The Risk of Home Fetal Heart Monitors

By Tara Parker-Pope
pregnant ladyFilip Kwiatkowski for The New York Times Pregnant women often use home fetal heart monitors for reassurance.

Internet advertisements and parenting Web sites often advise pregnant women to use a fetal heart monitor at home and be reassured by listening to their baby’s heart beat.

“Share the joy of pregnancy and peace of mind of knowing your baby is safe,” the Belly Beats Web site says. The site Heartbeats at Home claims its fetal heart monitors are “simply the best way to gain the assurance and peace of mind every pregnant women desires, especially during a high-risk pregnancy.”

But now British doctors are warning parents-to-be that the home heart monitors can give a false sense of security and lead to delays in medical treatment. In a commentary published today at BMJ.com, Dr. Abhijoy Chakladar and Dr. Hazel Adams, both of the Princess Royal Hospital in Britain, tell the tragic story of a pregnant woman who used a home heart monitor to reassure herself that her baby was fine.

The 34-year-old woman was nearly full-term with her first baby and had experienced a healthy and uneventful 38 weeks of pregnancy. On a Friday, she noticed that the baby wasn’t moving. She used a home fetal heartbeat monitor, and after hearing what she believed to be her baby’s heartbeat, was reassured that nothing was wrong. When she finally visited the doctor on Monday, an ultrasound scan showed the baby had died.

Dr. Chakladar said there was no way to know if the baby’s death could have been prevented, but the fetal heart monitor gave false reassurance and delayed the woman from seeking medical attention. It is difficult for an inexperienced person to distinguish between a baby’s heartbeat and the whooshing sounds of a mother’s own pulse or blood flow. And even when parents do find the fetal heartbeat, there is no way for them to know whether the baby is well or in distress.

“This is something that comes only with experience,” Dr. Chakladar said in an e-mail message. “In hospital, fetal health is assessed by experienced midwives and doctors who take a team approach.”

Dr. Chakladar notes that parents are not at fault and that there is nothing wrong with listening to a baby’s heartbeat. He said the devices should, however, never be used for reassurance. If a mother is concerned and feels she needs reassurance, she should immediately consult her doctor.

“On their own, these monitors are harmless; it is their improper use by parents to reassure themselves which can be dangerous,” Dr. Chakladar said. “These monitors can be great fun, and I would personally buy one. However, they are dangerous if they are used by untrained people as an alternative to seeking medical advice.”

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Z November 6, 2009 · 7:30 pm

It would be interesting to post a blog entry about the lack of evidence that routine use of fetal heart monitors, as opposed to old fashioned periodic stethoscope checks, are helpful even during child birth. It’s a classic example of doctors rejecting scientific proof at the expense of their patients, and it would tie in nicely with the article about evidence-based medicine in this week’s NYT Magazine.

Sarah November 7, 2009 · 9:25 am

I second the first comment. I am a Labor and Delivery nurse. I use fetal monitors every day. And the reality is that the scientific evidence shows that fetal hear monitors do not help mothers or babies. Since the beginning of their use, maternal and fetal outcomes have not improved at all. In fact, they may have hurt. OBs are (rightfully) so scared that FHR readings could later be used against them in malpractice suits that they rush to C-section. And c-sections always double the chance of fetal and maternal death. So lets not pretend that home monitors are the issue–fetal monitoring of any kind is not the boon it is cracked up to be, at home or at the hospital.

rini10 November 7, 2009 · 9:32 am

I don’t think everything done in a physician’s office has to be evidence based. Listening to a fetal heart monitor is non-invasive and easy to do. There is nothing wrong with it if it is not done in lieu of anything more important.

Of course, it’s actually important to listen to the monitor in cases of fetal distress and in cases where decisions about early delivery have to be made (during a non stress test.) I am not an obstetrician, but I think that there is some evidence based reasoning behind the use of the monitor in these situations.

Ayala Laufer-Cahana M.D. November 7, 2009 · 10:33 am

I wish there were some regulation on medical device sales, to protect the trusting public from wasting money on useless devices such as the fetal heart monitor.

This device was put out in the market without a shred of evidence it can aid fetal or maternal health in any way.

And I’m glad you mentioned the risk of false assurance.

Interpreting fetal heart rate is pretty complicated. Fetal heart rate undergoes constant changes in response to the fetal environment and stimuli. It’s the changes in rate relative to the environment–and during labor also to the uterine contractions–which makes the fetal monitor a useful tool in conjunction with other information and tests in the trained hands of an obstetrician.

