4D ultrasounds: what are we not being told?

Pretty much every pregnant woman in Australia would have come across the ubiquitous Bounty bag. The little navy blue bag stuffed full of samples and brochures are a marketer’s dream. Captured audience, perfect product placement. All of the contents of Bounty’s Mother To Be bag comply with the WHO code (which bans the promotion of infant formula) and SIDS guidelines.

I didn’t have my babies in Australia, so I didn’t know about the Bounty bag until I started working as a Lamaze childbirth educator in Melbourne. It wasn’t until the other week though that I finally got to have a peek into a bag. A lot of the usual suspects had their product samples and brochures inside, including flyers sporting attractive discounts for storing your baby’s cord blood in a private cord blood bank, a topic I wrote about a few weeks ago.

4D ultrasound flyerAnother flyer that caught my interest was one for a private company that offered non-medical 4D ultrasounds. As a former marketing professional, I am the first one to admire savvy marketing. It’s a clever flyer that features a pregnant woman’s belly on the front that opens up to reveal a 4D ultrasound photo of a baby. 4D ultrasound is the next level in diagnostic ultrasound, the ultimate window to the womb, if you will. Unlike the grainy black and white images that most people are familiar with when they have an ultrasound during pregnancy, the 4D ultrasound is both three dimensional and in real time, giving you the best idea of what your baby actually looks like – until they’re born of course!

When I was pregnant with both my children (who are now six and seven years old) my doctor, who is a highly-regarded ultrasound specialist in Israel, performed 4D ultrasounds routinely throughout my pregnancy. In total, I estimate that I had about six ultrasounds with each pregnancy. She proudly boasted; “the ultrasound machine is my eyes”, meaning she no longer relied on palpation, or feeling the baby with her own hands. At the time, I remember being incredibly excited that I was going to see my baby move around in my womb. For a pregnant woman, there are few things more enticing than the offer of seeing your unborn baby. I get that, I really do.

At the time, I never gave it a second’s thought as to whether this was potentially harmful for my baby. After all, ultrasound is supposed to be completely safe isn’t it? Isn’t that what we are told by the experts – our own care providers?

I recently had a look at the ultrasound images of my daughter that were saved from one of the scans. For a long time I just oohed and ahhed, admiring my beautiful unborn baby girl. That’s not what I see now. Have a look for yourself. What do you see?

Amalia ultrasound


If she could have talked to me, I truly believe she would have been screaming, “Stop it! Stop the noise! It’s hurting me!” Look at how her hands are up by her head, and over her ears. Have you ever wondered why so many ultrasound images show a baby with their hands over their ears, or why so many babies are “uncooperative” and turn away during the ultrasound so that you can’t see their face?

There are so many things I’ve learned since becoming a childbirth educator that I wish I had known when I was pregnant. And one of those things is that ultrasound may not be the totally safe, innocuous procedure that we’ve been told it is.

Internationally-renowned physician, Dr Sarah Buckley has been researching and writing about the effects of prenatal ultrasound for over 20 years. I have provided a link to one of her articles at the end of this blog. I would also encourage you to read her book, Gentle Birth, Gentle Mothering which devotes an entire chapter to prenatal ultrasound.

When a former president of the Royal College of Obstetricians and Gynaecologists was asked what were the three most important advances in his specialty in the 20th century he replied ultrasound, ultrasound and ultrasound. If you are a bit of a history buff, you might enjoy reading this fascinating (but reasonably brief!) history of the use of ultrasound in obstetrics and gynaecology.

Prenatal ultrasound for diagnostic purposes is a relatively new technology, with widespread use only coming into effect in the mid-1970s, but do we know enough about it to assume that it is it safe enough to be using routinely on all mothers and babies? Is it beneficial?

Firstly, we cannot underestimate the huge range of beneficial effects of ultrasound examination in improving the health of women and babies. Ultrasound can be used to detect a wide range of foetal abnormalities, including cardiac defects, foetal chromosome abnormalities, locating the baby accurately in order to perform invasive procedures such as amniocentesis or even surgery on an unborn baby – an amazing example of this was surgery performed on a 24-week old foetus diagnosed with spina bifida.

So yes, ultrasound can be a powerful diagnostic tool. However, there is a lot that we don’t know about ultrasound. In May 2006, figures from the Centers for Disease Control (CDC) confirmed what too many parents and educators already knew: the incidence of autism is high, making it an “urgent public health issue,” according to Dr José Cordero, director of the CDC’s National Center on Birth Defects and Developmental Disabilities. Twenty years ago autism spectrum disorder (ASD) was so rare that it occurred in just one in 10,000 births. Today ASD, which is characterised by a range of learning and social impairments, now occurs in one in 68 children – with no sign of levelling off. The steep increase in autism is a global phenomenon, occurring in industrialised nations around the world.

The cause of autism has been pinned on everything from “emotionally remote” mothers (since totally discredited) to vaccines (also discredited), genetics, immunological disorders, environmental toxins and maternal infections. Today most researchers theorise that autism is caused by a complex interplay of genetics and environmental triggers. A far simpler possibility worthy of investigation is the pervasive use of prenatal ultrasound, which can cause potentially dangerous thermal effects. I’d encourage you to check out this really comprehensive (and balanced) article on autism on TheBabbleOut.

