Hello, All--
The first stethescopes were used in the early 1800s, and were developed because it was improprietous for male physicians to place their ears directly on the (particularly female) chest to listen to heart and lung sounds. I believe that they originally were monaural, but quickly became biaural. The monaural form was certainly similar to the shape of what we today call the Pinard, with a wider bell shaped cup at the contact end, and a smaller and more flattened end for the listening ear. Pinard was the one who applied the monaural version to obstetric use, in the later 19th century, which would indicate that awareness of the fetal heart rate was at least considered. I was unable to find anything about how the FHR obtained by a Pinard was interpreted, but at least use of one could determine whether the fetus was alive or dead. This would have been useful for determining what course to take if the labor was profoundly obstructed, and forceps were thought to be inadequate to
resolve the situation (and it would have been a given, at least until the latter 19th century that c-section was not an option, primarily for anesthesia reasons, and until the mid-20th century for surgical and antibiotic reasons). The various forms of the fetoscope, with the forehead support or the arching over-the-head brace, were developed after DeLee introduced this version in the 1920s-1930s in the US. I wonder what DeLee, et al, made of what they were hearing of FHR patterns.
In the US alternative birth movement, beginning primarily in the 1970s, the Pinard became a symbol of rejection of the high-technology approach to childbirth, and a counterstance to electronic fetal monitoring, because alternative birth movement practitioners and the women (etc.) to whom they provided care perceived newly implemented EFM to be a significant contributor to the high intervention rates in conventional care. I believe it still has that symbolism.
I have used the Pinard at home births, and in hospital births for those women who have a strong belief that EFM can be the beginning of the cascade of interventions that contribute to a highly medicalized birth. I have explained that the Pinard, or any non-continuous FHR assessment, is intermittent, and parents accept this as quite sufficient, indicative of the inherent normalcy of childbirth, and the trade off from the perceived risk and lack of benefit of continuous EFM.
So there's a little history, and a little personal experience. I would be interested in what others have found on this topic.
Jo Anne Davis
Jo Anne P. Davis, CNM, PhD
Midwifery Faculty
New York University College of Nursing
----- Original Message -----
From: margy hughes <[log in to unmask]>
Date: Friday, August 17, 2007 2:00 pm
Subject: Re: How do pinards look/why do parents use them?
To: [log in to unmask]
> Dear Annette,
>
> I use a wooden one; maybe wood is warmer than plastic or metal.
>
> I believe you can get one in pure silver.
>
> When I hear the fetal heart clearly (usually intrapartum; I work on
> labour
> ward at present), I offer for the partner to listen, as it is very
> different
> from hearing the FH electronically translated.
>
> My pinard stethoscope is my own and is precious to me, as a symbol of
>
> Midwifery and because I had to work very hard to learn to use it.
>
> It is also the chosen symbol of the Association of Radical Midwives.
>
>
> Kind regards,
>
> Margy Hughes RM
>
> >From: Annette Dalsgaard Vilain <[log in to unmask]>
> >Reply-To: "A forum for discussion on midwifery and reproductive
> health
> > research." <[log in to unmask]>
> >To: [log in to unmask]
> >Subject: How do pinards look/why do parents use them?
> >Date: Thu, 16 Aug 2007 19:47:29 +0200
> >
> >To the ICM -researchmailing list fra Jette Aaroe Clausen (e-mail:
> >[log in to unmask]):
> >
> >Greeting everybody out there
> >
> >I am currently finishing an article about midwifes work with pinards,
> CTG
> >and the doptone. And this has made me wonder a little about what a
> >stethoscope is, and what midwifes mean when they say they work with
> >Pinards.
> >
> >I know English midwifes use the word Pinard for the stethoscope they
> use
> >during childbirth. In Denmark a stethoscope in called "a wooden tube"
> >(trærør) or wooden stethoscope (træ stetoskop). It is a app. 20 cm long
> >wodden tube. when I have visited English labourward, I have seen midwifes
> >use smaller stethoscopes and called them Pinard. In the literature I
> can
> >see that the stethoscope got its name from an English doctor Pinard.
> For a
> >reference see. http://fan.BM.comb/chi/reprint/91/3/F231
> >
> >I found these pictures on the homemade from radical midwifes.
> >http://www.radioed.demon.Co.UK/Pindar's.html
> >And this make me think that the word Pindar now is used for all types
> of
> >stethoscopes used during labour whether they are of wood, plastic or
> metal.
> >Am I right in assuming that the most common used stethoscope in
> England is
> >of wood and it is short? Where are the stethoscopes of metal and plastic
> >used?
> >
> >What kind of stethoscopes are used by midwifes in other countries? I
> once
> >visited a Mennonite midwife in Canada (Mennonite is closely related
> to the
> >Amish, but less radical, they do drive cars ect), she used a stethoscope
> >that was placed between the women's abdomen, and her forehead and two
> >listening probes where placed in her ears. I wonder if this was just
> her,
> >or is other midwifes out there using this kind of stethoscopes?
> >
> >Sparked by the discussion about a list for historians, I wonder if there
> >are anybody out there who knows how short and small stethoscopes came
> into
> >being and why they became the chosen form? I was once told that Danish
> >midwifes used a long stethoscope for courtesy and for avoiding lice.
> But I
> >have never seen this in writing and don't remember who told me this many
> >years ago.
> >
> >In Denmark parents to be, have started to buy Pinards and some also buy
> >doptones and use them at home. have you hear of this and what are your
> >experience with this. Why do parents do this? and do you experience and
> >problems whit this?
> >
> >Looking forward to hear from you
> >
> >All the best
> >Jette
> >
> >Jette Aaroe Clausen
> >Jordemoderlærer / Midwifery Lecturer
> >MHH (Master in Health Humanities)
> >CVU Øresund
> >Jordemoderuddannelsen/ Faculty of Midwifery
> >Sigurdsgade 24
> >2200 København N
> >Telefon + 45 3531 0511/ + 45 3531 0500
> >Hjemmetelefon + 45 8678 2327
> >e-mail: [log in to unmask]
>
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