When Sarah Carter was pregnant with her first child, she started digging into the research on ultrasounds, scouring studies in mice and rats. She couldn’t find any evidence in humans they cause harm — professional groups agree that ultrasounds are helpful and safe to perform during pregnancy.

But Carter didn’t see any studies that explicitly showed they were safe. Then, she heard something that compounded her concerns. After an ultrasound, a friend of a friend was told her fetus had a limb malformation. She spent her pregnancy riddled with anxiety, only to find out nothing was wrong after the baby’s birth.

Carter decided to refuse every ultrasound while pregnant. To her, the idea of spending her pregnancy anxious about ultrasound results seemed risky — riskier than the chance of missing something rare, but important, on a standard scan. When her birthing center told her an ultrasound was mandatory to deliver there, she found a new provider.

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“I felt they were forcing my hand and not letting me make my own decision,” said the 38-year-old art therapist. “I wanted to trust my body.”

Carter’s decision reflects a debate among some women about whether to forgo ultrasounds altogether, a question that has cropped up on social media groups for pregnant women and pregnancy and parenting blogs. And while health care providers agree it’s a woman’s choice whether to have a scan, they worry about women skipping all of them. Ultrasounds are key to screening for serious developmental problems — including some that can be addressed in utero. Ultrasound results can dictate whether a woman needs to give birth at a certain kind of facility, so that specialists are on hand to care for the baby after birth. They can tell providers and women whether they’re carrying twins, or whether their placenta is too low or their baby is breech as labor begins.

Prenatal care providers who spoke with STAT reported varying numbers of patients who refused ultrasound. Some often encountered skepticism, while others more frequently cared for women who were on the opposite end of the spectrum: getting far more ultrasounds than they needed at new standalone clinics that offer 3D and 4D scans. All of them suggested the deviations from recommended scans were a new cause for concern.

“It’s pretty scary that there are some women out there who have no ultrasounds during pregnancy, because we really rely on it as a screening and diagnostic tool,” said Dr. Leena Nathan, an obstetrician-gynecologist at UCLA Health.

Ultrasounds use sound waves to capture images of a fetus inside the uterus. Many women have ultrasounds during the first trimester, which is helpful to estimate how far along a pregnancy is. Several providers told STAT they aren’t troubled by women who skip that “dating” scan. But they strongly recommend all women have what’s known as the anatomy scan, or an ultrasound around 20 weeks gestation to look at fetal development and check for any problems. Some women — including those with high-risk pregnancies or women carrying twins — have more scans.

Ultrasounds have been used to monitor pregnancy for decades, and there’s no meaningful evidence that they can cause harm to a developing fetus. The American College of Obstetricians and Gynecologists notes that “no links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life.”

But experts can’t rule out the possibility that future research could point to possible effects, which is why they recommend that pregnant women only get ultrasounds that are necessary and are performed by trained providers as part of their prenatal care.

“We know that it’s safe to the degree that nearly every person gets one or two scans in their pregnancy, and we haven’t seen any untoward effects,” said Nathan.

But some women still want to avoid them, like Erin Rice Petrillo, a 36-year-old from Pennsylvania. Pregnant with her first child in 2015, Petrillo took a birthing class where her teacher shared a traumatic birth experience in the hospital. That story pushed Petrillo to seek out other women’s stories. She started reading the research on prenatal care and poring over articles on her choices as a pregnant woman.

She set out to find a provider who would be on the same page as her when it came to her prenatal care. She ended up selecting a midwife who practiced at a hospital, hoping she might support Petrillo in declining some kinds of standard care, like ultrasounds. Petrillo knows that experts recommend the scans during pregnancy when it’s medically necessary. But she didn’t feel that the scans were necessary for what she saw as a “routine pregnancy” without any problems.

Petrillo firmly believes that pregnancy isn’t a medical condition, but a natural state for a woman’s body. Unnecessary medical procedures, she said, can lead to a “cascade of treatments, tests, or procedures” that also aren’t necessary.