Health practitioners involved in prenatal care have reason to be concerned about the use of ultrasound. Despite the fact that ultrasound has been used in obstetrics for 50 years and early studies indicated it was safe for both mother and child, enough research has implicated it in neurodevelopmental disorders to warrant serious attention.

In recent years, ultrasound technology has advanced considerably. In the early 1990s, a huge increase in allowable acoustic output potentially made prenatal ultrasound riskier than ever:

  • Most women in industrialised nations will receive at least two ultrasounds during her pregnancy. Women in “high-risk” situations may receive many more scans – which, ironically, may raise their risk.
  • The range of time within an embryo or foetus’s development when ultrasound is performed has extended to very early in the first trimester and continues into the third trimester, right up to delivery.
  • The development of the vaginal probe, which positions the beam of sound much closer to the embryo or foetus, may put it at higher risk.
  • The use of Doppler ultrasound, which is used to study blood flow or to monitor the baby’s heartbeat, has increased. According to the 2006 Cochrane Database of Systematic Reviews, “routine Doppler ultrasound in pregnancy does not have health benefits for women or babies and may do some harm.”
  • The advent of 4D ultrasounds, specifically for non-diagnostic, or “keepsake” purposes is completely unregulated and therefore there is no limit on either the number of ultrasounds performed during pregnancy or the amount of time the foetus is exposed to ultrasound.

Early studies showed that subtle effects of neurological damage linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker for brain problems when not hereditary) and speech delays. Then in August 2006, Pasko Rakic, chair of Yale School of Medicine’s Department of Neurobiology, announced the results of a ground-breaking study in which pregnant mice underwent various durations of ultrasound. The brains of the offspring showed damage consistent with that found in the brains of people with autism. The research, funded by the National Institute of Neurological Disorders and Stroke, also implicated ultrasound in neurodevelopmental problems in children, such as dyslexia, epilepsy, mental retardation and schizophrenia, and showed that damage to brain cells increased with longer exposures.

My children are only a year and a week apart in age. (I know – what the hell was I thinking?!) When both of them turned six months old they both suffered an unexplained seizure. In the case of my son, he went on to experience multiple seizures over the course of a week. He was hospitalised and underwent pretty much every test known to modern medicine to try and understand why he was having these seizures. They had ruled out febrile seizures, or other illness. They ruled out epilepsy. My little boy had countless blood tests, EEGs – a test that detects electrical activity in the brain; he even had an MRI, which required him to go under general anaesthesia.

In the end, he was prescribed phenobarbital, an anti-seizure medication. He was on a daily dose of this medication, which is also known to have some pretty scary side-effects, for the next 12 months. When he was 18 months old, we slowly weaned him off the drug. Thankfully, he never had another seizure, but in that whole time, we never received a conclusive diagnosis.

Just as we were ending the nightmare with our first child, we went through the same thing with our daughter. Her symptoms were milder thank god, but the fact that they both suffered unexplained seizures at exactly the same point in their lives seems like far too great a coincidence.

Can I prove that the over-exposure to ultrasound in my pregnancies was to blame? Sadly no, I can’t. But as I outlined earlier, there is mounting scientific evidence to suggest at least a correlation between ultrasound and neurodevelopmental problems in children.

I am not suggesting that ultrasound should not be used in pregnancy. Clearly there are many reasons why the technology is extremely beneficial. But what I am suggesting is that non-diagnostic, “keepsake” ultrasound, particularly the use of 4D ultrasound, should not be permitted. Just because someone is a trained and accredited sonographer does not make the technology itself safe and without risk.

I strongly believe that our peak obstetric and gynaecological body, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG); together with the federal health department should implement stronger guidelines that limit the use of obstetric ultrasound for medical and diagnostic usage only.

My personal message to all the beautiful pregnant mamas out there is this; please don’t be seduced by the slick marketing that goes into promoting these totally unnecessary and potentially dangerous ultrasounds. Forget about the “digitally brilliant home theatre equipment, the private viewing suite complete with superb digital plasma vision and crystal clear audio.” Who cares about the “luxurious lounge and playroom for older kids”?

Pregnancy is a remarkably brief period in our lives and our wombs do a wonderful job of protecting our beautiful unborn children for nine months. Let us honour and respect that space – and allow them to grow into healthy, full-term babies. They will be earth-side before we know it and then we can stare at them 24 hours a day!

Want to learn more?

Ultrasound: More Harm than Good? By Marsden Wagner

Ultrasound Scans in Pregnancy – Your Questions Answered! By Dr Sarah Buckley

Tanya Strusberg is the founder of birthwell birthright. She is a Melbourne-based Lamaze Certified Childbirth Educator and a Fellow of the Association of Certified Childbirth Educators (FACCE). She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), Empowering Birth Magazine, Rockstar Birth Magazine, Mum’s Lounge, Go Ask Mum and Whole Woman. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators. Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.