Ultrasound examinations are now also possible in 3D and 4D, i.e. video. This makes medical screening easier and improves diagnostics. But the following also applies: as often as necessary and as little as possible. What this means for you in concrete terms.
A little person is growing inside you, but you can’t see it. And you’ll have to wait until the 20th week of pregnancy before you can feel it. No wonder you are eagerly awaiting your first ultrasound scan. For the first time, you will be able to take a look at your unborn baby. See that it is doing well, observe how it moves and maybe even suck its thumb. But which and how many ultrasound examinations are actually carried out before the birth? Who pays for them and when does it make sense to attend more appointments than the statutory screening recommends? We have compiled the most important information for you.
How many ultrasound examinations are included in prenatal care?
If you have not been classified as a high-risk pregnant woman and everything else is normal, the three basic ultrasound examinations covered by health insurance are completely sufficient.
First ultrasound
When: 9th to 12th week of pregnancy
The heartbeat can now be detected. Based on the current size of the embryo, your doctor will calculate the age and the expected date of birth. A multiple pregnancy can also be detected during the first ultrasound scan.
Second ultrasound
When: 19th to 22nd week of pregnancy
During the second ultrasound scan, your baby’s head diameter, chest circumference and length (crown-rump length) are measured again. This allows the developmental age to be determined and the date of birth to be specified. The organs, the position of the placenta and the amount of amniotic fluid are also examined. If you want to know, the gynecologist can now also tell you whether you are having a boy or a girl.
You can now decide whether you would like more detailed examinations beyond this basic ultrasound (here is our article on the topic of detailed diagnostics). This is where the boundary to prenatal diagnostics lies. An extended ultrasound can already indicate possible malformations and genetic disorders such as Down’s syndrome during the second screening. As parents, you should be as clear as possible in advance about how you would deal with such news.
Third ultrasound
When: 29th to 32nd week of pregnancy
Your child will be measured again, the function of its organs assessed and its approximate birth weight estimated. The position of the placenta will also be checked again, as this can change during pregnancy. If the baby is now lying head down – like most babies in the third trimester – and is not too heavy, a spontaneous birth is possible.
What types of ultrasound are there?
Whether 2D, 3D or 4D – the technology is always the same. Sound waves are emitted from the ultrasound probe, which are reflected back from the body tissue as an echo and converted into images. Wherever the tissue layer changes, the sound is reflected. For example, between the uterine wall and the amniotic fluid. Or between the bones and the muscle tissue of the unborn child. The ultrasound image that appears on the monitor is like a cross-section of the body.
- 2D ultrasound – the surface: A normal 2D ultrasound produces a flat image. Depending on how favorably your baby was positioned during the examination, you can imagine the little creature on the printout more or less well. Your doctor can also recognize tiny details with modern 2D devices. For example, the width of the bridge of the nose or the blood vessels of the brain.
- 3D ultrasound – the depth: 3D technology gives the ultrasound image depth. For an even finer diagnosis, it is often helpful if the child can be viewed from all sides. In addition, the gynecologist can have the ultrasound machine calculate away anything that obscures the view. For example, an umbilical cord floating around. 3D images are best taken between the 20th and 30th week of pregnancy. You can find out more in this article: 3D ultrasound.
- 4D ultrasound – the movement: The dimension of time turns the 3D images into “baby television” in 4D. A three-dimensional image is taken around five to seven times per second. Your baby’s movements become a movie.
- (Color) Doppler ultrasound: This method is used to measure the blood flow in the unborn child’s body. Doctors can determine whether all organs are well supplied, whether the baby is receiving sufficient nourishment via the umbilical cord and whether the brain is well supplied with blood. Measuring the blood flow patterns also makes it possible to assess the risk of pre-eclampsia (formerly known as pregnancy poisoning).
When are additional ultrasound appointments useful?
Normally, three ultrasound examinations during your pregnancy are sufficient. There is only one decisive reason for additional examinations, for which 3D or 4D technology is sometimes used: your doctor recommends them because he or she suspects that your baby is not developing normally or you are classified as a high-risk pregnant woman. In other words, further ultrasound appointments are medically justified.
Simply saying hello to the unborn child via 4D ultrasound became a lucrative trend known as baby TV, baby television, baby cinema or baby watching. A number of providers established themselves on the free market, some of which had this service carried out by non-medically trained staff. In some cases, parents-to-be could even invite future grandparents and friends to a fetus party. However, many gynecologists also offered baby TV as an IGeL service outside of preventive care. This service has now been banned due to an updated Radiation Protection Ordinance. This is because no diagnosis is made. For this reason, ultrasound applications for pregnant women that are not medically necessary are no longer permitted in order to protect the unborn child.