“My philosophy is that your body is gonna do what it’s gonna do. Hearing the heartbeat super early or seeing whatever development early on, it’s not going to change the outcome,” she said.

It wasn’t a clear-cut choice. Petrillo hesitated, in particular, about skipping the 20-week scan, knowing it could catch some problems that, if discovered before birth, would warrant intervention in utero or right after a baby’s birth.

“I questioned myself making that decision the most,” she said. Ultimately, Petrillo didn’t have ultrasounds while pregnant with either of her children, born in 2016 and 2019. She said she would have reconsidered that decision if there were any signs of serious complications.

Prenatal care providers often field questions from pregnant women about the potential risks of ultrasounds. They walk women through the evidence, emphasize the benefits of ultrasound, and lay out the risks of skipping a scan. They make it clear that forgoing the scans can leave women and providers in the dark about certain problems, like a heart malformation or underdeveloped kidneys.

“When we find things with ultrasound, we can counsel the parents about what to expect, make all kinds of plans for newborn care, and make sure the baby is born in a place that can take care of those problems right away,” said Dr. Celeste Sheppard, a maternal-fetal medicine specialist at the University of Texas at Austin.

It’s a delicate balance for providers. They want to hear out a woman’s questions and concerns. They don’t want to downplay a woman’s worries or strong-arm her into having a scan she doesn’t want to have. But they do want to make sure women are armed with accurate information.

“These are long conversations that you have to take the time to have, to make sure the family understands the provider’s concerns and the benefits [of an ultrasound],” said Shadman Habibi, a nurse-midwife at UCLA Health.

If a woman decides to abstain from ultrasounds, Sheppard said, “that’s her prerogative.” She would continue to care for that patient and avoid “an arm wrestle” about the question of ultrasounds. But Sheppard said she understands why some providers might dismiss a patient from their practice if she refuses any scans.

“It’s also the prerogative of the physician to say ‘Well, OK, I can’t see you anymore … I’m happy to help you find someone else,’” said Sheppard, who is also the clinical director of ultrasound at UT’s women’s health department.

Several providers said they see women having too many ultrasounds more often than they see women skipping the scans altogether.

“Usually, people want more ultrasounds and we’re trying to talk them out of ultrasounds,” said Dr. Chemen Neal, an obstetrician-gynecologist at Indiana University Health.

The fast-growing business of 3D and 4D ultrasound centers has fueled that trend. Some clinics offer package deals, bundling multiple scans at different stages of pregnancy. Others tout a discount or keepsakes if women come back for more ultrasounds.

“It’s become a cultural norm,’” said Carter, one of the women who opted to have no ultrasounds.

And all those extra ultrasounds have providers worried. While there is no evidence that ultrasounds pose a risk to developing fetus, it isn’t clear whether there are any risks with excessive ultrasounds. ACOG cautions against the “casual use of ultrasound.”

“All of our professional societies — and I as well — have some concern about unregulated use of medical ultrasounds,” Sheppard said.

Among those concerns: the scans aren’t necessary and the people providing them might not be trained to stick to medical guidelines, like operating the ultrasound machine at too high a power setting or using it for longer than recommended.

Providers are also concerned about the possibility of an ultrasound technician at a freestanding clinic missing a problem with a pregnancy, giving a woman a false sense of security. Sheppard pointed to a case in which a fetus had a hole in its abdominal wall, leaving its intestines growing outside the body — a problem missed in an ultrasound at a 3D/4D clinic.

“When a mom is falsely reassured, I think [that] is harmful and concerns me,” said Sheppard.

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  • Some of the physicians quoted in the article state that ultrasound is a screening tool. Would these physicians dismiss patients from their practices for declining other screenings (such as a quad screen) after being counseled? I don’t think so.

  • If ultrasounds…..which are done in HUGE excess with some women having greater then 20 in pregnancy, are helping women and babies, why is the maternal and neonatal death rate so high in the USA? We have more interventions in pregnancy and birth, spend the most money of any developed nation and have the worst outcomes!

