Measuring Up Infant Scales

When it comes to choosing the best scale for measuring newborns, it can be easy to opt for the lightest and most convenient option – the Chatillon Hanging Scale. Commonly used among midwives, the hanging scale is small enough to tuck into a midwifery bag, making it one less thing to lug around when performing home visits. But are they really effective?

The major issue we have come across in our years of feedback from midwives using scales of many shapes and sizes, is that hanging scales are not always accurate. On average they tend to be inaccurate by up to 4 oz. They are also limited in their scope of use because a hanging scale can't be used beyond the first few days and are ineffective in measuring small weight gains.

So why are they so popular? They’re affordable and small. However, there are a variety of portable digital scales that we recommend using in place of hanging scales and here’s why.


Portable scales are designed to be lightweight and compact, so you can store them in your trunk if you are a traveling practitioner, or you can store them in a small closet space if you work at a birth center or facility. Some designs like the Health O Meter 8320KL Digital Portable Pediatric Tray Scale (featured above) have built-in handles and fold in half, while others, like the Health O Meter 549KL Digital Pediatric Tray Scales, have optional carry cases.


The readings of digital scales that sit firmly on flat surfaces allow for more stability, and are calibrated to offer you more accurate readings than mechanical hanging scales. Depending on your preference, there are scales that also offer measurements in both pounds and kilograms. The Health O Meter 553KL Digital Pediatric Tray Scale for example, weighs up to 44 lbs in 1/2 oz increments in both kilograms and pounds.


No need to re-weigh a baby if you forgot to jot down the weight, digital scales offer helpful technology that holds the weight measurement for a few minutes after the baby is removed, or has an auto-recall option. It is also a lot easier and faster to place a baby on a stationary scale than it is to prepare a sling. Hanging scales also have no way of recalling a weight measurement. Recall is particularly handy after birth when there’s a time crunch for midwives wanting to do all the necessary testing quickly so that babies can be reunited with their mothers as soon as possible.


The most important feature that a scale offers is the ability to use it for neonates as well as infants up to a few years old. Since many midwives do follow-ups with families, having a scale to weigh babies as they grow is crucial. The same applies to birth centers or midwifery offices where families attend follow-up appointments. Having a portable scale that can be tucked away until needed is a great space saver.

So when considering which scale is best for your practice, take a minute to think of how it will serve you over the long term. If you plan on using it beyond birth, consider the variety of quality scales available to you that are now designed to be convenient too.

For our full selection of Scales from Digital Scales to Hanging Scales, just click here.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Entering the New Age of Midwifery', 'How to Choose Sutures', and 'Iron Duck Bags: American Made Strength'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products




What About the Baby? The Debate on Paid Maternity Leave in the US

The social media world was in an uproar around Yahoo CEO Marissa Mayer’s publicly stated decision to only take a 14 day maternity leave after her upcoming December birth of twins. The biggest backlash seemed to come from outraged people who see her actions as setting a detrimental tone for women in business - and employed females in general - fighting for the right to fair paid maternity leave in the United States.

This situation has brought to light two very interesting and seemingly opposing perspectives that we should all be considering. One: women are consistently under scrutiny both publicly and privately when it comes to decisions about birth, pregnancy and motherhood. Does it help to vilify Mayer for making a decision she feels is best? And two: professional women in powerful positions are scarce, so the few that make it to the top have a significant impact on how other professional women, especially young women, approach a sense of balance between career and motherhood. Should they not be spearheading the movement for change in fair maternity leave?

Amidst all of the excitement, something extremely significant has been overlooked: how does a short maternity leave impact the healthy development of a newborn baby? Long story short – not well and here’s why.


