4D Ultrasounds – Picture This!

Some of you may remember my niece and nephew who are pregnant with twins. They’re the ones who sent me over the moon musing about the next generation when I heard the news. Well, they’re now almost through the 2nd trimester, and sooo adorable! Let me bring you up to date:

A few weeks ago they scheduled the *big* 4D ultrasound (3D plus live motion). By “big”, I mean the one where they can see every detail, measure both babies, take a close look at each organ system, and offer the reveal that all soon-to-be-parents wait for — ta daaahhh … GENDER. This up-close look is like real-time photography, accompanied by video that would make any documentary filmmaker proud.

Full disclosure. I have to admit I’m feeling very … um … o*l*d.  So much has changed. Once upon a time, ultrasounds looked like a mix of black, grey and white fuzz that was indecipherable to the untrained eye. Even as a pediatrician I routinely deferred to the radiologist to explain the fine points. It was expert medical technology requiring expert interpretation. So this new world kinda freaks me out.  But back to my couple …

In their very creative and playful way, Mom & Dad planned a carefully orchestrated mega-event to accompany the medical information to come.

First, they invited both grandmothers-to-be to join them for the big day — but with rules. They could watch all the on-screen details, but had to turn away when GENDER presented itself. The ultrasonographer was instructed to give a ‘heads up’ when the private parts came into view and all eyes were to face the wall. Then, after it was over, said ultrasonographer was to contact a designated bakery to pass along a secret password meaning … 1 girl + 1 boy, 2 girls, or 2 boys.

The baker would then create 2 cakes reflecting the newly discovered genders and present them at a party later that evening where all friends, family, and, yes, the parents themselves would  be surprised when the twin’s sex was revealed.

The plan went seamlessly, and the party was a HUGE success. 2 GIRLS! 2 pink cakes! A complete surprise and tremendous fun.

All good, right?

When I first heard the plan I thought, “Wow, what a scream … times sure have changed”. But a moment later I had some misgivings. My ‘doctor’ brain kicked in and I started to worry about what would happen if — god forbid — the ultrasound revealed a problem of some kind. What if the party was spoiled by an unexpected medical issue with one of the babies? Or both? I spent the next several days with a knot in my chest, waiting to hear that all was well.

And that got me wondering … what’s going on out there with new moms and these spectacularly detailed images? How is the technology changing the culture, and vice versa? What’s the effect of mixing science and healthcare with family bonding? Some of what I learned was pretty surprising.

Fetal ultrasound has taken on a whole new look. While the primary purpose is still to ensure the obstetrical health of mother and baby, another option has entered the game. These new photo ops (known as entertainment ultrasounds) are wildly popular, often having nothing to do with the health of the developing fetus. Some couples are having in-womb pictures taken as often as once a month; just come on in to your local ultrasound center/photography studio and flash a credit card for a one hour “sitting”.

With names like A Baby Visit, Hi Mom!, and Ultrasound Memories, these studios aren’t regulated by the FDA and aren’t required to use licensed technicians.  One center I checked out online advertises a Sneak a Peek Special. $69.00 for a CD with pictures, 20 Min 3D/4D Ultrasound, and 1 DVD Recording. Another offers floor-to-ceiling viewing screens and theater seating for family and friends. Hmm.

Don’t get me wrong. I’m all for having every bit of medical information needed to ensure the health of mom and baby, and who doesn’t love an adorable baby pic? But there’s something a little weird and worrisome about popping into the mall for repeated sessions with your growing fetus, especially when the guy taking the photos has little or no medical training.

Medical technology originally aimed at improving pregnancy outcomes and diagnosing in-utero problems (with the fun side-effect and added bonus of revealing gender) has morphed into providing a “You’re on Candid Camera” view of life before birth. What was previously a private and sacred space has become wide open for all to see, friend and stranger alike, as often as we’re willing to pay for it, come one come all.

And do we even know the risks of these “fetal portrait” sessions?

Though ultrasound in the care of obstetrical patients has been studied  for 25 to 30 years, the data cannot clearly state there is no risk. We just don’t know for sure. The sound waves used to create the image vary from machine to machine, and so do their intensity. The FDA has stated that centers providing 3D or 4D entertainment ultrasounds often utilize higher levels of energy for longer periods of time.

I’m also concerned about the possibility of failing to detect anomalies during entertainment scans. Portraiture is not intended for diagnosis, and often the scan is performed by a technician who knows little about fetal development. Most of these centers require a signed release stating the ultrasound is for entertainment purposes only, but wouldn’t it be upsetting if an abnormality was missed?

Having a CT scan, MRI, or colonoscopy for our own enjoyment would be considered inappropriate, wouldn’t it? Then why would we subject our precious babies to testing in an unregulated site, by unregulated practitioners, just for fun?

I’m relieved that our twins are healthy and developing beautifully, and that they were scanned in a state-of-the-art medical center by trained professionals. Shouldn’t all babies be? Let’s face it, there are no guarantees in this human life. Sometimes things go wrong, whether we like to think about it or not.

Yup, I’m old, but what do you say we save the medical technology for health screening and the portraits for after delivery. Then go wild if you like, ’cause who doesn’t love a cute baby pic?





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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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