  • Good response Jen. As a nurse with more than 40 years experience, I have worked with many, many women who want and demand to be active participants in decision-making during pregnancy and that is as it should be. When women are passive and do not ask questions, others will make decisions for them. I also have discovered that many women are motivated to question all aspects of care and refuse testing and some treatments that have been found to be generally benign, because they are mistrustful of the healthcare system and the way it has treated women in the past. The issue is compounded by nurses who become frustrated and even angry when women question care or come to the labor and delivery period with very specific birth plans, refusing IVs, fetal monitors, and other “routine” assessments including periodic blood pressure measurements during labor. Nurses who care for multiple patients may find themselves struggling to find time to address the legitimate questions and concerns verbalized by these women and their support person(s). Nurses are often not trained to deal effectively and with sensitivity to the challenge of meeting a woman’s needs for clarification and support in the decision-making process. The patient, support person(s) and nurse (along with the physician or nurse midwife) are a TEAM and must effectively communicate with the woman to make the best decisions. Nurses and other providers are not the enemy. Ignorance is and we can best help the woman by positively responding the women’ questions and concerns.

    • Yes, Rose! I once went on a hospital tour with a couple (at a big urban academic medical center, not a birthing center) in which the husband questioned every single thing the tour guide said. He was concerned his son would be circumsized without his permission, that his wife would be given antibiotics if she was positive, etc. etc. I was there at the end of a twin pregnancy (in a wheelchair) and had to ask him if he could hold some of his questions to the end of the tour. I switched OBs early in my pregnancy when she had me schedule a c-section because she didn’t even attempt vaginal births of twins. My new OB did allow you to try and I did have a vaginal birth of twins. However, our birth plan (as posted on the wall) was: give birth to 2 healthy babies. One intern came in and explained that if one shifted during delivery, they would attempt to shift him back in the womb. Another intern came in and said they wouldn’t do that but would do a different procedure. Our response was “whatever you feel confident about, and think is best, please do! We are not trained in this area. We do not care which process you use – please try to get us healthy babies.” And they did. 🙂

  • Maternal and fetal death are also not abnormal and happen for “natural” causes. I am someone whose placenta previa (a potentially fatal condition for mothers and babies) was found during a routine ultrasound. I had superlative care and my daughter and I suffered no ill effects (because of the superlative care). My high school friend’s ultrasound made it possible for her son to survive heart defects that required immediate surgery upon birth (and birth at a medical center in a different state than which she lived). Pregnancy and birth are normal and natural. So are complications. So is death. So is doing all you reasonably can to have a healthy pregnancy and birth – like routine medical care.

  • We were looking at pictures with our grandson, who was about 3 yrs old at the time. When we came across his ultra sound picture immediately he exclaimed that when that picture was taken it got real hot and the music was too loud and hurt his ears. Just saying!

    • So you are saying that a child, (and child imagine stories all the time), said that he remembers when he was still a fetus in development how the ultrasound felt like? It is anatomically and scientifically impossible for them to remember that. Just saying!

  • Go to a cemetery from a few hundred years ago, and you can see lots of young women and their stillborn buried together. Most of the time, it doesn’t matter. Cab drivers and cops deliver babies. But when it does, the information not known because the mother didn’t get an ultrasound can kill her, the baby, or both, and it’s preventable.

    • Exactly. Just like vaccines and many other inventions. They give us the luxury to feel safe. Because we don’t know (or don’t remember) how it was before these inventions.

  • Please for anybody reading this who might be thinking of forgoing ultrasounds – please do not. With my third pregnancy I kept getting called back for better heart pictures. At 38w4d I went for the last one. I can remember thinking it was silly. What were the odds anything was wrong?

    Congenital heart defects are 1 in 100. They are not some crazy rare thing. They can happen to anybody. My baby has hypoplastic right heart syndrome caused by tricuspid atresia as well as other defects. We were flown to a larger centre for her birth. Without the knowledge provided by the ultrasound, it’s likely she would not be alive today. There are too many mothers in my heart parent circles who have lost children. You don’t want to join that club.

