Your Biggest Pregnancy Ultrasound Fears (and How They Stack Up Against Reality)

I remember my first pregnancy ultrasound like it happened yesterday.

There I was, sitting in the brightly lit OBGYN lobby, reading a Health magazine and acting like I was pregnant with my 5th child.

In reality, it was Baby no. 1, and we had just moved to the U.S from India in the dead of winter. No friends, no family.

My monkey mind was conjuring up at least five different worst-case scenarios that the scan would reveal. In short, I was a freakin’ mess on the inside and praying I don’t end up barfing in the large fancy planter next to my chair.

If your first ultrasound is around the corner, and your anxiety is through the roof, let me give you a virtual hug.

After having two kids (which makes me a seasoned ultrasound-ee), I’m happy to share how our worst fears about ultrasounds stack up against reality.

Spoiler alert: Most scan experiences are overwhelmingly positive – meaning you can keep calm and eat a cupcake.

The Ultimate Guide to Understanding Pregnancy Ultrasounds

You may have spent hours on the Internet looking up pregnancy ultrasound stages, how many times you need a scan, and how much water to drink before your pregnancy ultrasound. There are many exhaustive and scientific guidelines in the Interweb, explaining first trimester scans and other pregnancy ultrasounds in great (technical) detail.

This isn’t one of them.

This article is a list of the common concerns and fears women have about pregnancy ultrasounds, and I’ve done my best to answer them in a way that’s easy to understand and not filled with medical jargon.

What is a pregnancy ultrasound, and do you need one?

A pregnancy ultrasound image, produced through high-frequency sound waves, helps your healthcare provider monitor the health of you and your baby. A trained ultrasound technician (sonographer) smears a cold, gel-like substance on your belly and uses a small wand-like device (called a transducer) to view the baby and your reproductive organs on an ultrasound screen.

(No, the gel doesn’t stain your clothes, and yes, it’s surreal to see your little peanut for the first time on a screen!)

But why have a pregnancy ultrasound?

It helps your doctor confirm that you are pregnant (raise your hand if you, like me, detest those false positive home pregnancy tests).

During the first trimester (1-12 weeks), it’s a great way to check the baby’s heartbeat, estimate the due date, check for multiples (twins, triplets, anyone?), examine the placenta, uterus and check for any abnormal growth, and also rule out an ectopic pregnancy.

Apart from early pregnancy ultrasounds, scans during the second (12-24 weeks) and third (24-40 weeks/until birth) trimesters can determine the baby’s sex, check for congenital abnormalities, monitor the baby’s growth and position, and keep an eye out for placenta previa, placental abruption, and Down’s Syndrome.

Are there any risks associated with pregnancy ultrasounds?

Short answer – The jury is still out on this one.

Several studies show that there are no real benefits to early pregnancy ultrasounds, while some even go so far as to say the heat from a doppler can damage the baby’s brain or lead to congenital disabilities. Here’s a good read on why routine ultrasounds are unnecessary and how they can do more harm than good.

However, other studies say that sonograms/ultrasounds are safe, and there is very little evidence that they can harm the baby.

Here’s my take – as a mama who took the unmedicated, natural birth route in both my pregnancies – you can find a safe middle ground if you can’t figure out ‘to ultrasound or not.’

I had no clue with my first pregnancy and assumed that ‘the doc knows best.’

However, I insisted on having a natural birth (I’d like to say I’m a real trooper, but the truth is I was petrified of an epidural), and my OBGYN was open to it.

With baby no.2, I opted for midwifery care at the hospital.

I delivered at the regular family and maternity center. Still, I was cared for by five midwives throughout the pregnancy, and it was a certified midwife who delivered our beautiful baby girl. I had far fewer scans in my second pregnancy than the first! Not more than 2, if I remember correctly.

When Do You Need a 3D/4D Ultrasound? Are They Safe During Pregnancy?

Diagnostically speaking, never.

And, frankly, they aren’t worth the risk.

There are many different kinds of ultrasounds – abdominal, transvaginal, fetal echocardiography. All of these are advanced diagnostic ultrasounds to detect any problems in a pregnancy.

3D and 4D ultrasounds require specialized training and equipment and are not used for diagnostic purposes.

