Is a 4D ultrasound worth it?

What you get for the money

The U.S. Food and Drug Administration (FDA) says 3D ultrasound “allows the visualization of some facial features,” and that “Four-dimensional (4D) ultrasound is 3D ultrasound in motion” (FDA). At a keepsake studio, you pay to watch that live and take pictures home. 2D, 3D or 4D: which ultrasound do you actually need? explains the difference.

In the U.S., GoodRx notes, 3D and 4D ultrasounds during pregnancy “are often considered elective” and “typically aren’t covered by insurance unless a healthcare professional says they’re medically necessary” (GoodRx, 2024). Each studio sets its own price, and we found no national survey of studio prices, so compare what each one includes. Our prices page lists each session’s price and what you take home.

In the U.S., the practice guideline for standard medical pregnancy scans says the baby’s anatomy “may be adequately assessed by ultrasound after approximately 18 weeks gestational age” (ACR–ACOG–AIUM–SMFM–SRU). In England, the NHS 20-week screening scan, usually done at 18 to 21 weeks, checks for signs of 11 conditions (NHS). A keepsake scan does neither job.

What the research says about parents

The studies below compare 3D or 4D scans with ordinary 2D ones. They’re small (the largest had 160 women), date from 2005 to 2013, and took place in hospitals and universities, not keepsake studios. A 2022 review warned that early 3D/4D findings “may not be wholly generalisable to the current context,” because image quality has improved (Skelton and colleagues).

Attachment, or bonding

Attachment is scored with questionnaires. In the comparisons that scored it during pregnancy, 3D or 4D didn’t come out ahead of 2D:

• Australia, 2006: 68 first-time mothers at a hospital in western Sydney, “allocated arbitrarily” to 2D or 3D at a routine scan at about 12 or 18 weeks. Attachment rose after both, and “3D ultrasound did not offer enhanced benefits” (Sedgmen and colleagues).
• Milan, 2005: 100 women in the second or third trimester, randomly assigned to 2D alone or 2D plus 4D. Scores were similar in the 46 who completed the attachment scale, though more of the 4D group had positive ratings. Adding 4D didn’t significantly change attachment, the authors concluded (Rustico and colleagues).
• Italy, 2005: 44 couples at 19 to 23 weeks. Mothers’ attachment grew between a questionnaire before the scan and one 2 weeks later, with “no significant differences” between the 2D and 4D groups (Righetti and colleagues).

Two more are in Does a 4D ultrasound help you bond with your baby? In a 2013 Dutch study of 160 women, scores rose after 2D and 3D/4D scans alike (de Jong-Pleij and colleagues). In a 2005 San Diego study of 100 mothers, surveyed by phone after the birth, those who’d also had 3D shared their pictures more widely. More of them said they could form a mental picture of their baby after the scan (82% versus 39%). The authors concluded that 3D “may have a greater impact” on bonding, but as with the Dutch study, the abstract doesn’t say how the groups were formed (Ji and colleagues). The 2022 review of 23 studies found that scan type “did not seem to significantly impact” parents’ attachment, and rated the studies’ quality as moderate.

…there is only some scientific evidence that 3D sonography has a positive impact on parental-fetal bonding…

American Institute of Ultrasound in Medicine, 2020

What 3D and 4D seem to add

• Recognizing your baby. In Basel, Switzerland, 60 low-risk women at 23 to 34 weeks had a 2D and a 3D scan, in random order. They recognized their baby better in 3D, though the examiner rated the 2D pictures higher in quality. First-time mothers found 2D harder to make out. Bonding didn’t differ, on questionnaires written for the study (Lapaire and colleagues).
• Expressions. In the Milan trial, facial expressions and hand-to-mouth movements were twice as likely to be seen with 4D, though the difference wasn’t statistically significant.

Worry, satisfaction and a clear view

A Hong Kong trial enrolled 124 women at higher risk of a baby with a birth defect, at a teaching hospital’s prenatal diagnosis clinic, and randomly assigned them to 2D alone or 2D plus 3D/4D. On a standard anxiety questionnaire, scores fell by about 2 points just after the scan in both groups, with no significant difference (Leung and colleagues). The Dutch team’s review of 13 psychological studies found anxiety and stress fell as much after 2D as after 3D/4D, and conflicting results on satisfaction.

What you see on the day matters. In the Milan trial, satisfaction was similar with 2D and 4D. Women who saw everything they’d hoped to see more often said the scan changed their view of their baby for the better, with either scan. In the Dutch 3D/4D group, the better the baby could be seen and recognized, the more attachment scores rose.

Who tends to value it

Why do people pay? A UK study interviewed 48 women with low-risk pregnancies at two clinics of one commercial scan company, in 2012 and 2013. Half had booked a 2D scan to find out the sex, and 31% a 4D scan. Reasons were often several at once: 29 mentioned finding out the sex, 19 reassurance, 19 seeing the baby, 8 keepsake pictures and 7 bonding (Roberts and colleagues).

A smaller UK study, of six women planning a commercial 3D/4D scan, heard “meeting the baby”, “curiosity” and “finding out more about the baby” most often (Wadephul and colleagues, 2015). The American Institute of Ultrasound in Medicine (AIUM) discourages keepsake scans, but “recognizes that many parents may pursue scanning for this purpose”: bonding (AIUM).