Monitoring at home in untrained hands, even if done correctly with a good device, can only tell expectant parents if the fetus has a heartbeat.

If the fetus is moving they can be sure it does. If fetal movements are a worry, or if there’s bleeding, a pregnant women should be seen by her doctor.

What’s next, home fetal ultrasound?

nurse Kathy November 7, 2009 · 2:48 pm

Thanks you for pointing this out. This device ought to be sold with a disclaimer detailing the limitations of its technology, as well as a list of maternal or fetal signs/symptoms for which to seek medical advice.

Marie November 7, 2009 · 4:30 pm

Is a fetal heart monitor a microphone, or a form of ultrasound? The link between ultrasound and autism is terrifying. If I were having children today, I would avoid any and all types of electronic monitoring of my child until delivery.

Alexis November 7, 2009 · 6:04 pm

Z: That would be comparing continuous fetal monitoring (cardiotocography) with Doppler or fetoscope. The parents are using a handheld Doppler. Unless you’re a celebrity, you do not buy a CTG machine for home use. It’s expensive, it’s large, and unless you’ve been trained you don’t know how to interpret the strip anyway.

These parents are doing exactly what many midwives would do–the Doppler is simply easier than listening with a fetoscope. It doesn’t produce the continuous tracing that is the hallmark of hospital monitoring (and which still has benefits under certain circumstances).

By the way, an article on EFM was published in the Times not long ago.

Deb, CA November 7, 2009 · 10:43 pm

Keep it simple. Save your money for the college fund.

FETAL MOVEMENT is the best indicator of fetal well-being. Do your kick counts once a day, preferably in a quiet place with no distractions, and after you have eaten something. You should get 10 kicks within two hours, although most babies will give you that in 15 to 20 minutes.

If you notice a significant decrease in the quantity or quality of movements, or it is taking you much longer than it used to to get your kicks, call your provider.

Fetal heart rate monitoring is a valid tool when the results are interpreted correctly. Therein lies the rub. Hearing a heartbeat just tells you that a heart is beating. It doesn’t tell you anything about the health of the being that is associated with that heartbeat.

ER November 7, 2009 · 11:47 pm

This is a very sad story, and I am also interested in Z #1’s comment, which may very well be valid.

That said, I used a fetal heart monitor during both of my pregnancies. After years of infertility, which resulted in a sense of doom even when I did finally get pregnant, and, in the case of my second pregnancy, a blood clot in my uterus, the doppler kept me from calling my doctors constantly. I had an irrational sense of dread, and just having the doppler — even when I didn’t use it for weeks on end — helped keep me from spiraling out of control with visions of tragedy.

All ended well in both pregnancies, and I feel lucky.

E November 8, 2009 · 12:19 am

You assume there is proof to accept. There simply isn’t scientific proof to reject.

Of course we are more likely to reject scientific proof, when the scientific proof is flawed. The data behind intrapartum FHM’s from the 1980’s and 1990’s are too heterogenous for anyone to draw a truly valid conclusion.

Besides. How are you going to convince a practitioner or expectant mother to be “blinded” for such monitoring?

Also, interpretation and training is so variable among practitioners. ACOG, the group responsible for standardizing guidelines among ob/gyne’s, recently revised its guidelines (JAMA, September 2009).

//jama.ama-assn.org/cgi/content/full/302/9/935

They’ve resorted to devising a classification system that’s based on expert opinion. A sad way of saying no rigorous evidence actually exists.

Keep up to date about the actual scientific literature before spouting such nonsense.

Dr. Linda Burke-Galloway November 8, 2009 · 1:05 am

A fetal monitor is not a toy! I reiterate this message to my ob patients on a daily basis. It is a diagnostic tool that should only be used in the hands of a trained professional. There needs to be greater regulation and scrutiny of unreputable companies to prevent the misuse of “home” monitors that, in most cases, do not have the sensitivity to detect a fetal heart tone. The margin of error is great and in the case listed above, tragic. The absence of fetal movement is an immediate emergency. Better counseling from the patient’s healthcare professional and a trip to labor and delivery for further evaluation might have produced a more favorable outcome.

J Cline November 8, 2009 · 6:46 am

I disagree with critics who posit that non-medical personnel should not be using medical equipment for their own body’s care.

(Home blood pressure monitors, anyone? Are those to be discarded, too?)