The biggest red flag about these ultrasounds? They are used for commercial purposes and offer parents ‘keepsake’ photos and videos of their little thumper.

‘Fall in love with your baby’ package and 4D ultrasound set to music? That sounds cute, and what could be wrong with that?

For starters, you need to pay out of pocket. Since 3D/4D ultrasounds are elective and not ‘doctor ordered,’ most insurances don’t cover them.

And they are most often not performed by registered sonographers trained in pregnancy ultrasound safety. Even the FDA warns against 3D/4D scans, saying there is absolutely no medical benefit from such scans.

And here’s one last heads-up – those super cute pictures and videos aren’t that easy to come by, as it depends on a lot of factors like the baby’s position, fluid around the baby, etc. You may have to do it multiple times to get a decent image.

I remember seeing my bestie’s 3-D scan photo of her baby and doing a mental ‘whoa, that’s scary!’. If you don’t know what I mean, take a look at this.  

Preparing for Your First Pregnancy Ultrasound – Please Don’t Do What I Did!

Remember when I was having a near heart attack waiting in the lobby for my first-trimester scan?

In my muddled state of mind, I did the one thing that would give me some relief (quite literally!). I used the restroom.

It turns out; you need a full bladder for a pregnancy ultrasound…because it helps get a clear image of the baby and all your reproductive organs.

Make sure you empty your bladder and THEN drink enough water (about 16-24 ounces) at least an hour before your scheduled appointment…and don’t forget to hold your pee until the scan gets over!

An ultrasound procedure usually takes 30-40 mins. Wear loose, comfortable 2-piece outfits so that the sonographer can access your belly having to remove any clothing.

Oh, and wait to be blown away when you see your little one for the first time!

Other Top Concerns about Pregnancy Ultrasounds Answered:

This section is a compilation of the biggest/worst fears women have about pregnancy ultrasounds…and how unfounded most of them are.

Are Ultrasounds Accurate?

An ultrasound is relatively accurate when it comes to finding the due date, conception date, baby’s sex, and heartbeat. But the early pregnancy ultrasound can miss certain things. For example, you may need a couple of ultrasounds to determine the baby’s sex because the fetus’s position may make it difficult to tell.

When it comes to miscarriages, fetal abnormalities, and baby’s size, the ultrasound is known to be less than accurate. For example, it’s hard to tell the difference between a miscarriage and a viable early pregnancy in the first trimester. The doctor may require a second ultrasound after a week or so to ensure accurate results.

Can Too Many Ultrasounds Harm My Baby?

Again, I’m on the fence about this one. Some recent studies say there is no long term harm to the baby from multiple ultrasounds, while others give a cautious warning.

You will want to check with your doctor on each scan’s purpose and if it is ‘mandatory’ for you or optional, based on your unique medical history.

What Can You Expect at Your First Pregnancy Ultrasound?

As mentioned earlier, a trained sonographer will use a transducer to create images of your baby and your reproductive organs and view it on an ultrasound screen.

Go with a full bladder and be prepared to spend at least 30-40 mins in the scan room. When the scan is over, the radiologist will go over the results and forward it to your healthcare provider, who will then share it with you.

And if your sonographer goes quiet, don’t worry. The technician is probably trying to find your baby’s private parts to determine the sex, …and that can be tricky if you have a bashful little one!

What Can an Ultrasound Detect in Pregnancy?

Depending on the pregnancy stage you are in, the ultrasound can detect routine stuff like confirming the pregnancy, possible due date, baby’s sex, and heartbeat. It can also determine the baby’s position, amniotic fluid level, and baby’s anatomy (physical measurements, growth of internal organs, etc.), among other things.

The 20-week ultrasound is more detailed and will scan for certain rare but serious conditions, such as Edward’s Syndrome, cleft lip, heart defects, etc.

How Many Ultrasounds Do You Need During A High-Risk Pregnancy? 

A high-risk pregnancy is when moms have a chronic condition, such as type 2 diabetes, high blood pressure, or a fetus with some growth restrictions.

The healthy low-risk pregnancy does not need more than two scans, but many moms get up to 5 scans in a low-risk pregnancy.