The research suggests it may mean more if:

• You want to see the face and movements, which 3D and 4D add to a flat 2D picture, when your baby’s position allows.
• You find 2D pictures hard to read. In Basel, first-time mothers had more trouble making out their baby in 2D.
• You want to share it. The San Diego mothers with 3D pictures shared them more widely.

Reasons to skip it, or wait

Neither UK study asked families who decided against booking, so these reasons come from the research and from medical bodies.

• You want to hear that everything is fine. A keepsake scan can’t tell you that. UPMC, a U.S. hospital system, warns in a health article that keepsake scans “may give you a false sense of security.” They may also cause anxiety if the person scanning suggests a problem that isn’t there (UPMC, 2023). If you’re worried about your pregnancy, call your doctor or midwife. Is an early reassurance scan worth it? looks at how a scan’s relief can fade.
• You’re counting on it to make you feel closer. The comparisons that scored attachment during pregnancy found no extra effect from 3D or 4D, and the evidence that it does more is thin.
• The money is needed elsewhere. In the U.S., insurance typically won’t pay, and prenatal care comes first.
• You’d rather follow medical advice. The FDA, the AIUM and the American College of Obstetricians and Gynecologists (ACOG) ask for a medical reason (see below). In the UK, the British Medical Ultrasound Society says ultrasound “should not be used on pregnant women solely for ‘entertainment’ or ‘bonding’ purposes” (BMUS, 2017). UPMC puts it bluntly: “the answer from medical experts is a resounding no.”
• Your medical scans may give you pictures. UPMC suggests asking for images to take home at your medical scans. What is an elective ultrasound? has what the FDA and the NHS say about pictures from medical scans.
• A hidden face would spoil the day. In the six UK case studies, one woman was very happy with the experience, and most of the other five expressed some disappointment at not seeing their baby as clearly as expected. Paying may make that worse, the authors note. The best week for a 4D ultrasound covers what affects the view.

Is it safe, and is it allowed?

Ultrasound is sound, not X-rays: the FDA says it “is based on non-ionizing radiation, so it does not have the same risks as X-rays.” It says ultrasound “has an excellent safety record,” but that its waves “can heat the tissues slightly” and can sometimes form small pockets of gas. “The long-term consequences of these effects are still unknown” (FDA).

So the safety bodies ask for a medical reason:

• The FDA: using ultrasound “solely for non-medical purposes such as obtaining fetal ‘keepsake’ videos has been discouraged.”
• The AIUM “strongly discourages the nonmedical use of ultrasound.” It counts only images from medical exams and teaching scans as consistent with the ethical principles of the AIUM, the American Medical Association and ACOG. That leaves out freestanding commercial sites like ours.
• ACOG wants ultrasound used “prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient” (ACOG Committee Opinion 723).

4D ultrasound side effects covers heat, exposure and studies of children, Safety, in plain words has the statements, and Is an early ultrasound safe for the baby? covers early pregnancy.

Where keepsake scans aren’t allowed

In Connecticut, since July 1, 2009, an obstetric ultrasound must be “ordered by a licensed health care provider” and “for a medical or diagnostic purpose” (Connecticut General Statutes § 19a-901). Germany has banned ultrasound in pregnancy without a medical reason since December 31, 2020 (NiSV § 10, Federal Environment Ministry), and the ban includes Doppler, 3D and 4D (Deutsches Ärzteblatt, 2020). The U.S. practice guideline adds that using an ultrasound system for keepsake videos without a physician’s order “may be in violation of state laws or regulations.” What is an elective ultrasound? covers the rules.

How to decide

Six questions to ask yourself:

1. What do I want from it? A face, movement, pictures, a moment with your people: a 4D scan can give you those, on a good day. A health check, or a promise that all is well: it can’t.
2. How would I feel if my baby hid their face? If that would spoil it, ask what happens then before you pay.
3. Could my medical scans be enough? Ask whether you can have pictures from them.
4. Does it fit the budget once prenatal care is covered?
5. What does my doctor or midwife think? It’s your decision, and a reasonable thing to ask them about.
6. Is it allowed where I live?

Questions to ask a studio

Can you get a pregnancy ultrasound without a doctor’s referral? has a full checklist. For 4D, add these:

• What happens if my baby won’t show their face? More time, another visit, and whether either costs extra.
• Is boy or girl included, and can it stay a secret?
• Can everyone in the room see the screen?
• Do you say up front that it isn’t a medical exam? A careful studio does.

Weighing it up? Pop in your due date, and the planner flags which of our sessions you can have now and which open later. It keeps the date on this device, where we can’t see it.

4D Bonding at our Glendale studio

At our studio in Glendale, Los Angeles County, 4D Bonding runs from 16 to 40 weeks. You watch live 4D on the big screen, and take home 100+ color images on a USB drive and 12 color prints. Boy or girl is included, if you’d like to know. 3D is a still picture with depth, and 4D is that picture moving, live: every 4D session here gives you both.

There’s no single best week. At 16 to 24 weeks, your baby is small enough to fit in one frame. At 28 to 34, it’s the time for close-ups of the face and hands. From 35 weeks to your due date is still a good time, though the view depends on how your baby is lying. We can’t promise a perfect face on a given day, and nobody can. When a session is particularly difficult, we take extra time, and we bring you back for another try (our promise).

Family and friends are welcome. It’s a keepsake visit, not a medical exam: we don’t screen or diagnose, and your doctor or midwife still comes first. Come for the joy of it, not for a health benefit. See 4D Bonding and prices.

Questions