It is quite common to believe that gestation for a fetus ends at birth; however, in humans, birth is dictated by the maximum size a fetal head can grow before being too large to pass through the birth canal. Quite beautifully stated, anthropologist Dr. Ashley Montague, who is well known for his pivotal book ‘Touching: The Human Significance of the Skin’, notes that:

“the first year of life requires a great deal of unobtrusive packing for a journey that will continue for the rest of the traveler's life. To perform this packing safely, the infant must possess a brain much larger than 375 to 400 cubic centimeters, but quite clearly he cannot wait until he has grown a brain of 750 cubic centimeters before being born. Hence, he must be born with the maximum-sized brain possible, and do the remainder of his brain growing after birth. Since the human fetus must be born when its brain has reached the limit of size congruent with its admission into and extrusion through the birth canal, such maturation or further development as other mammals complete before birth, the human mammal will have to complete after birth…The biological unity, the symbiotic relationship, maintained by mother and conceptus throughout pregnancy does not cease at birth; indeed, it is naturally designed to become even more intensively functional and mutually involving after birth than during gestation in the uterus.1

Newborn babies require skin-to-skin connection with their mothers for healthy development. Touch is important and can be administered by anyone, but there is special significance in touch coming from the infant’s biological mother: from the familiar rhythm of a mother’s heartbeat to the mutual health benefits of breastfeeding. The connection between mother and baby extends beyond the womb and “there is need for continuance of close body contact with the mother to satisfy the requirements of the kinesthetic and muscle senses. This requires that the baby be held firmly, nursed at intervals, rocked, stroked, talked to, and reassured”1.


When Marissa Mayer stated, “Since my pregnancy has been healthy and uncomplicated and since this is a unique time in Yahoo’s transformation, I plan to approach the pregnancy and delivery as I did with my son three years ago, taking limited time away and working throughout,”2 it made a bold statement about healthy pregnancies and time off: if you have an uncomplicated, healthy pregnancy, you shouldn’t need much of a maternity leave. That is in fact not true.

Studies have shown that there is a direct connection between cases of postpartum depression, increased stress, both personal and family stress, and poor health in women who worked full time with infants as young as 3 months old.3 Maternity leave is more than taking time off work. It is a time for mothers and infants to make important emotional connections and for mothers’ bodies to heal after birth. The National Bureau of Economic Research shared a 2004 study by Pinka Chatterji and Sara Markowitz that explored the possible parallel between mothers who return to work later and better mental and physical health. Here’s what they found: “returning to work later is associated with a reduction in the CES-D scale. This means that mothers who return to work later are reporting fewer symptoms of depression, such as "my sleep was restless" or "I could not get going," or are experiencing such symptoms with less frequency or both.”4

It goes without saying that a healthier, happier mother has a positive impact on her baby’s development. More articles and studies are showing the desperately low amount of maternity leave in the United States compared to virtually every other industrialized country in the world, where “the median amount of fully-paid time off available to a mom for the birth of a child is about five-to-six months…[and] the median amount of protected leave for new mothers among [38 Nations] is about 13 months”5. In the US the amount of protected leave – unpaid – is a mere 12 weeks. The obvious question is…why?


One of the main reasons most companies in the US haven’t tripped over themselves to offer new mothers – or fathers – a paid maternity/paternity leave comparable to other industrialized countries, is the misconception that it will cost too much. According to a recent article in The New York Times, The Economic Benefits of Paid Parental Leave, the three states that actually offer paid parental leave saw no negative results. In fact “89 percent to 99 percent of employers say it has had no effect or a positive one on productivity, profitability, turnover and morale.6 These results came from a report7 by economists Eileen Appelbaum and Ruth Milkman at the Center for Economic and Policy Research who looked at the benefits of paid leave in California, and also concluded that “Eighty-seven percent [of businesses] say [paid family leave] has not increased costs. Nine percent say they saved money, because of decreased turnover or benefit payments.6

Paid maternity leave also addresses a larger social and racial issue: in a country where unpaid maternity leave is the only option, it is an option only available to a specific demographic that can afford it. Mothers from lower-income families may have the opportunity to take unpaid maternity leave, but they don’t have the option to take it when it means they are unable to provide vital financial support for their family. Currently in the US, “a record 40 percent of all households with children under the age of 18 include mothers who are either the sole or primary source of income for the family.”8 The result is a disparity between the notion of equal rights and the reality of those rights, for all new mothers in the United States.