High-risk pregnancies warrant more monitoring, and that includes at least 4-5 scans. The number of scans largely depends on the individual and her health history and the baby’s health.

Can Pregnancy Ultrasounds Be Wrong?

Pregnancy ultrasounds, especially first trimester ones, are known to be inaccurate about pregnancy viability, baby’s sex, size, and due date. Often, this requires more than one ultrasound to confirm.

What if There’s No Heartbeat in My First Trimester Ultrasound?

Abdominal ultrasounds done very early (6-7 weeks) may not detect a fetal heartbeat due to several reasons, like inaccurate period date, big abdomen, or a tipped uterus. A transvaginal ultrasound is the best way to detect a heartbeat if it’s very early. 

If follow-up scans, combined with other factors like low HCG levels, don’t detect a heartbeat, it could mean a miscarriage.

I’ve read stories of women who had gone on to have a healthy pregnancy even when there was no heartbeat in their very first scan. 

Is a Pregnancy Ultrasound Painful?

Uncomfortable, yes (especially when you have a full bladder and someone’s putting pressure on your lower pelvic area). But not at all painful. So, relax!

Who Does Pregnancy Ultrasounds?

A trained sonographer/technician in a hospital or clinical setting.

Can I Eat Before a Pregnancy Ultrasound?

Yaaas! (imagine being ravenous AND having a full bladder). The good news is you can eat before the scan.

Why Do I Need an Ultrasound During Pregnancy?

They help monitor your baby’s health as well as yours. You can also find out your due date, baby’s sex, screen for congenital disabilities, etc.

What Weeks of Pregnancy Do I Get an Ultrasound? 

One scan in the first trimester (8-12 weeks) to confirm the pregnancy and determine the due date, etc. 

The second is usually done between 18-22 weeks, to determine the baby’s sex and the baby’s anatomy. A high-risk pregnancy may require additional ultrasounds in the third trimester.

Can You Detect an Ectopic Pregnancy in an Ultrasound?

A transvaginal ultrasound can accurately detect an ectopic or tubal pregnancy than an abdominal scan. If you have bleeding or cramping with low HCG levels, your doctor may order an ultrasound to rule out an ectopic pregnancy, as it can be life-threatening if left untreated.

How Do I Ensure Ultrasound Safety During Pregnancy?

Try to keep your ultrasounds to an absolute minimum (1-2) during your pregnancy.

Avoid using dopplers/fetal monitors at home, even though you want to keep hearing that magnificent heartbeat 24/7.

Don’t fall into the temptation of 3D/4D scans unless there’s an absolute, doctor-recommended, medical need.

And encourage your sonographer to save the chat for later and get the scan done as quickly as possible. It could reduce your baby’s exposure by 10-15 minutes!

Is a Pregnancy Ultrasound Covered by Insurance (Is It Free)?

A fetal ultrasound can range between $280-$325, depending on your geographic location. It can be four times higher when done in a large hospital setting vs. an independent clinic. Most insurances cover the cost of routine prenatal testing and ultrasounds. 

But, always check with your insurance provider before scheduling your appointment.

Don’t Dread Your Upcoming Ultrasound!

The fetal ultrasound risks vs. benefits debate continues to rage around us. 

But here’s the simple truth – the vast majority of women have an overwhelmingly positive scan experience, filled with the joy of seeing their baby grow within while anticipating the day they will get to hold their sweet little one(s).

As with anything related to pregnancy, every woman is different and will require different levels of care during a pregnancy.

If you have any concerns about too many ultrasounds (or too few, if you are high-risk), don’t be afraid to share it with your healthcare provider.

Have you found our reliable information on pregnancy ultrasounds useful? I hope it will help you find the safe middle ground to enjoy your pregnancy without any fear or anxiety about prenatal ultrasounds.

Have you had an ultrasound (or two!)?

If yes, I’d love to hear your own experience and how it stacks up against any concern you had going in. Feel free to leave a comment below or share this article with someone you know who has the ‘scan jitters’!


This article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Caroline Nandakumar About Author

I am a freelance copywriter and blogger, who’s also passionate about holistic health and wellness. When I’m not writing, I love to read, paint, and clean (yes, I find cleaning therapeutic!). I live in the stunning Pacific Northwest with my husband and two rambunctious kids.