Exploring how people make decisions about using (or not using) fetal Dopplers outside of clinical settings

Problem

Fetal Dopplers are handheld devices that use ultrasonography to listen to an unborn baby’s heartbeat. In recent years, medical regulatory bodies and charities have issued warnings advising against the use of at-home fetal Dopplers because of concerns including safety and (mis)interpretation, delayed care-seeking and exacerbation of anxiety. However, they are widely available and utilised outside of medical settings by pregnant people. Little is known about the drivers for this use, or how this intersects with medical care.

Approach

We conducted semi-structured interviews with individuals who chose to use an at-home Doppler (N=15) and those who did not choose to (N=5) to explore decision-making around and experiences with at-home Dopplers. Interviews were transcribed verbatim and analysed thematically (NVivo12). We will gather feedback on the potential implications of our findings in focus group discussions with healthcare practitioners (midwives, GPs, and obstetricians).

Findings

The tensions between awareness of surrounding safety concerns (including misidentification of maternal and foetal heartbeats), alongside widespread commercial availability was apparent to both Doppler users and non-users.

In navigating decision-making about Doppler use, individuals constructed a nuanced set of ‘right’ and ‘wrong’ reasons which informed what was deemed acceptable use..

Acceptable Doppler use was typically framed as ‘non-medical’, including social listening in with family, for early pregnancy validation and bonding, and for reassurance about the baby and pregnancy. Accounts differentiated (acceptable) checking in at home for maternal reassurance from (unacceptable) use in response to pregnancy ‘medical’ concerns, for example reduced movements, or anything which warranted medical assessment. Some Doppler users identified the potential for Doppler use, intended to mitigate against pregnancy-related anxiety, to instead paradoxically exacerbate this. The need for training or skills to make Doppler use ‘safe’ was identified as important.

Awareness of the messaging against at-home Dopplers resulted in hesitancy towards initiating conversations around the use or desire to use the devices with medical professionals. Participants reported avoiding conversations about Dopplers as they worried that they would be judged negatively or reprimanded. This resulted in secrecy and stigma around the devices, and reduced opportunities to discuss how to approach Doppler use more safely, or to explore underlying concerns that act as drivers towards use.

Consequences

Despite the saturation of messaging about the risks and harms of at-home Doppler use, the devices remain commercially available and desirable to pregnant people. Our interviews with people who considered using at-home Dopplers highlight potential opportunities for pregnancy care to account for this by enabling open conversation about the devices and their interactions with anxiety during pregnancy. In upcoming clinician focus groups, our study will further explore the potentials to provide increased support and communication to facilitate safer use of at-home Dopplers.