In his State of the Union Address, President Obama addressed the need for paid maternity leave in the US: “It’s time we stop treating child care as a side issue or a women’s issue, and treat it like the national economic priority that it is.6 He went on to explain that paid leave could help increase the amount of women in the work force, which would inevitably help middle-class families earn stable incomes.6

Additionally, women who have a paid maternity leave are more likely to be valuable assets to the economy when returning to work later – from working more hours to earning higher wages. Economists have noted that “with paid leave, more people take time off, particularly low-income parents who may have taken no leave or dropped out of the work force after the birth. Paid leave raises the probability that mothers return to employment later, and then work more hours and earn higher wages. Paid leave does not necessarily help businesses — but it does not seem to hurt them, either.”6

Perhaps the more productive outcome of working mothers who took a paid maternity leave is a result of them having a chance to connect with their babies and to acclimatize to the many changes that accompany the arrival of a new baby. Or it might just be that after going through a birth, their bodies were afforded the time to heal without a looming sense of guilt or financial burden. As Maureen Shaw puts it in her recent article, The painful, hidden hell that awaits mothers who return to work two weeks after giving birth: “For a nation that prides itself on so-called family values, the US has a long way to go in terms of actually supporting its all American families. Guaranteeing paid leave is certainly a step in the right direction. You shouldn’t have to have experienced the physical scars of childbirth to understand why mothers need time to heal.”9 We couldn't agree more.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Entering the New Age of Midwifery', 'Why Water Birth?', and 'Why Do We Use Plastic Cord Clamps?'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products



1Dr. Ashley Montagu, Touching: The Human Significance of the Skin, 1978
Caroline Fairchild, LinkedIn New Economy Editor:
How Marissa Mayer's Maternity Decision Affects Young Women -- Whether She Likes It Or Not
3Meredith Melnick, Study: Why Maternity Leave is Important
4The National Bureau of Economic Health: Do Longer Maternity Leaves Affect Maternal Health?
Gretchen Livingston, Pew Research Center: Among 38 nations, U.S. is the outlier when it comes to paid parental leave
Claire Cain Miller, The New York Times: The Economic Benefits of Paid Parental Leave
7Eileen Appelbaum and Ruth Milkman, Center for Economic and Policy Research: Leaves That Pay: Employer and Worker Experiences With Paid Family Leave in California
8Mark Memmott, NPR: Moms Are Now Primary Breadwinners In 40 Percent Of Homes
9Maureen Shaw, Quartz: The painful, hidden hell that awaits mothers who return to work two weeks after giving birth

Why Do We Use Fetoscopes?


Fetoscopes have been in use since the 19th century. Midwives and others worldwide continue to use fetoscopes for listening to fetal heart tones. The United States is one of the few countries where the Doppler has replaced the fetoscope. Though there are many types of fetoscopes available, the most commonly used in the Allen Type.

Fetoscopes are designed to listen to the heartbeat of unborn babies. Fetal heart tones can be detected as early as 18 weeks, but in most cases a fetoscope is most effective after 22 weeks. When using a fetoscope, you will note that the sound is very soft and far different than the amplified sound provided by a Doppler.

According to Penny Simkin, using a fetoscope is especially useful for determining fetal position.

In most fetuses near term, the loudest sounds of the fetal heart are heard through the fetal back, at approximately the level of the scapula or shoulders. Locating this PMI [point of maximum intensity] of the fetal heart tones helps determine the orientation of the fetal back - either anterior or posterior. The best tool for this purpose is a fetoscope…which allows for the direct auscultation of the fetal heart…1


During the 19th century, the Pinard Horn was designed by French obstetrician Adolphe Pinard, to listen to the heart rate of a fetus. The Pinard Horn is a cone shaped fetoscope that amplifies the sound of the fetal heart beat, and has been described as a type of ‘ear trumpet’. The monaural – meaning it only requires one ear for use - design “rapidly became the fetal stethoscope of choice because the widely faring bell prevented rocking on the mother's abdomen during auscultation.”2 The Pinard Horn is often made of wood or aluminum – the wooden style still popularly used amongst midwives, especially in developing countries where metal instruments are not always welcomed due to cultural superstitions.

