The only educational resource I found regarding the Pinard stethoscope—the use of this ancient wisdom and one of the authentic midwifery skills—is a two-part article by Sarah Wickham – Tips and Tricks for Midwives Part 1 and 2.

In the past, the Pinard stethoscope was the only tool midwives had to listen to fetal heart tones. And the advice from these midwives is—use the Pinard stethoscope regularly and practice as much as possible. Many midwives recall practicing listening with the Pinard stethoscope for months without hearing anything, and then suddenly it “clicked.” These midwives understand that it’s very difficult for students, especially if they don’t have a suitable (compassionate) mentor. At the same time, this includes explaining to women that they probably won’t hear anything. And those of us who initially struggled to hear heartbeats with the Pinard stethoscope know how true this really is.

So, why use the “Pinard”?

• when technology fails (no electricity, dead batteries…) we can still use the Pinard.
• if we don’t hear the heartbeat, it will give us a warning sign and we’ll start thinking about what words to use to explain this to the woman in labor.
• we use it to confirm our palpation (Leopold’s maneuvers, which we’re also increasingly abandoning and neglecting, even though they belong—like listening to heartbeats with the Pinard stethoscope—among authentic midwifery skills). Especially to confirm “incorrect” presentations and positions of babies—OP central and also very clearly far around on the side, and with breech presentation, hearing the heartbeat high, usually above the navel.
• also to show couples that we don’t need technology to hear their baby’s heartbeat and that the partner can also hear the fetal heartbeat if they simply place their ear where the baby’s back is.
• to check and verify when the monitor detects a very fast or very slow heartbeat, that it hasn’t halved or doubled it.
• for the sheer satisfaction of finding and hearing the heartbeat with the Pinard.
• the author also mentions her experience working in a prenatal unit, where finding and hearing the heartbeat with the Pinard calmed women waiting for CTG (cardiotocography), and by locating the heartbeat before placing the monitor, she could position the monitor more easily and correctly.
• The Pinard is better than the Doppler in that you’re listening to sound and not an echo, which allows you to hear different tones. You’re not just counting the beats of valves opening and closing.

Although some midwives have said that the heartbeat can be heard with the Pinard before 28 weeks of pregnancy (pregnancy lasts 40 weeks or 42), most midwives said that you still shouldn’t expect to hear the heartbeat during these weeks. Some don’t even monitor the heartbeat before the end of the second trimester. They pay much more attention to movement! First baby movements: “Quickening” (click)

There was also much debate about what material the Pinard stethoscope should be made of—wood, plastic, or metal. Some midwives note that wood absorbs some sound and that plastic or metal ones are therefore more suitable for learning. However, most agree that wood is a friendlier material, especially for women.

And every midwife should have her own Pinard, not only to learn to listen to heartbeats with it, but also to distinguish between different tones.

5 Steps to Successfully Using the Pinard

• palpation, palpation, and more palpation (Leopold’s maneuvers) to determine the baby’s position. Also ask the woman where she feels the baby most, its kicks, etc. The main goal is to hear the fetal heartbeat where the back is (the baby’s lungs are not inflated).
• use your knowledge and experience (or the table below) to see where the baby’s heart might be in different positions and then choose a “target point.”
• place the Pinard on the chosen spot, put your ear on the “O,” take your hand off the Pinard, and listen—and keep listening.
• at the same time, feel the mother’s pulse. If it matches what you’re hearing, you’re listening to the mother’s heartbeat.
• if you really don’t hear the heartbeat, repeat the palpation and listen for the heartbeat in a different location.

Practical Tips:

• make sure your ear is directly over the opening.
• don’t press the stethoscope too much or too little—be prepared to adjust the pressure.
• pressure on the abdomen should be gentle—slightly less than a centimeter.

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What are we listening for/hearing?

