By Mike Pulfer
The Cincinnati Enquirer

Babies, look at them now.

More mothers and fathers want to, even as they're developing in the womb.

Ultrasound imaging, or sonography, standard practice during private visits to the doctor's office, is turning into a commercial industry.

Companies that produce and market custom, high-tech still images and videos of unborn babies have been embraced by expectant parents, especially in the western United States.

Although the trend is controversial for some in the medical community, industry sources say on-demand ultrasounds offer a better look at baby, with higher-quality images.

This industry is scheduled to arrive in Greater Cincinnati as soon as this spring. Fetal Fotos Inc., based in Salt Lake City and specializing in non-medical ultrasound images, plans to open a franchise store - its 12th in the nation - in the Kenwood area.

"I can imagine women wanting to do that," says Landen's Julie Worsham, who is expecting a baby in June. But, she adds, "I think it's ridiculous."

FETAL IMAGE FIRMS

Fetal Fotos Inc., which is scouting locations for a Cincinnati store, already operates in Scottsdale, Ariz.; Costa Mesa, Pasadena and Redlands, Calif.; Denver; Portland; Dallas; and Salt Lake City and Layton, Utah. Two additional stores are scheduled to open in February in West Hartford, Conn., and Boise, Idaho. Other names in the business include Womb with a View, That's My Baby and Before the Stork. The nearest, Before the Stork, operates in Bloomington, Ind.

"Out West," chimes her husband, Paul, noting the stores' success in that region. "Things are a little strange out there."

Most of Fetal Fotos' nine operating stores are in strip shopping centers in the West. Two other new stores are scheduled to open in February in Connecticut and Idaho.

"We have had husbands come in with their partners and ask, `Can you tell me what I had for lunch?' and things like that," says Tracie Pierce, operations director for the company. When they get that out of their system, it's all business, she says. The company does not honor such requests.

"The first thing we want to make clear to women is they must be receiving prenatal care before they come in. It's an FDA (Federal Drug Administration) requirement, and it's important for women to understand."This is not for fun or entertainment," she says. "They can't come in 50 times because it's cheaper and easier than their doctors' offices."

Apparently, some women would be that eager.

"Although ultrasound is safe, and high-risk pregnancies receive an ultrasound almost every time they have an appointment, we at Fetal Fotos do limit the times to four paid visits," Pierce said. The price per visit ranges from $75 to $200, depending on the imaging techniques selected and number of images.

"We also limit the ultrasound appointment to half an hour because we do not believe in having these women lie there for long periods of time on their backs," Pierce said.

All Fetal Foto technicians are certified, Pierce says. Some have as much as 25 years experience; some are fresh out of radiology school (two months training).

"They will check for minimal medical things," she said, but their purpose is not to check on internal things.

"If there is something major externally wrong, they refer them back to the doctor."

Rebecca Dickson, who was happy with the fetal pictures she got from her doctor, says she would consider commercial ultrasounds for additional images, if the service were available locally now. (Her baby is due in February.)

She and her husband, Edward, who live in Milford, were delighted with the three small black-and-white pictures they got from her doctor at about 15 weeks.

"You can see his eye sockets, nose - even teeth," she said. "They did offer the video, but I didn't bring a blank tape."

The pictures will go in her baby boy's book of mementoes.

Most women get one - and only one - sonogram from their physicians, usually at 18 to 20 weeks. In most cases, experts say, there is no medical reason for more.

Companies such as Fetal Fotos and at least three others offer pending parents multiple images, which might be of better photo quality than images from a doctor's visit.

"Women come to us for a number of reasons," Pierce says. Among them:

To determine baby gender. (Sometimes a doctor's ultrasound provides this information. Sometimes it doesn't.)

To include family members in the ultrasound experience and the first look at the baby.

Three-dimensional imaging (more lifelike pictures), which doctors don't offer in all pregnancies.

An opportunity to buy extra prints and videos for friends and relatives.

Like parents picking school pictures, customers choose from a variety of product packages. Each package includes a videotape. The least expensive option guarantees at least four photos.

"Women want this," says Pierce. "There is a huge demand for it."

Since opening its first store in Utah nine years ago, Fetal Fotos business has been brisk, Pierce says. "All the stores stay really busy."

More than a month before its scheduled February grand opening, the company's first store in the East (in Connecticut) was fully booked for its first few days of business.

Doctor's objection

Some doctors and clinicians consider the service a misuse of diagnostic equipment that unnecessarily exposes the fetus to ultrasound energy.

"They (ultrasounds) appear to be safe, but we try to avoid them when they are unnecessary," says Baha M. Sibai, chairman of the department of obstetrics and gynecology at the University of Cincinnati. "You're never 100 percent sure."

"There are no known side effects," Pierce emphasizes.

Although ultrasound fetal scanning is generally considered safe, the FDA reports studies have shown diagnostic levels of ultrasound can produce physical effects in tissue, such as mechanical vibrations and a rise in temperature.

While they are not confirmed, "Recent reports in ... medical literature suggest that an increase in the number of ultrasound examinations during pregnancy may restrict fetal growth and that prenatal ultrasonography may be associated with delayed speech in children," according to an FDA bulletin. "Other experimental studies have reported adverse effects (lung hemorrhage) in animals resulting from ultrasound exposure. Ultrasound use continues for nonmedical reasons (e.g., `keepsake' videos or live model ultrasound modeling). These issues support the need for continued research."

The American College of Obstetricians and Gynecologists is concerned that patients might consider a studio appointment a valid substitute for a medical ultrasound.

"It's not about safety, it's the principle," said Dr. Laura Riley, a Boston-area obstetrician-gynecologist and chairwoman of the association's Committee on Obstetric Practice. "What was it designed for? It was designed to determine if there's a fetal malformation or some uterine malformation that should be addressed."

Introduced in the late 1950s and used widely by the late '70s, ultrasound machines translate high-frequency sound waves into visual images. During pregnancy, obstetricians use ultrasounds to check the number of babies in the womb, measure size and location, monitor breathing and heartbeat and check for some birth defects.

Insurance usually covers ultrasounds ($150-$300) but not at commercial outlets.

Training facility

The Cincinnati Fetal Fotos franchise will serve as a training facility other franchisees, Pierce says.

"They receive training in all aspects of the business," she says, over a period of two weeks to two months.

"Sometimes ... the providers are focused on the medical things, and they're sometimes cold, clinical. We're more personal.

But, she says, "Our business is not just about entertainment or fun. We do serve a medical benefit ... We do not offer any six-session portrait deals or anything like that, because we do not consider ourselves a portrait studio like some businesses similar to ours.

"So many people view us as being there for entertainment and for just obtaining keepsake videos, which is just not the case."

E-mail mpulfer@enquirer.com