The binaural fetoscope design that allows users to hear the heart beat through both ears is most commonly used today. The first binaural fetoscope was originally described in 1917 by David Hillis, and then later by his supervisor Joseph DeLee in 1922, who apparently claimed credit for its creation.3 As a result, the first binaural fetoscope eventually became known as the DeLee-Hillis Fetoscope.

Choosing between the monaural design of a Pinard Horn and binaural fetoscope designs really comes down to personal preference. Here is a synopsis of the different types of fetoscopes along with their corresponding features.

 ‘Ear Trumpets’ – PINARD HORNS

Pinard Horns are the oldest form of fetoscope, offering the same effectiveness as the popularly used Allen Type Fetoscope and is useful for determining fetal position.  

Although it is less commonly used than the modern binaural fetoscope designs, the Pinard Horn is still commonly used by midwives in a variety of countries. It is offered in both wooden and aluminum designs - the wooden option being most popular as it absorbs sound rather than reflecting sound like aluminum.

Not everyone is comfortable using the Pinard Horn because it requires a high level of spatial intimacy between the mother and practitioner. More modern binaural designs have a long tube between the earpieces and the horn to allow for more personal space if/when it is desired.

‘Get Your Head in the Game’ – DELEE-HILLIS FETOSCOPE

As mentioned earlier in this article, the DeLee-Hillis is one of the earliest fetal stethoscope designs. What makes this style unique is the headband that offers a hands-free option to practitioners. The fetoscope horn is strapped to the headband and much like the Pinard Horn, it allows you to slowly and consistently apply pressure to the belly for greater amplification of the FHR by using your head.

‘Home is Where the Heart Beat Is’ – ALLEN TYPE FETOSCOPES

Designed after the exceptionally popular - but unfortunately discontinued – Allen Series 10 Fetoscope, the Allen Type Fetoscope is our best selling fetoscope. It could be that it’s so affordable or it could be that it’s the only fetoscope available in purple – the official color of midwifery. Or it simply could be both!

The Allen Type Fetoscope has a longer 22” tube that allows mothers to listen to their own bellies. The tubing can also easily be trimmed for practitioners who want a shorter tube for better audio clarity. This design feature makes it ideal for anyone to use, whether for professional or personal use.

Unlike the DeLee-Hillis and Pinard Horn Fetoscopes, the Allen Type Fetoscope has a horn at the end of the 22” tubing that allows you to apply pressure with your hand or forehead. The design allows for more flexibility for positioning the fetoscope and is perfect for mothers who are looking for an inexpensive fetoscope that is long enough for them to hear the fetal heart beat at home on their own.


Pricier than most, but definitely worth the investment, the Leff Fetoscope goes above and beyond the capabilities of other fetoscopes. The Leff features an unusual conductor that blocks external noise to isolate heart tones as well as cord and placental pulses. It has a very large, heavier bell that allows for superb sound quality, rivaling that afforded by medical Dopplers.

The Leff Fetoscope works best after 17 weeks and can effectively be used throughout pregnancy, labor, through contractions and even under water. The weight of the bell takes some getting used to and is best to warm up first in your hands before applying to a mother’s belly – simply for comfort.

As you can tell, each fetoscope offers a unique selection of features. When it comes time to choose one, there are a few things you can consider before making a decision. What will its main purpose be for - will it be used infrequently as a backup instrument, or regularly throughout pregnancy and labor? What works best for your client base - are they comfortable with close proximity examinations? Are there any cultural barriers that might make them uncomfortable with a specific style of instrument? And lastly, what are you comfortable with – do you need the option to choose from smaller or larger ear tips? Do you want to offer families a chance to use the fetoscope as a bonding instrument that anyone can use to hear the fetal heart beat?