During my high-risk pregnancy, when I was feeling anxious or simply curious, I used my rented fetal heart monitor to feel more connected to the little life inside me. I didn’t use it daily, didn’t keep a log, or make assumptions that my baby was fine. I was monitored twice weekly, but — in between those times — the home monitor was a nice REassurance that yes, the baby was still there, doing fine.

Contrary to the article’s ridiculous suggestion, a woman of normal weight should be perfectly able to distinguish her own heartbeat of about 60-70 bpm from her baby’s, which is substantially faster and has a distinctive “galloping” sound on a fetal monitor.

While my son was being born, I agreed to have a monitor attached to his scalp as I labored. The monitor’s real-time feedback gave both my midwife and me a sense of well-being to a birth process which otherwise would have been fraught with my concern and her uncertainty.

In a free country, if a woman wants to rent a fetal heart monitor, then step aside, nanny-staters. No harm can be done by the monitor itself, and if the woman chooses to rely upon it, or even forgo her prenatal care, that is a personal choice that she makes for her own body… much like abortion, for that matter. (Anyone on NYT in favor of banning THAT?)

Sarah November 8, 2009 · 9:34 am

Again, I have to say this–any PubMed search will show several evidenced-based articles which show that all FHR systems, home, office or hospital, have not made any positive difference in maternal or fetal outcomes. None. It has not reduced maternal or fetal death rates, it has not reduced the rates of hypoxic brain injuries in the least.

And to rini10, why shouldn’t everything in medicine be evidence-based? Doctors and nurses who stick to methods out of habit or old teaching do a great deal of damage in this world. We in the health fields have a responsibility to our patients to have evidence-based practices, in all settings. Otherwise, what are we doing?

Leticia November 8, 2009 · 3:00 pm

Evidence (data) is one thing. Interpretation of evidence is another. Things may not be as simple as they may seem at first glance, and the early interpretations of a particular body of evidence may well be influenced (a less incendiary term than biased) by the prior beliefs or hopes of the physician, scientist, or inventor who introduces a product or treatment.

Why restrict use of a device that cannot harm either the mother or the unborn child, just because there is disagreement over its value? To many women, the value of using a fetal heart monitor is simple reassurance, and that is worth more than you can imagine if you’ve never been pregnant.

Geraldine November 8, 2009 · 6:07 pm

Antenatal/prenatal fetal monitoring vs. intrapartum monitoring are two totally different animals. This article is about home fetal monitoring. Why the debate on intrapartum monitoring, either continuous or intermittent?

Dr. Meh November 8, 2009 · 10:17 pm

“No harm can be done by the monitor itself, and if the woman chooses to rely upon it, or even forgo her prenatal care, that is a personal choice that she makes for her own body… much like abortion, for that matter.”

When a mother forgoes prenatal care, she increases her risk of having a low birth-weight baby. Those low birth-weight babies tend to end up with “special needs” and, by extension, require public money for special education, transportation, and other wonderful services. So pardon me if I look askance at this particular choice. If I don’t have to pay for it, that’s fine.

As for doing no harm otherwise…what happens when a mother decides to sue the doctors and nurses at a particular hospital for being misleading when her monitor says one thing and theirs says another? You KNOW that’s coming.

Cartier November 9, 2009 · 12:07 am

For all viewers interested in pregnancy, a good website to check out frequently is:

//freshlyskilled.blogspot.com/

It is updated a couple times a day on relevent pregnancy info & frequently asked questions! :)
Enjoy

hystericaluterus11 November 9, 2009 · 3:04 pm

Oh come on!

One piece of anecdotal evidence that this thing MIGHT have contributed to this woman delaying medical attention and now it’s a horrible dangerous devices that should be banned? Makes no sense at all.

It’s not something that I personally see much value in having, but to extrapolate from the fuzzy details in this one case and declare that the devices are dangerous is patently absurd. I’m not a conspiracy person at all, but stuff like this really does make you feel that the medical establishment believes that women are too stupid to think for themselves.

maya November 9, 2009 · 4:39 pm

When I was pregnant with each of my 2 children, listening to their heart beat during the occasional visits to the doctor’s was one of my greatest delights. If the doctor had let me lie in there for 1 hour and listen, I would have- because it was such a pleasure to hear that a tiny creature inside me had a heart beat. I don’t think that letting parents hear their babies heart beats from home is necessarily dangerous. Its all- as are many things- about common sense, as well as not trying to be a doctor/midwife when you aren’t, and understanding that the tool is really to just give you another way to delight in that new soul furrowing deep in your belly.

ambrose November 9, 2009 · 4:57 pm

seems kind of a dodgey option, but i suppose if it was used for specific high-risk women who received proper training it could *maybe* be useful. as described, it sounds way too over-marketed to me. reminds me a bit of those ultrasounds that are more for the pics than the medical value.

the continious fetal monitoring issue isn’t an exact parallel, but it’s sure hard not to think ot it. And i second #1 and third #3.

