrator]

You can hear on some mamas as early as 18 weeks, but for others with placentas in the front or a little padding or a posterior baby, it might be as late as 30-32 weeks before you can reliably hear. I often chart when I feel kicks during palpation in the second trimester as a way of documenting that I felt the baby's vitality if I can't hear the heartbeat.

You can hear maternal blood vessels and placenta sounds -- those are slower. Most traditional fetoscopes have a sort of curved bar at the top, making them t-shaped. You are supposed to put your forehead there to help amplify the sound, but that has not really worked for me, so I use that part as a handle. Usually when I am starting out and unsure of baby position (like at 20 or 22 weeks, I will just listen once every inch or so in a line across the lower abdomen a little lower than halfway between the umbilicus and the pubic bone until I find the heartbeat. If I can't hear it I try again in a line about two inches higher and then again in a line about two inches lower than the original spot. Later in pregnancy, I will palpate and try to feel where the heart would be -- I listen directly on top of where the heart is through the baby's back if the baby is anterior. If the baby is posterior, sometimes I hear on the opposite side of the back, through the chest (so if I am listening to an ROP baby I would listen approximately where I would listen to an LOA baby). Babies who are posterior often have heart tones in a position higher on the abdomen than anterior babies. I have often found them up above the umbilicus, as if the baby were breech. (On the other hand, frank breech babies can sometimes have heart tones quite low in the pelvis if they are engaged)

I am sure all of this is stuff that you know, but sometimes you have to be more precise when using a fetoscope, so some small bits of it might be helpful.

I am really glad that this mom has you -- thanks for being open and flexible!

[BeckiCNM]

Is it normal for it to feel like it takes you forever to find it? I have a few women who have requested the fetoscope, and I do try my best, but I always feel like it takes me forever to find the right spot, and I wonder if they think I'm inept or what....I never saw one used when I was in school, so I'm pretty much self-taught. I have to say, though, I'm really proud of the docs that I work with that they bought one for me. :

[doctorjen]

Stacia, thanks so much, that's really helpful. My partner trained before the era of routine doppler use and told me he always had better luck with the forehead thing, so maybe it's sort of individual?

[MidwifeErika]

You know, I have never actually tried it on my forhead, I have always just used it as a handle..... maybe I will try it and see if it helps. I just thought it was there to be handy as a hands-free way to check fht.

[JunipersMom]

It takes me a while to find a good strong read-able FHT when I use the fetoscope until about 36 weeks when its much easier to find and faster. I start useing the heel of my hand and if its taking a bit I do switch to my forehead which for some reason works for me. I have had a heck of a time with the fetoscope in labor though and I do ask my moms to let me use a doppler in labor if I feel it necessary. It took me a while to figure out the placement as it is much more precise than the doppler. Best of luck and if you find any tricks - pass them on!

[courtenay_e]

Um, I'm pretty much a newbie, as well, but I think the forehead vs hand thing may be a combination of personal preference and particular fetoscope. I "learned" on one fetoscope and could NOT get a bit of sound with my forehead, only my hand. Now, the midwife I work with is quite kind to let me find the tones and listen with HER fetoscope, and I can't get it UNLESS I do it with my forehead...and she says that she has better luck with her forehead, as well. *shrug* The two different experiences make me wonder if it was the scopes...

[Defenestrator]

I agree with courtenay about the difference between fetoscopes. The only fetoscope that works for me is the cheap $15 one that has a long tube. I have some hearing problems -- I don't think that my hearing is all that less sensitive than normal, but I have scarring in my ears that mean that the earpieces have to be at just the right angle. I would guess that the nicer fetoscopes probably have better mechanisms for the amplification of sound.

It can take a while when the baby is little to find a heartbeat. Once you can determine the baby's position, though, it shouldn't take that long. One thing that you might have to do is to try on a few spots along a vertical line -- the location of the sound can be higher or lower than you expect..

It definitely is a learned skill but I was pretty much self-taught and my apprentices seem to do just fine with instruction. I feel like it has taken me about 200 prenatals to get to this point (though who knows, I'm a little bit slow).

[paquerette]

We just got a brief intro to it this weekend (I took the ALACE doula workshop) and it was explained to us that the bones in either the hand or the forehead work to amplify the sound. So it makes sense that slight variations in our hands or foreheads would make one or the other work better.

Our mama model was about 22 weeks and we did get to hear, but we had to chase the baby around a bit. And you do have to press in a bit firmly. But I've never used a doppler so I don't know how that compares.

[doctorjen]

I heard the baby with the fetoscope today! Mama is 22 weeks now, and she is quite thin, so perhaps a bit easier to hear. She has her own fetoscope with a long tube, and I also got out my partner's which is an Allen fetoscope with a very short tube. I do better listening with the forehead thing, but I was able to hear much more faintly even with hers, but when I passed the ear pieces to her, she couldn't hear yet. I like my partner's much better - I think the shorter tube works better for me, but he has a type of ear piece that I don't like on a stethoscope. In order to hear, I have to use one hand to hold the ear pieces up higher in my ears. With my head pratically on her belly with the forehead part, I had a hard time seeing my watch to count! I'm definitely awkward, but she doesn't seem too fed up with me yet.

