Ultrasounds in Pregnancy
Here at Soul Midwifery, we aren’t against the routine use of ultrasounds to give us insight into baby’s wellbeing in utero. Absolutely, this can be an overused and abused test, but I’m very mindful of both the benefits and the flaws within this system.
In general, most of my clients receive just the dating scan and the 20-week morphology scan. I think of these as pretty low-risk tests that come with the great benefit of knowing bub is doing well. It is always the woman’s choice, and I’m happy supporting women in the decisions they make around ultrasound testing.
The Dating Scan
The dating scan can be helpful, especially when a woman isn’t sure exactly when she became pregnant. Most women are excited to see baby moving about and appreciate the early reassurance this scan can provide. While not essential, it can help guide us later in pregnancy, particularly if we approach 42 weeks and are trying to determine when conception may have occurred.
(Conversation for another day, but women can ovulate and conceive at very different times to the "magical" due date calculated by apps or online calculators.)
Overall, the dating scan tends to be about early reassurance and gathering a bit more information.
The Morphology Scan
The “fun” scan, as many women call it. This scan usually takes around 40 minutes and is when the sonographer checks over every little part of your baby — fingers, toes, heart chambers, internal organs. Their job is to check that everything is there and appears to be functioning normally.
They also check that the placenta is far enough from the cervical os (the opening), assess the cord insertion site, and confirm the number of arteries and veins in the cord.
As a homebirth midwife, I do like women to have a morphology scan. When we’re planning a homebirth, it’s reassuring to know that everything appears normal for baby. If abnormalities are picked up, it can help guide us in choosing the safest place for birth. For example, if a heart condition or congenital abnormality is detected, hospital birth may provide quicker access to medical care. If the finding is minor or unlikely to cause issues in the early hours or days of life, then a homebirth may still be the safest and most appropriate option.
Navigating Abnormal Results
Another important factor to consider is this: if the scan tells us something isn’t 100 percent normal, what would you do about it?
I’ve recently reflected on the aftermath of ultrasounds when abnormal results come through. For many clients, it doesn’t change their care or birth plan but it causes a lot of stress. In other situations, both the woman and I have felt reassured by the information and made a plan we both feel good about.
It’s definitely been my experience that most abnormalities picked up on scans turn out to be nothing at all. Do I still encourage these two routine ultrasounds? Yes, I do. But my experience has deepened my understanding of this topic, and I now focus even more on encouraging women to make a fully informed decision about what steps they want to take.
A Third Trimester Scan ??
When I worked in the system, I was always cautious about recommending any ultrasounds beyond the dating and morphology scans without a clear medical need. I saw time and again how a third-trimester ultrasound could derail a woman’s birth, often without any true medical concern. Labels like “baby too small,” “baby too big,” or “fluid slightly low” were incredibly common, and I saw women left at the mercy of the report and the fear of their care provider.
Now, as a private practicing midwife, I’ve developed a new perspective. Women in my care have full autonomy to make the decisions that feel right for them. I trust that they are well-informed and value my input. When a scan shows something unexpected, we can have a balanced conversation about what that means for her and what steps she wants to take.
I no longer see this as a birth derailing moment, but instead as another option on the path. One where the woman is in control and decides how the results affect her, her birth, and her baby.
Routine third-trimester ultrasounds are not recommended in low-risk pregnancies. There is no strong research to support that they improve outcomes in these situations. Despite this, they are often recommended in mainstream care models for reasons such as higher BMI, previous large baby, age over 35, and so on.
42-Week Optional Ultrasound
One scan I do find value in beyond the standard two is a 42-week ultrasound, helpful if we haven’t yet had baby and you’re planning to continue with expectant management. There’s actually some good evidence that a scan at this stage may help us pick up any signs that baby’s wellbeing needs closer attention, like low fluid levels, changes in blood flow, or a placenta that may not be functioning as well as it was earlier on.
While most babies and placentas continue to do beautifully past 42 weeks, a scan around this time can help guide our decision-making. It’s a way to check in and get reassurance, or, if something unusual shows up, to have a meaningful conversation about what it means for your birth options.
At Soul Midwifery, we only recommend extra ultrasounds if there’s a genuine medical concern or if it's supported by solid evidence.
This post just touches on the edges of what ultrasounds you might be offered in pregnancy and what they can mean for your journey. I encourage you to talk through the risks and benefits of any ultrasound with your trusted care provider.
Until next time,
Hannah x
