You’re pregnant and the BIG day is finally here; no, not your due date, but your ultrasound appointment! For most expectant mothers, this is a huge day for you and understandably so. You get to hear a heartbeat, find out the gender (at least that’s what your pregnancy app told you), and you finally get to see that little miracle that is growing inside you! You can’t wait to get those cute little pictures to upload on Facebook to show off your future bundle of joy. While I understand your excitement because it is a momentous time in your life, I am here to shed some light on the real reason your ultrasound is being done.

My name is Sarah and I am a sonographer. I am the one who performs the exam, but most of you know me as “the person who takes the pictures.” I position you on the bed and smile as you watch the screen, anxiously awaiting to find out whether you will be painting that extra bedroom blue or pink. As you pray to hear whether it’s a boy or girl, every single time I put the probe on your belly, I am praying that there IS a heartbeat for you to hear, and hoping that it IS a normal pregnancy with no abnormalities so I don’t have to deliver bad news to my doctor, who in turn delivers the bad news to you. There are a million and one things that can go wrong in utero and it is me, and only me, that has that tremendous burden placed on my shoulders as I scan intently as to not miss anything. The images we take and what we report are what the doctor sees, so if we miss a finding on an exam, guess what? The Doctor will not have seen it and you and your baby can have a condition that will go undiagnosed.



While it may appear I’m just snapping random pictures of your baby, in reality I’m analyzing every part of your baby from head to toe and running down a mental checklist of questions. Does the baby have a heartbeat? Are there four chambers visible? Are there any atrial or ventral septal defects? Are there any echogenic foci in the heart? Are the vessels in proper place or is there transposition? Is the heart angled 45 degrees to the left and does it occupy 1/3rd of the chest? Is there any congenital diaphragmatic hernias? Are there two kidneys? Do the kidneys have pyelectasis? Is there blood flow to the kidneys? How’s the waveform of the ductus venosus? Is the abdomen measuring within range? Is the portal vein of the liver coursing the correct way? Is there a visible stomach bubble? Any indications of duodenal atresia? Is there a three vessel cord? Is the bladder normal or is it a keyhole shaped? Where is the placenta in relation to the cervix? Is there placenta previa? Is there placenta accreta(which can be fatal to the mother)? How is the placental cord insert? Is it marginal? Is it battledore? Is the ossification centers of the spine normal? Is there sacral agenesis? Is the sacral spine visible in transverse and longitudinal views showing the skin line to rule out spina bifida? Is there any omphaloceles protruding from the cord insert? Is the brain normal? Is there even a brain? Are there cysts in the choroid plexus of the brain? Is the cerebellum of the brain a normal shape? Is the nuchal fold thickened? Are there any masses protruding from the neck? Is the palate of the mouth intact or are there clefts? Is the intraorbital distance within normal limits? Is there a nasal bone present? Are the nose/lips clear of any clefts? Are the long bones of the legs and arms measuring within range and are they bowed or perhaps fractured? Are all digits on the hands and feet present? Do the feet present normal or are they clubbed? Are the fingers spread or are the fist clenched? How is the growth of the baby? Is the baby under the 10th percentile for growth? How is the Doppler flow from the MCA of the brain? How is the Doppler flow from the umbilical artery?

These are just SOME of the questions that us sonographers run through on our mental checklist as we scan each baby, because each one of these things can give us a better indication of whether your baby has a birth defect, or is suffering from any other pathology, which in some cases can result in the death of the fetus and/or you, if left untreated without further surveillance.

When we are quiet, please don’t take it to mean that we are being mean or rude: we are just really focused on examining every inch of your baby. The same applies if we ask for quiet in the room: as much as we love meeting your family, it can be difficult to concentrate when your kids are running around the room and screaming. You wouldn’t want your child screaming in a movie theater distracting other movie goers so why would you want the person performing an extremely important medical exam being distracted? If we aren’t able to determine the gender, please don’t fault us for it. Many times the baby is in a position where it’s impossible to see, and truth be told, gender isn’t even part of the diagnostic exam so if your sonographer did tell you, that means she or he went the extra step to do so just to make you happy.

If you are reading this and have had pleasant ultrasounds, then I just want you to know how lucky you really are, because unfortunately there are a lot of women who can’t say the same. There are mommies who never got to hear that precious heartbeat. It breaks my heart when I see an expectant mother grinning as she stares at the monitor, because I know that her smile will soon turn to tears when she finds out her baby won’t survive past a few minutes outside of the womb. We try our best to keep a poker face, but just know that our heart aches for you when things like this happen.

But this is why we chose this profession: we care about the wellbeing of you and your baby. We LOVE what we do. We want nothing more than to see you go home happy, and we will accommodate your requests to the best of our abilities. All we ask of you the next time you come for an ultrasound is to please know we are more than just the “person who takes the pictures.”

About the Author:

Sarah Olavarria, RDMS, is a perinatal sonographer specializing in high risk obstetrical and gynecological ultrasounds in New York City.