Photo studio in-utero
By Emily Huhn

Danielle Skelley got a flat tire traveling near Bedford, New Hampshire. Pregnant and alone on the trip, a flat was the last thing she wanted to deal with. But her misfortune led to an unexpected tip. It was the tow truck driver who mentioned a business in Salem, Massachusetts that offered three-dimensional images and videos of babies in the womb. He and his wife had seen their baby this way when she was pregnant. Intrigued, Danielle decided to make the trip from her home in Merrimack, New Hampshire to Sneak Peek Ultrasound to get a tape of their unborn son as a surprise holiday gift for her husband Chris. She played the video Christmas morning. “It was the best Christmas I’ve ever had,” Chris said. “It totally surprised me and it was just great to see my baby.”

Sneak Peek Ultrasound is just one of many businesses across the country opening to meet the demand for “fetal keepsake videos” from expectant couples. Typically, parents-to-be receive a flat, grainy black-and-white image of their growing baby from their doctor after a standard diagnostic ultrasound at 18 weeks. But parents are increasingly shelling out $100-$300 for live-3D images of their babies later in their pregnancies in order to obtain golden-hued videos and photographs that can capture a yawn or a smile and reveal distinctive features such as the baby’s eyes, nose, and chin.

“It is clear that women want this service, they want that connection,” said Kelli Twiss, who runs Sneak Peek’s Salem branch. Twiss, a mother of four, wished she had had the chance to bond more closely with her babies when she was pregnant. “For some people I don’t think the reality hits until they see a little baby’s face.” She and her husband Dan, a carpenter, decided to open their branch of Sneak Peek Ultrasound a year ago after buying a used General Electric ultrasound machine and hiring a certified ultrasound technician to run it.

“The more people that bond with the baby, the better that baby is going to be cared for, it’s that simple,” said Twiss, who is convinced this service isn’t just for moms, but for extended families as well. Prenatal sonograms are important because they let moms relax and enjoy what is on the screen, said Terri Truex, president of Sneak Peek and owner of the Nevada branch. “We’ve had such a positive response from doctors out here because it makes the moms feel better,” and because doctors usually don’t have the time or the space to make this a part of their practice, she said.

But not everyone is happy about this trend. Regulatory agencies and much of the medical community have raised questions and criticisms about the use of ultrasound for entertainment purposes.

“I think that ultrasound is a medical test and it has always been a medical test. It really doesn’t belong in the hands of non-medical personnel,” said Dr. Beryl Benacerraf, Clinical Professor of Obstetrics, Gynecology, Radiology, and Reproductive Biology at Harvard Medical School. “It is like construction workers that use heavy equipment. I don’t think that should be in the wrong hands either.”

Dr. Benacerraf also wonders what happens if fetal abnormalities are missed during an ultrasound session at a private business. “One reason we use [ultrasound] is to determine the health of the baby,” she said. “What if the baby was abnormal and that wasn’t recognized? Before we start introducing the baby to the parents we check for abnormalities.”

During an ultrasound procedure, sound waves from a transducer placed on the mother’s abdomen are emitted and reflected off the fetus to create an image on the monitor screen. This technology has been in use for about the last 50 years and has a good safety record. Harmful effects in human cells have not been shown by the bulk of published scientific studies.

Dr. David Jones, director of the Fetal Diagnostic Center at the University of Vermont College of Medicine said he would not hesitate to give a patient a 3D photo or a couple of minutes of video time to see their fetus at the end of a diagnostic medical exam, a generally well-accepted practice. But he said he would not give his consent if one of his patients asked about having a non-diagnostic ultrasound performed at a private company, partly because keepsake sessions can last twice as long as a typical 30-minute diagnostic ultrasound session. “It is hard to state definitively just where the line should be drawn,” he said.

The Food and Drug Administration and some state agencies are trying to do just that. The FDA opposes the practice of exposing fetuses to ultrasound waves for non-medical purposes. Tests have shown that ultrasound can cause vibrations and a rise in temperature in human tissues, and although there is no evidence that this can harm the fetus, the agency states that casual exposure to ultrasound is not assumed to be innocuous and should be avoided.

Technically, the FDA regulates medical devices, while the state regulates the qualifications and behavior of physicians and technicians. An agency consumer update states that “persons who promote, sell or lease ultrasound equipment for making keepsake fetal videos should know that the FDA views this as an unapproved use of a medical device.” However, while the agency has issued warnings to some businesses, none have been shut down and more continue to open each year.

The Massachusetts State Board of Registration in Medicine adopted a policy last December supporting the views of the FDA. The Board urges Massachusetts doctors not to perform medically unnecessary ultrasounds. The Board also notes that it will report anyone practicing a medical procedure without a license to the attorney general or a district attorney.

Sneak Peek’s Twiss acknowledged that she operates in a gray area, but would welcome stricter, clearer guidelines. She does not claim to run a medical practice or offer medical procedures, and requires that all clients be under the care of a physician. In an effort to avoid concerns about diagnosis of fetal abnormalities, Twiss does not see anyone for their first ultrasound. She said she also makes it clear to her clients that the session is not to be used in place of a diagnostic ultrasound. “Moms want this, and I just want to do it right,” she said, adding that she would do whatever it required in order to comply with future regulations.

Robert Wolfson, a maternal-fetal specialist in Colorado Springs, argued that keepsake imaging is not a question of if, but a question of how. He said it is “a consumer driven issue” that is here to stay. The question then becomes how to provide imaging services in a safe manner that is supportive of a pregnancy. He is urging organizations like the American Institute of Ultrasound in Medicine (AIUM) to take the lead, so keepsake ultrasounds remain in the hands of medical professionals rather than in those of commercial operators. He said he doesn’t want to see something that is so “valuable to patients” discarded by the medical community, and has himself offered keepsake packages for $95-$150 in his practice since November 2002.

Dr. Wolfson said that 3D/4D ultrasound goes beyond entertainment by providing a keepsake for the future that is part of the parents’ relationship with their child. But he is not in the majority on this. Dr. Wesley Lee of the Division of Fetal Imaging at the William Beaumont Hospital in Royal Oak, Michigan points out that while some bonding may occur, the psychological risks and benefits of ultrasound have not yet been studied or quantified.

Most practitioners recommend that ultrasound be offered primarily as a medical diagnostic procedure and only if there is a valid clinical reason to do so. And at this point, they have the FDA, AIUM, and the American College of Obstetricians and Gynecologists behind them.

But that isn’t stopping expectant mothers. As Danielle Skelley described it, “You can’t put a price tag on seeing your baby before it’s born.”