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose the Right Doppler', and 'Why Do We Use Plastic Cord Clamps?', 'The Importance of Newborn Pulse Oximeters'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products




1Penny Simkin, The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia:

2The Monaural Stethoscope:

3Fetal Stethoscope History, Center for Experiential Learning:

How to Properly Clean and Sterilize Your Instruments

When working in any environment where surgical instruments are required, knowing how to clean and care for them properly is vital. For midwives and small centers on a budget, we have some great tips for getting back to the basics for sterilization.

The best part about proper care of your instruments is that it will increase their life expectancy significantly. Even the highest quality stainless steel instruments, from brands like Miltex, are vulnerable to wear and tear if not cared for properly. Here are some important pointers to always keep in mind when caring for your instruments. Print this list off, keep it close-by or tucked into your equipment bag for easy access.


Keeping It Clean

1. Rinse or soak instruments in sterile water immediately after use with an enzymatic detergent. Never let soiled instruments dry before cleaning. Dried body fluids and tissue cause pitting and staining on the metal. Enzymatic detergents are great for breaking down the organic residue on instruments to make washing them with detergent easier.

Instruments should never be soaked in saline or sodium hypochlorite (bleach). Chloride ions are highly corrosive and can eat away at the finishes and metal on your instruments.

2. If you don't have the time to rinse or soak your instruments right after use, wrap them in a cold damp towel.

3. When choosing your cleaning detergent or disinfectant, select an option with a pH between 7 and 10. Detergents with a pH that is higher than 7 are generally more effective when it comes to removing organic debris like blood, feces or fat.

Never use antimicrobial solutions that are used for skin antisepsis when cleaning your instruments.

Remember, when in doubt, check the manufacturer's instructions for the type of detergent to use. Here are some characteristics of an ideal detergent:

  • Minimal suds or foaming
  • Rinses off easily
  • Nontoxic
  • Biodegradable
  • Can disperse organic debris
  • Nonabrasive

4. When using an instrument cleaning brush, keep this in mind: stainless steel brushes are designed to clean instruments with serrations, rasps, files and burs, while nylon brushes are excellent for cleaning instruments without scratching or harming delicate surfaces. Don't use abrasive scouring pads that can damage the finish of your instruments.

5. Rinsing is imperative after cleaning because any residual detergents or disinfectants that are not properly rinsed off can reduce the efficacy of the sterilization process.

Got It Clean? Make It Sterile

1. Before sterilizing your instruments, you want to make sure they are dried thoroughly.

2. Lubricate your instruments well with water-soluble lubricant.

3. There are a variety of options available for sterilization: heat or steam autoclaves, steam sterilizers, pressure cookers or conventional ovens.

4. If you are sterilizing with an autoclave, always use distilled water because tap water can discolor and damage the metal of your instruments.

5. Regardless of the method you use, it is imperative to wrap the instruments securely for sterilization. You can use self-sealing sterilization pouches, sterilization tubing, and for larger instruments use sterilization wrap or surgical towels. Everything needs to be secured with sterilization tape, except for the self-sealing pouches.

6. Remember to unlock and open any ratchets during high-pressure autoclaving, because the pressure may break them if they cannot move flexibly and openly.

7. Surgical towels are your best friend when it comes to instrument cleaning and sterilization. These 100% cotton towels can be used as a sterile surface for instruments where sterilizing a surface may not be possible (think home births, emergency births and midwives working in developing countries); they can be used as a damp wrap for instruments you can't clean immediately; use them to dry your instruments; and use/re-use them to wrap your instruments for sterilization.

Taking It Back To Basics - Oven Sterilization

If investing in a medical sterilizer or autoclave is not an option, you can always use an oven. Here are some simple steps for effective oven sterilization.