Just thought you all might like to hear about my first ever fetal heart tones through a fetoscope!

[courtenay_e]

Hoooray!!! Isn't it COOL?

[heartandhandsdoula]

My MW always just used a plain old stethescope and we could all take turns listening to it, it was very faint but there.

[tinyshoes]

Heh! That is wonderful, Dr. Jen.

I just bought my own cheapie $20 long-tubed fetoscope for fun, and both dh and I found FHT at 16 weeks (yes, I'm thin, but not THAT thin--and I gain a pound a week when pg.)

At my 17 wk prenatal appt yesterday, my primary mw used her short-corded Allen to find the heartbeat. Her partner, a veteran CNM of 8 yrs (who is now learning the homebirth ropes) was having a heck of a time w/ the fetoscope & heard nothing. Then we discovered that perhaps the former CNM midwife had the ear pieces in backwards--and that little detail can make a difference...you gotta have the earpiece thingies angled forwards (if that description makes any sense at all!)

Another factor is good hearing (like my 6 year old who heard the FHT after I found them...I watched her tap it out) and/or having lived a blah non-concert-going lifestyle (like me!)

Now that I've heard them for the first time last week, I find the trueness and heart-beating-pureness of FHT via fetoscope soooooo compelling and beautiful; even more beautiful than those lovely galloping Doppler horsehooves.

[cathicog]

Originally Posted by doctorjen

Stacia, thanks so much, that's really helpful. My partner trained before the era of routine doppler use and told me he always had better luck with the forehead thing, so maybe it's sort of individual?

I have found taht using the forehead thing helps.When you find the hb, it sounds much like a watch ticking under a pillow... Sometimes it does take a little looking(we are so spoiled with the ease of dopplers, huh?) but once you find it, you will always remember that sound. It also makes it easier to find it again, cuz you know what you are looking for. What's hard for me, is the pinard horn...have only used it once, but need to practice. It works well...

[sevenkids]

I find a wooden Pinard horn easiest to hear with, it becomes part of my ear. I LOVE my pinard!
But I've gotten FHT's with a fetoscope under water using my hand.
My MW only used a pinard, she put an X on my belly in labour so she could find it again, by the time the baby was born I had a trail of X's according to the baby's rotation, very funny.

[nizhoni]

I have used almost every type of manual fetoscope there is. For me, the Allen with the short tube works best for picking up FHTs. I have a little hearing problem (at age 53 I have a lot of concerts under my belt, lol!) but thankfully I can still get FHTs with an Allen. There is definitely a challenge to hearing heart tones at 18-20 wks if the placenta is anterior, however. I did not have as much success with the longer-tubed Allen or the less expensive Mabis model.

I also have a Sklar-Leff fetoscope which I purchased back in 1981 before most of us carried dopplers; I bought it so that I could hear heart tones in second stage without asking the mama to lie on her back. The tones with a Sklar-Leff are less crisp than with the Allen and I find that I cannot hear FHTs as early in pregnancy with the Sklar-Leff as I can with the Allen. However, it becomes much easier for me to hear them as the pregnancy progresses and the baby gets larger. So if my doppler ever fails during labor, I won't be out of options.

Besides, have you ever hefted one of those Sklar-Leff fetoscopes? You could use it as a weapon! I often think that if I'm confronted with an assailant in the middle of the night I can bean him with my fetoscope if I can just get him to wait for me to get it out of my midwifery kit!

I cannot hear with the Pinard horn--sad, because they're so lovely! But the aluminum Pinard has a base that unscrews and I knew one physician who had used it that way to suction a newborn because there was no bulb at hand.

I have never been able to hear with the DeLee "unicorn" style fetoscope. Has anyone used the DeLee successfully?

Marla

[davidah]

I'm not a birth professional, but we brought our own fetoscope to our prenatals with a very cool family practice Dr. She had a little bit of experience with fetoscopes due to some work she had done in Africa. We have fantastic pictures of our older daughter attempting to listen to the baby's heartbeat with the fetoscope and looking like a real midwife. You should definitely encourage these clients to take some photos of you with the fetoscope and DH, siblings, etc.

Have fun!

Davidah

[sweetsadie77]

Sometimes, if with the fetoscope I can't hear heart tones where I think the back is or with an OP baby, if I listen right over top of a woman's belly button I can hear there.

[mwherbs]

I am glad to read that you could hear. things that I do when they are little is to limit the space they are in by putting one hand on the unoccupied half of the uterus so that keeps the little one from swimming away- the head piece really helps with conductive hearing and I use it early and when it is hard to hear-- my favorite fetalscopes are the wide wooden pinards- they have a deeper tone and even the outer parts of my ears feel the beats--
as for the kind with ear pieces just like with a stethoscope how the ear pieces fit into your ears and that they are pointing right into the ear canal - that you are not touching the tubing or having things rub against it will decrease the artifacts and make for better hearing--
I palpate first then listen it helps to narrow down where to listen--