• it’s more about listening to “vibrations” than sound.
• it’s therefore more about sensing the heartbeat than hearing it. That’s why a lot of practice is needed, as it’s very difficult to hear at first.
• it’s similar to when we listen to/measure blood pressure with a stethoscope—the ear needs time to get used to the sound.
• you need to know what sound you’re listening for—close your ear with one finger and cover that finger with another finger.
• you’re listening to a background sound, it sounds like listening to a clock ticking under a pillow, but faster (actually try how an old clock ticking under a pillow sounds, to get a sense of what you need to listen for with the Pinard).
• if you hear a slow “noise” or heartbeat, it’s probably the mother’s pulse. You’re hearing the vessels that go through the uterus and supply it with blood.
• we often close our eyes while listening. This “turns off” one of our senses and makes it easier to focus on listening. The author notes that she sometimes does this with palpation too. She has a funny feeling that she hears and feels better if she doesn’t see.
• if you have serious difficulty hearing/detecting sound with the Pinard, it may make sense to have a hearing test. They may discover that you perhaps hear poorly in only one ear. In that case, you’ll also have difficulty or won’t be able to detect heartbeats with the Pinard at all.

Use a digital watch or a watch with a second hand to count fetal heartbeats. Wait until the second hand is on one of the quarters (12, 3, 6, or 9) and start counting. Multiply the number of beats you count in 15 seconds by 4 (e.g., if you hear 35 beats in 15 seconds, multiply by 4 and you get 140 fetal beats per minute). To calculate the average fetal heart rate, listen 4 times in 15-second intervals, not necessarily consecutively.

If you can’t find the heartbeat:

• try changing the position of the Pinard by lifting it and placing the stethoscope in a different spot.
• sometimes you’ll hear the heartbeat much farther away than you expected.
• if you can’t find the heartbeat with the Pinard, use the Doppler (or ask for help), so the mother doesn’t get too anxious if you can’t find the heartbeat for too long.
• if the woman doesn’t mind, you can use the Doppler first to locate the heartbeat, and where the heartbeat is clearly heard (so you hear the opening and closing of the valve, the “lub-dub sound”), place the Pinard there.

Most midwives use the Pinard during pregnancy, but not during labor itself. Those who talk about using the Pinard during labor say it was difficult to hear the heartbeat during contractions, and they also don’t think it’s fair to listen to the heartbeat during a contraction, even with a Doppler, as this can be distracting and unpleasant for the woman. Some midwives have found that the American form of the Pinard—the fetoscope (Pinard on stethoscope earpieces)—is much more practical, especially when the woman is on all fours or standing.

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More Pinard Wisdom

Once you master listening to heartbeats with the Pinard, you can do many things:

• you can hear different sounds and melodies at different weeks of pregnancy. You can also sometimes determine the baby’s sex, as the sound differs between boys and girls.
• to measure variability, count the number of beats in 5-second intervals; the number of beats will vary, which will confirm variability. If the number of beats is approximately the same, the baby is probably sleeping. Therefore, repeat the procedure after some time (e.g., 15 minutes).

We must also consider the woman’s wishes. Some want to hear the heartbeat themselves and therefore want you to use the Doppler as well.

Using the Pinard is one of the most basic midwifery skills, but it’s also one that’s in danger of being lost due to dependence on technology. Nevertheless, with the Pinard we can hear/sense some things that we’ll never be able to with technology.

Source 1: Pinard Wisdom – Tips and Tricks from Midwives (Part 1) – Sara Wickham

Source 2: Pinard Wisdom – Tips and Tricks from Midwives (Part 2) – Sara Wickham

A Midwife Who Sees Life as Joy; Dnevnik.si, May 11, 2011

“When she started working, they only had one CTG, and even that wasn’t as sophisticated as it is now. That’s why they were very skilled at listening to heartbeats with the Pinard stethoscope, which they used to listen to the heartbeat of the mother and the arriving newborn. “We really mastered this well, which was also shown by excellent practice. Perhaps we trusted ourselves a bit more back then,” she recalls somewhat nostalgically of those times when expecting childbirth was still a somewhat more natural process than it is today. “For certain moments during childbirth, if you ask me, I’d rather turn back time.”

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