1. Set your oven to 225 degrees.
2. Place a pan of boiling water at the bottom of the oven.
3. Put your wrapped instruments on a clean rack - do not place them directly onto the oven rack.
4. Ovens range in temperature so watch the process carefully. If using sterilization pouches and the oven gets too hot, the pouches may burn.
5. When steam is generated, you know the sterilization process is in progress.
6. Use a clean utensil to remove the sterilized instruments and once cooled, place into a sterile towel or paper bag to store for future use.

*Note: sterilization tape will not change color in an oven as it is designed to do in an autoclave or sterilizer.

Proper instrument care may take a bit of time in the moment, but the long-term rewards are worth it.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose Sutures', 'Measuring Up Infant Scales', and 'How to Choose the Right Doppler'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products



Cascade HealthCare Instrument Care:

Miltex Instrument Care:


All American Medical Sterilizers:

Sterilization Products:

Why Do We Use Plastic Cord Clamps?

Probably the most popular selling umbilical cord clamping product we carry is the plastic cord clamp. It is also the bulkiest and least environmentally-sound choice available. We decided to look at why many midwives and hospital birth wards favor the plastic cord clamp, and what alternatives are available that are just as effective without causing discomfort for newborns.

According to a 2004 article posted in NeoReviews: an official journal of the American Academy of Pediatrics, plastic cord clamps were designed to offer a secure, reliable constriction to ensure no bleeding occurred from the umbilical cord after it was cut. The traditional method prior to plastic cord clamps was cotton umbilical tape, but concerns developed regarding the possibility of babies hemorrhaging if the tape was not tied tightly enough.

Convenience was another factor. According to the authors of Management of the Umbilical Cord: Care Regimens, Colonization, Infection, and Separation, JoDee M. Anderson, MD and Alistair G.S. Philip, MD: "The first method [of umbilical cord ligation] was to use constricting bands, which were effective, but somewhat difficult to apply...the more usual method in developed countries currently is plastic or metal clamps, which produce safe, reliable constriction"1.


For those who are interested in an effective alternative, options are available that are economical and more environmentally-friendly than plastic cord clamps. Cord rings, also referred to as cord bands mentioned above, are an effective way to discreetly secure the umbilical cord without excess bulk or materials to irritate the newborn. Popular among midwives, cord rings are relatively easy to apply and the procedure only requires a pair of hemostatic forceps. For those who have difficulty applying cord rings manually, another alternative is the Cord Bander - a reusable device specially designed to apply cord bands. Cord Banders allow you to clamp a cord and place a latex band on the stump with ease.

In both instances, the cord rings and cord bands shrink along with the umbilical cord, so there is no need for removal. Cord banders are made of sterilizable metal, making them reusable. Both options also eliminate the need and cost of cord clamp clippers. Metal clamp clippers can be reused, but plastic clippers are still popular amongst midwives wanting to give parents a plastic clipper to cut their baby's clamp or hospitals following regulations mandating a new clipper for each baby's cord clamp. Cord rings and bands are a simple way to reduce the excess waste cost of disposing of plastic cord clamp clippers and used cord clamps.

Even though concerns have been raised about not tying umbilical tape tightly enough, it is still a popular option for those looking for a biodegradable, lightweight solution to cord clamping. Umbilical tape is a braided cloth that comes in 100% cotton as well as a polyester-cotton blend. For those wanting to take extra precautions to ensure the tape it effectively tied, tying it in two different locations on the cord will provide additional ligation.

So although plastic cord clamps have proven reliable at securing umbilical cords, there are effective alternatives for those looking for a less invasive, lightweight option that is also more economical. Choosing the cord care option that works best for you and the needs of the families you work with is of optimal importance. Equally as important is knowing what options are available to you.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose Sutures', 'Measuring Up Infant Scales', and 'Entering the New Age of Midwifery'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products



Cord Care, Cascade HealthCare Products:

1JoDee M. Anderson, MD and Alistair G.S. Philip, MD. 'Management of the Umbilical Cord: Care Regimens, Colonization, Infection, and Separation', 2004, NeoReviews