  • I had ultrasounds for both my pregnancies and never questioned them. I found them to be very reassuring. That procedure, and others, became more important with my second child since genetic testing showed the baby was a carrier for a disease that can be fatal. Thankfully, in the end my child was fine.

  • I learned recently that ultrasounds during pregnancy are not standard in the UK. (This greatly disappointed the American grandmother to be.)

    Just one more data point . Someone else will have to report whether the UK or US has better outcomes.

  • Happened upon this article today. I’m currently 16 weeks pregnant and am skipping all ultrasounds. I will remain anonymous but I am director of a USMLE company and work with doctors constantly. Here’s why:

    – The Confirmation Ultrasound Scan: My ObGyn was one month out of residency. She replaced the two retiring ObGyn doctors at my care, and research insists that younger ObGyns save more lives than older doctors. However, our mothers ten to twenty years ago did not have 5-6 week Ultrasound scans. I went in, and naturally the nurses “assumed” I was going to get a pap smear (useless since there’s nothing they could do until after I give birth if cells were abnormal), pelvic exam (useless, since I was getting a blood test for all possible HIV & STD’s) and an early ultrasound. By assuming, they did not ask for informed consent. They thought they could get away with telling me what to do, until I paused them. The young doctor, who was a peer to me, came in up in arms about how I could die from being pregnant. Her concern wasn’t acknowledging the child “living” inside me at this stage, it was to take all preventative measures no matter how small the chances.

    She told me I could have a miscarriage (even though I had no symptoms, making the chances low). She then told me I could have a miscarriage that would not pass naturally (chances even lower) and lead to infection where she would need to perform a D&E of the tissue. She then told me I could have an Ectopic Pregnancy where the baby was in my fallopian tube. This is a reasonable concern. However, I knew I would feel some kind of pain around 7-9 weeks. I told her I’d wait and listen to my body. I never had any signs of pain.

    Here is why I opted out of the 6 Week Early Ultrasound – this is when the baby is most vulnerable. The 1st Trimester is that of brain development, and recent research from University of Washington notes that those genetically predisposed to Autism (which I am) have a higher chance of disrupting the neural paths in the child. Even if you put aside the potential for Autism (like most doctors do, because finding triggers for Autism is taboo in the health community), doctors are well aware that Ultrasounds raise the temperature when amplifying waves into the womb, vibrate cellular structures and can result in anomalies such as dyslexia or left-handedness (NO, I am not saying there is anything wrong with being left-handed. It is the non-genetic change that is concerning). This is why the Obgyn Association and the FDA both recommend limited Ultrasounds throughout pregnancy if there is no medical need, though doctors insist on 3-5 scans.

    I find this article a bit misrepresenting the vast opinions of doctors, in “caring for the best interests of baby”. Women are well aware that most doctors recommend early termination in the face of ALMOST ANY percentage of genetic problems. In the case of my doctor, she didn’t look at my pregnancy as a process to best protect the child. She asked me if I was having a “happy” or “unhappy” unplanned pregnancy (making a sad and happy face), insinuating I may want an abortion. Furthermore, she was uneducated in any of the risks from ultrasounds, stating they were “perfectly safe” no matter what. I found this naive. Once again, the ObGyn Association and FDA disagree.

    In my annoyance, I found a Midwifery Birth Center, directed by a doctor (who had better surgical reviews online, whereas my late resident had none). The fear-mongering that came with rejecting a mere 1st Trimester scan made me realize that delivering in a hospital where I would be depleted of my rights would be a huge pain. At the Birth Center, they read me a list of all the tests and care they would be doing over the next eight months, and had me check off the ones I did and did not want, with no questions. THAT is informed consent.

    I declined all ultrasound scans – with the exceptions that if I measured small, leaked fluids, or had twins, along with other odd symptoms, then I would gladly scan. Why no Anatomy Scan? Again, the chances that I would need to have an in-utero surgery, although very possible, were also very small. What else could they do if they found something out about my baby during that scan? I would never terminate even with the worst chromosome abnormality or if my child would live for only a few days after birth. I could deal with the pain if that happened rather than surgically cutting my child out of my womb. I know, from living my entire life in a special needs family, that I didn’t need months in advance to “prepare” for government assistance or household help should my child have a problem. What if there was nothing they could do and my child would inevitably die, and in turn I would die in the process? That is my choice. That is part of the risk I believe I took by becoming pregnant; and I believe that it is a private, personal choice that all women have the right to make.