I didn’t fully understand #10. But i think he/she might be addressing my big question which is: is it even accurate to surmise that the delay led to a different outcome? If the movement had stopped already, could it have mabye been too late regardless?

cause i’m sure this would-be mom feels terrible, and we don’t need to heap extra guilt on her.

Ruth November 9, 2009 · 11:07 pm

An amplified stethoscope is what this device is, nothing more. It is exciting to listen to your fetus’s heartbeat, starting as early as 16 weeks . Expectant couples would not know how to differentiate between their baby’s heartbeat at 130 to 140 beats per minute versus the woman’s own heartrate of 70 to 80, the rate at which one hears (very specific sounds) the mother’s placental swish/pulse (which is not the baby’s heart sound). But knowlege and practice helps to give you the direction in which to go. It is a device to give you pleasure and to promote your bonding, which is the most important part of it. You are not monitoring your pregnancy, unless you’ve been previously, thoroughly trained and tested. Daily counting of fetal kicks in the last trimester is the gold standard for self monitoring. Arriving at your OB office or E.R. is what you do if kicks/movements are absent, or can’t be elicited. Use your own excellent good sense.

MM November 10, 2009 · 3:18 am

Let them have their fetal heart monitors. Women are not children. They’re capable of making their own decisions. They can choose not to get pregnant, to get pregnant and have an abortion, to drink wine during their pregnancy, to eat raw milk cheese and sushi, gain too much weight, to refuse bedrest… They’re adults. You might not like it, but they have the right to decide what to do with their bodies while they’re pregnant. Arguments about whether we have to “pay” for their “special needs children” are absurd. People who make those arguments are always looking for excuses to control someone else’s behavior. The “costs” associated with those “outcomes” are the costs of living in a free society. I’m sick of people looking at pregnancy as a perfect opportunity to control a woman’s behavior.

The evidence suggests that fetal heart monitors do not improve outcomes. So, if a patient comes to a doctor about acquiring one, the doctor should be honest about the limitations and his/her concerns. But let her make the choice herself. Frankly, if it doesn’t work out, that’s her problem. She can take responsibility for it just like she would take responsibility for any other decision she made that day.

mr. xiong November 10, 2009 · 10:19 am

I think that every medical device must be test by the goverment,and baby is very important to the family,for the baby’s safe ,all pregnant women should go to the clinic for the fetal test.

Sandradginzburg November 10, 2009 · 11:25 am

This is article is just plain silly. As other commenters have pointed out, fetal monitoring, even in the hands of doctors, is pretty useless, let alone in the hands of expectant parents. The doctor quoted is trying to make it sound as if the outcome may have been different if the parents had not been “falsely reassured” by the home fetal monitor. But all this doctor is doing is falsely reassuring parents that they, the obstetricians, can prevent stillbirths. Unless you’re prepared to hook pregnant women up to machines 24/7 and tolerate an astronomical c-section rate based on the high rate of “false alarms” caused by fetal monitors, they most certainly cannot.

Lynn Fraley, RN, DrPH November 10, 2009 · 1:19 pm

Listening TO a fetal heart monitor is of course non-invasive. Listening WITH a fetal heart monitor requires a feedback mechanism with sound waves and affects the baby.

Many women told me, when I worked in an antepartum unit in a hospital, that their baby moved away from the hand held dopplers we used to get the heart rate. Most of the time I used a fetoscope, a simple and truly noninvasive piece of equipment, which allows one to hear the baby’s heart rate and not create a negative effect with the baby. Moms commented on the difference and preferred the fetoscope. (“Why doesn’t everyone use that?” was a frequent question.)

A pregnant friend just told me how her baby is agitated by sonograms. Why do we think (or rather, hope) that all these tests and monitoring devices are benign? Posts here that comment on the lack of evidence are right on, and women should be alert to the risks.

There is a huge financial issue here, of course, but that’s another topic.