This sounds as if ultrasound examinations could be dangerous. The German Society for Ultrasound in Medicine (DEGUM) vehemently disagrees with this assessment. “Despite decades of intensive research, there are still no study results that indicate that ultrasound examinations during pregnancy pose any health risk to the unborn child,” emphasizes Berlin-based prenatal physician Dr. Kai-Sven Heling from DEGUM. The specialist regrets that 3D ultrasound technology as a whole has come under criticism as a result of the reporting. “You can be critical of so-called “baby television” for commercial purposes, as there is a very real risk of not recognizing actual problems in the fetus, partly due to the fact that users are often less qualified,” says Heling. “However, we fully support the use of ultrasound for diagnostic purposes.”
What does the sounding cost?
The statutory health insurance companies pay for the usual three ultrasound examinations in 2D. According to the maternity guidelines, these take place between the 9th and 12th, 19th and 22nd and 29th and 32nd weeks of pregnancy. If abnormalities are detected during the screening appointments, they also cover the costs of further examinations – including 3D or 4D, if this is deemed useful and necessary.
What can I show from an ultrasound examination at home?
You usually go to the ultrasound appointment alone or with your partner. However, your parents and best friends may all want to know what your baby looks like before the birth. Most gynecologists will give you a printout of the 2D or 3D image to take home so that you have something to show off and as the first picture in your baby album.
Tip: You can also ask if you can film the screen.
Two opinions: A prenatal diagnostician and a midwife on ultrasound during pregnancy
Privatdozent Dr. Kai-Sven Heling works as a gynaecologist in a group practice for prenatal diagnostics in Berlin:
Ultrasound helps to establish an early bond with the unborn child!
“What are midwives actually talking about when they invoke the much-cited ‘gut feeling’? I’ll be honest: this ‘gut feeling’ has never existed and never will. Especially at the beginning of a pregnancy, women have no reliable indication of their pregnancy other than the absence of their period. Until the 20th week, they don’t feel the baby moving and the majority of them are constantly worried about “Is it still alive?”. The fear of a miscarriage is great, and women are relieved and overjoyed when they see a monitor every few weeks showing that the baby’s heart is still beating.
Just 30 years ago, parents-to-be lived in a big bubble of uncertainty. You waited, and waited, and waited … Until, if you were lucky, you felt the first movements of the baby. Today, women can be reassured much earlier, and I think that’s a major achievement of modern medicine. This has nothing to do with ‘baby TV’ in the first place! If you can relieve a pregnant woman of her greatest worry, I think sonography is also perfectly justified from a medical point of view.
I am also sure that the ultrasound helps to establish contact with the unborn child at an early stage and thus promote a strong bond during pregnancy. For us men in particular, it is unimaginable at first that a child, our child, is growing in our partner’s belly. It is not until the 25th week at the earliest that you can feel the baby’s movements from the outside – by then the pregnancy is almost over!
With an ultrasound, this incomprehensible event becomes very real. First through a tiny flickering dot, later through razor-sharp 3D images, which from the 28th week onwards actually show the baby as it will later be born. You can see what the nose looks like, the mouth, the eyes. You can see how it sucks its thumb or plays with the umbilical cord. It warms your heart and you suddenly realize: Oops, that’s a real person!
Of course, we must not forget that ultrasound is a medical diagnostic procedure that should not be misused as baby TV. When a pregnant woman brings her four-year-old child for a detailed diagnosis because she ‘really wants to see her sibling’, I also realize that we are in a bad position. After all, there is always the possibility that we will discover serious malformations. Many parents-to-be are not aware of this enough. And, of course, siblings have no place at all in this examination!”
Barbara Kosfeld is a midwife and expert in the field of “Traditional Midwifery”:
Ultrasound usually brings more excitement than safety!
“Apart from the fact that it is not yet clear what damage the sound energy can do to the unborn child, I ask myself: what does this do to us women? It is simply not true that a pregnant woman feels better and safer if she is frequently scanned. For a moment, she may be relieved (‘Luckily, the little heart is still beating!’), but then the doubts immediately return: ‘What did the doctor say? The baby is too small? It hardly moved at all? Was there a shadow on the head?’ … In most cases, looking at the belly brings more anxiety and excitement than certainty.
At the end of the day, all this noise just means that we can’t develop our gut feeling. The psychological dependence on the doctor’s assessment, the worry that something might be wrong, the inability to be hopeful – if a pregnancy is so full of reservations, it can’t possibly have a positive effect on bonding! How are you supposed to establish good inner contact with the baby if you don’t learn to rely on yourself and your feelings?
And yet another dimension of pregnancy is lost through baby television: the mystical, magical, spiritual. Pregnancy is a very special time, and it gets its magic not least from the fact that a little person is growing up in secret, very intimately, in the mother’s womb. What will he be like? What will he look like? The unknown being offers plenty of room for imagination and projection. A bizarre, almost grotesque 3D image of the fetus leaves no room for this.
I advise every pregnant woman to find a midwife for preventive care right from the start. The mother-to-be will find out: Your pregnancy can be a time full of anticipation and good hope – without any baby TV!”