    It really doesn’t matter how concerned doctors are if women don’t receive ultrasound scans. Are they going to force them to have them; call child protective services if we don’t? That would make the child inside us, obviously a life worth protecting, and what happens to a woman’s right to her abortion then? To do with her own body as she pleases?

    This isn’t about doctor’s concern for the baby. It’s clearly about making money, a grab for control, and not realizing what we all know to be true about every medical procedure since the dawn of time: Almost every treatment or tool doctor’s use has imperfections and dangers. Health is an ever-changing, ever-involving thing and doctors are notorious for not being more critical of their treatments and for being too rash in their preventative measures.

    • You say “Ultrasounds raise the temperature when amplifying waves into the womb, vibrate cellular structures and can result in anomalies such as dyslexia or left-handedness.”

      That’s quite a statement. Do you have anything to back that up? If you do, will you post a link to the article? And, if you do have a link for an article, is it from a reputable source?

    • I had an entirely normal pregnancy last time. No sign of anything wrong. An anatomy ultrasound showed my daughter had a very severe heart defect. This information does matter. It allows you to prepare for the birth of a baby who need immediate surgical repair to survive. For many families this requires travel to larger medical centres. Diagnosis before birth can be the difference between a baby that lives and a baby that dies. Congenital heart defects occur in 1 out of 100 pregnancies. They are not that uncommon and they can happen to anybody.

    • You are making bold statements, without any SCIENTIFIC STUDIES to back them up.
      You cannot do whatever you please with a child. Once you decide to keep it, it becomes you duty to care for and protect it.
      So many things could go wrong, and you would not even know it until it might be too late. I am very sorry for you.
      Thinking that you know better after reading a couple of articles (not even scientific ones) on the internet versus a medical practitionner, that has years of studies behind them, really is sad.

    • This is a reply to both the original poster and Orange.

      I am sonographer myself and have been trained in an accredited program and certified within our professional agency. Yes Ultrasound does heat tissue but it would take a considerable amount of time for that heating process to happen. Even if the tissue could be heated to a temperature that would cause damage the probe would have to be in the same spot the entire time with the power all the way up. When a sonographer is scanning any kind of procedure our probe is almost always moving. It may not appear so but we are constantly making minor adjustments to get the perfect picture and interrogate every view we need to get critical information. And our machines are hardly ever used at full power anyway especially for OB scanning.

      The risk in getting ultrasounds as stated in the article is going and getting a scan by someone not trained to use the correct setting for the specific exam, and or not trained at all (like can happen at those 3D/4D for “fun” clinics) to know what to look for in the first place. Sonography is a craft, we are part artist and part scientist. Yes we love to get beautiful pictures but foremost our job is to find pathology, if its there or if its not. And that takes a lot of knowledge of the human body and how it works but also a lot of knowledge of the physics and how to make it work to get those beautiful images and to find pathology.

      With all that being said, I am totally for patient education and your right to make your own decisions for your body, just don’t go thinking that 1 (or a few if there is need) ultrasound(s) at 20 weeks gestation is going to turn your baby into a hard boiled egg. The benefits far outweigh what negligible risk there may ever so possibly be.

