Why to avoid ‘keepsake’ 3-D and 4-D ultrasounds

The 2-D ultrasound image on the left and 3-D ultrasound image on the right both show a baby with a cleft lip.
The 2-D ultrasound image on the left and 3-D ultrasound image on the right both show a baby with a cleft lip.

A quick Google search reveals that nearly a dozen businesses in the Dallas-Fort Worth area offer 3-D and 4-D keepsake ultrasound services.

More expecting parents than ever are paying to get photos and videos of their babies that are more lifelike than the 2-D ultrasounds from their doctor’s offices. This is despite the fact that the Food and Drug Administration (FDA) warns parents to avoid them. Medical groups such as the American Congress of Obstetricians and Gynecologists (ACOG) also discourage the use of commercial ultrasounds.

I know you’re excited to see your baby. Booking a photo op can be tempting. But it’s important to remember that an ultrasound is not just for entertainment. It’s an important medical test. Let’s talk about why and when doctors use them, and I’ll share my concerns about having a 3-D or 4-D ultrasound in a non-medical setting.

2-D, 3-D, and 4-D ultrasounds: What’s the difference?

All ultrasounds use sound waves to create an image of your baby in the womb:

  • A regular 2-D ultrasound creates a cross-sectional view of your baby.
  • In a 3-D ultrasound, many 2-D images are taken from various angles and pieced together to form a three-dimensional image. This looks more like what you’re used to seeing in a typical photograph.
  • 4-D is similar to 3-D, but it shows movement, so you can see your baby kicking or opening and closing their eyes.

So why don’t we use 3-D all the time if we have the capability to do so? Simply, 2-D often is more efficient. We usually don’t need 3-D to assess how your baby is developing. While 3-D can give a nice picture of the outside of your baby, 2-D ultrasound is really the standard that has been developed by experts to look for abnormalities in development and growth of your baby.

However, 3-D and 4-D ultrasounds can be important tools to assess some abnormalities that are hard to look at in 2-D, such as cleft lip. They also are helpful when we need to explain an abnormality to parents. While doctors and sonographers may be able to easily recognize it in a 2-D image, parents are often able to better visualize the abnormality in a 3-D image.

Are ultrasounds safe for your baby?

The ultrasound waves used to image the baby expose the baby to energy in the form of heat. Under some circumstances, heat can lead to birth defects. That’s why we adhere to a principle while performing ultrasounds called ALARA: as low as reasonably achievable. That means we are careful with the settings on the ultrasound machine so we use as low amount of power as necessary and we limit the amount of time needed to obtain images, thereby exposing the developing baby to the least amount of energy possible.

In its warning against commercial use of ultrasound, ACOG endorsed this statement from the American Institute of Ultrasound in Medicine: “Although there are no confirmed biological effects on patients caused by exposures from present diagnostic ultrasound instruments, the possibility exists that such biological effects may be identified in the future. Thus ultrasound should be used in a prudent manner to provide medical benefit to the patient.”

Bottom line: When ultrasounds are performed to help manage the pregnancy and gather information about the developing fetus, I have no worries about its use.

Concerns about keepsake ultrasounds

Forty weeks can feel like a lifetime to wait to see your baby. 3-D and 4-D ultrasounds can seem like the perfect solution to get a sneak peek of your little one. Upon seeing one of these ultrasounds, I’ve heard parents say, “Oh, he’s got his grandfather’s nose,” or, “She looks just like her sister when she was born.”

But when you go outside the medical setting to get a 3-D or 4-D ultrasound, we worry about a couple things.

Qualifications of the person performing the ultrasound

If you get a 3-D or 4-D keepsake ultrasound outside of a medical setting, the person performing the ultrasound is focused on getting a good photo and video for you, not assessing the health of your baby. They may not have the same rigorous training that a certified ultrasound facility requires of its sonographers.

If they see something they are uncomfortable with, they may not be prepared to provide you with information, support, or follow-up. In those cases, you may need to go to your doctor for another ultrasound. This can result in unnecessary anxiety and concern.

Commercial ultrasounds also may result in false reassurance. Some women interpret a pleasing photo as evidence of healthy development. If the person assessing the ultrasound isn’t a trained medical professional, they may not have the skills to notice that something isn’t right with the baby or other structures like placenta and umbilical cord.

Cost

Commercial 3-D and 4-D ultrasounds are not cheap! And having a baby is expensive these days. Don’t skip a recommended ultrasound or other testing at your doctor’s office just because you got a keepsake ultrasound and believe everything is fine with the pregnancy. Think about how you might otherwise use the money you would save from choosing not to have a keepsake ultrasound – like purchasing diapers or starting a college fund!

Safety

I already mentioned why there are concerns about the use of ultrasound with developing fetuses. I worry that the person performing a commercial ultrasound isn’t as careful about lowering the power settings on the ultrasound machine or keeping the time the baby is being exposed to a minimum.

Parents’ expectations

Not all 3-D ultrasound images are pretty. Some images may look a little scary, but it doesn’t necessarily mean something is wrong with your baby.
Not all 3-D ultrasound images are pretty. Some images may look a little scary, but it doesn’t necessarily mean something is wrong with your baby.

You’ve probably seen friends’ 3-D ultrasound photos in which their babies look like, well, babies. And you may have seen magazine photos of beautiful 3-D ultrasound images.

But there is some luck involved in getting those perfect photos. It requires the baby to be in a good position with plenty of fluid surrounding them. The ultrasound may take longer, or you may need to go in more than once to get a good photo, increasing the amount of energy to which you and the baby are exposed. Even then, you may be disappointed that your photos don’t match what you expected.

Some 3-D ultrasound photos also can look a little scary. I’ve seen parents come in worried that something was wrong with their baby because the photo didn’t look “right.”

If you do decide to get a keepsake ultrasound, you’re more likely to get the pretty images you see in magazines between 24 and 28 weeks. At this point, your baby is beginning to fill out and won’t look so bony. There’s also a good amount of fluid around the baby, which is necessary to get a good photo. By the third trimester, the fluid around the face may not be as generous, and the baby will start pressing up against the uterus, making it more difficult to get a nice photo.

It may be worth asking your doctor if they can take a 3-D or 4-D ultrasound at the time of the 2-D ultrasound. They may be open to it if they have the technology and the time. But I urge you to follow FDA advice and limit ultrasounds to medical purposes and only when performed by trained health care professionals. There will be plenty of photo opportunities once your little one arrives!

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