Hearing the whooshing sound of your developing baby’s heartbeat is the best part of a prenatal appointment, and a heartbeat on an early scan is one of the strongest indications that your baby is doing well. So if you go in for an appointment and the doctor cannot detect a heartbeat, it’s understandable if you’re concerned.
Several factors come into play to understand why you may not detect your baby’s heartbeat. Here’s what to expect if this happens to you.
Why the Tool Matters
There are three main pieces of equipment most expectant mothers (or their doctors) may use to check for the embryo or fetal heartbeat:
- Transvaginal ultrasound: A medical professional inserts an ultrasound probe into your vagina to get the closest access possible to your uterus.
- Standard ultrasound, or Doppler: Your doctor uses a handheld wand or sensor on your belly to detect the heartbeat.
- Handheld, at-home Doppler: Some expectant parents, eager to hear their baby’s heartbeat, decide to buy equipment to use at home.
In the early weeks of pregnancy, transvaginal ultrasound is by far the best tool to detect a heartbeat. At 7 weeks’ gestation, the embryo is only the size of a blueberry, so imagine how tiny the heart is! Another tool may not be sensitive enough the catch the sound.
Later on in pregnancy, some parents get worried if their at-home Doppler isn’t picking up the baby’s heartbeat. You’re (probably) not professionally trained in how to use the equipment and interpret results. You can cause yourself unneeded stress by thinking there’s no heartbeat when really you’re holding the Doppler in the wrong spot or confuse heartbeat with your breathing and digestion noises.
Why Gestational Week Matters
Especially if you’ve been struggling to get pregnant, you may be eager to get in for a confirmation ultrasound as soon as possible. While the heart is one of the first organs to form, it’s still possible to get into your doctor’s office too early to hear it beating. With my second baby, we opted for an ultrasound as six weeks exactly. The heartbeat wasn’t audible, and only registered as a grainy flicker on the screen. The ultrasound technician told us our timing was lucky–the baby’s heart may have started beating that day! It’s fairly common not to pick up a heartbeat before you’re 7-8 weeks along.
After that point, though, your doctor should be able to find a heartbeat. A lack of heartbeat, or a heartbeat that’s below normal range, could indicate a miscarriage or impending loss.
Could It Be a Mistake?
Hearing that you have lost a wanted pregnancy is some of the most devastating news you could imagine. It’s natural to want to argue that the doctor is wrong, and there must be some mistake.
You can certainly ask for a second scan, or for another doctor to give a second opinion. If your experience was that the doctor seemed especially brusque or the scan time seemed shorter than usual, getting confirmation from someone else may feel best to you. Some factors, like carrying extra weight in your midsection or having an anterior placenta, can also make it more difficult to find a heartbeat with a smaller device like a Doppler.
In most cases, though, if your doctor tells you the pregnancy has terminated, this is actually the case, even if your body hasn’t started to miscarry yet.
What Happens If I Lost the Baby?
You may need some time to process or request a second opinion if you hear that the fetus has died. A doctor may also request another test, like a check of your HSG levels, to confirm that growth has stopped and the pregnancy has ended.
Once the loss is confirmed, your doctor will go over your options:
- Wait for your body to miscarry naturally. This sometimes takes several weeks after the pregnancy ends, and it can be difficult to wait for the closure of the actual miscarriage.
- Take medication to induce the miscarriage. You’ll take a course of pills and generally go through the miscarriage process at home.
- Opt for a D&C. This is a surgical procedure to remove the embryo or fetus, placenta, and other materials from your uterus.
Your doctor can also offer medical guidance on when it’s okay to try to conceive again. Some couples need to wait longer to process the emotions and grief from the loss, while others prefer to try for a baby as soon as they’re medically cleared to do so. Both are valid ways to respond to the emotional upheaval of losing a pregnancy.