    • There is a lot of misinformation in this post. I am a midwife at a free standing birth center, so many of my clients decline ultrasounds and I support that. However, first of all pelvic exams are not useless in early pregnancy. They give you info about the cervix and size of the uterus, confirming dates. A larger or smaller than expected uterus can give us info about dating, twins, possible SAB, etc. this is especially important for women with uncertain period dates or irregular cycles who decline early ultrasound. An accurate due date may seem unimportant, since babies are rarely born on their due date, but there are risks to both premature and post term babies and good dating can help us mitigate that. Also, you cannot screen for all STIs with blood tests, gonorrhea and chlamydia can only be diagnosed through urine a vaginal swab, trichomoniasis only by wet mount or swab. Although a pelvic exam can not definitively diagnose an STI, clues on the cervix and discharge can help determine proper testing and aid in diagnosis. Paps should be done on schedule (tons of research on that, look at the ASCCP website) although can be safely deferred until postpartum. It is absolutely incorrect that you will definitely feel pain at 7-9 weeks if an ectopic pregnancy (this is probably your most dangerous statement) as many ectopics are asymptomatic until they become an emergency, although even in the best of circumstances diagnosing an ectopic can be tricky and often involves more than one ultrasound. A miscarriage without symptoms is much more common than you think as well. The 20 week anatomy scan can find congenital defects, and as others have said is not just about termination. Most of my clients do not terminate, but if a baby may need interventions or surgery at or close to birth, that can really be lifesaving! but it also gives useful information about the location and health of the placenta (not all previas cause bleeding) the umbilical vessels (if running through the amniotic sac can cause stillbirth to baby and hemorrhage to mom), amniotic fluid volume, etc all of which help us take better care of you. This info is especially important if you are choosing an out of hospital birth because some conditions render out of hospital birth truly unsafe. Ultrasounds are by no means perfect: they don’t catch every problem and they do sometimes cause needless testing. But they can be a very important tool if used judiciously.

    • For Kristina: I truly commend you Kris for being so honest and truthful. As a mother of 3 adult children now, I only had 1 scan with my son due to spotting early from carrying his older sister who was 7 months at the time.

      This is not to blame anyone, but since losing my first grandbaby just this past weekend to miscarriage, I am so emotionally drained and have questioned how on earth can it be that here in America, miscarriage is 3.9 million babies a year! Having supposedly the best of the best, and yet losing so many!

      I doubt this was the case back in the 60’s when I was born and my family had the wonderful blessing of having babies left and right without this (some had c-sections as did I).

      My dear daughter had a sex determination a couple of weeks ago and we were planning her baby shower for next month. She was 5 months along and just went in on Friday for her regular check up (she had had 3 scans by this time) and they did the ultrasound and could not hear the babies heartbeat and said she miscarried! The pain that went through me when I got a text from her and her husband that said ” I miscarried” was so horrible! I thought for sure she had been messing around because of my shock! They started right away to induce her labor to deliver the baby and also gave her an epidural.

      Now, what I don’t understand is why didn;t they wait another week to try again? Why the haste? I searched and read other articles that supported allowing a woman to wait a little and then scan again. One in particular is the european study done here, which is mentioned on Dr. Sarah Buckley’s website:

      https://sarahbuckley.com/ultrasound-scans-cause-for-concern/

      Something is so wrong about all these things. How can they use the same amount of powered ultrasound on a 250 Lb. woman, whose tummy has plenty of padding to absord the waves and frequencies coming out of the medical instrument and then turn around and use that exact same thing on someone very thin? This may sound crazy, and I am still in mourning over this horrible event, but what is good for one woman, may not be good for all! Every woman is beautiful, yet we each are different .

      The weird thing is, is that when she told me a baby was on the way by sending my husband and I a keychain which mine said ” remember granma, I love you forever” and my husbands had “love you grampa”, I felt such a strong urge to tell her that she must start researching on everything from ultrasounds to vaccinations, so that her and her husband can make informed decisions for their first baby to be. Since her husband is in the medical field, all was ignored.

      I can only hope that through this time, we heal and learn to be closer as a family as we live in different states. My hearts desire is for you younger women…….please, please, please……do your research and never just trust your doctor for complete care of your own body. You and your husband/partner,etc… at least LOVE one another and you cannot expect your dr. to love you too! They don’t even actually know you!

      If something happens, don’t be too soon to agree to what they want to do to you and follow your heart and give yourself a little extra time. You at least deserve that much and so does your baby.

      Love to all women who have experienced loss by their angel going back to heaven!

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