fetal pain can unborn children feel pain in the womb?

7/29/2019 Fetal Pain Can Unborn Children Feel Pain in the Womb?

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Fetal PainCan Unborn Children Feel Pain

in the Womb?


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fetal pain

by ashley morrow fragoso

2010 family research council

all rights reserved.

printed in the united states

Fetal PainCan Unborn Children Feel Pain

in the Womb?

Advancements in biological science have vastlyincreased our knowledge of life in the womb.

We now know more than we ever have aboutthe experiences of children before they are born.

What is unborn life like? What can unborn

children do? Modern embryology tells us thatat the moment of conception, the new humanbeing possesses all of the genetic material thebaby will need to develop, and if the child will bea boy or a girl. Hereditary traits such as hair andeye color are determined at this very rst instantof life. Approximately 22 days later, the childsheart begins to circulate his own blood, often of

a blood type different from that of his mother.At six weeks of life, electrical brain activity canbe detected and the eyes, eyelids, nose, mouth,and tongue are formed. Babies this age canbend their hands at the wrist. This new skill ishelpful, as children of seven weeks may be foundsucking their ngers or thumbs. By eight weeksafter conception, the little boy or girl is medicallyknown as a fetus and contains all the organsand bodily structures, including 20 baby toothbuds, found in the newborn infant. Nine-weekold babies are growing ngernails and toenailsand are often seen swallowing, sucking theirngers or tongues, and yawning. By ten weeks

ashley morrow fragoso is a Masters of TheologicalStudies graduate of Harvard University and holds a degree inhistory and political theory from the New School for SocialResearch. She has done policy analysis for legislators andpolitical candidates and has worked as a Research Assistant at

the American Enterprise Institute for Public Policy Research inWashington, DC. She is happily married and the mother of a

young daughter. She lives with her family in South Bend, Indiana.

by ashley morrow fragoso


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of life, the childs sex has become clearly visible,the vocal cords are forming, and he is likely quiteactive, making stretching, leaping, and kicking

movements.1Two weeks later, at twelve weeks afterconception, the unborn child has developed ahabit of squirming when his mother prods herabdomen, and can perform an array of effortlessmovements. Unborn children at this stage ofdevelopment often have well-shaped eyebrows

and hair on their heads, along with softeningbaby cheeks. Babies of fourteen weeks are seenon ultrasound to be rather expressive, displayinga variety of facial expressions from wide smilesto grimaces and frowns, often in response toexternal stimuli. Over the next week, perceptivecapacities increase and the baby becomes evenbetter at coordinating movements in response

to his place in his environment. Over the nextseveral weeks, the childs lungs grow stronger andmore sophisticated, developing tiny air sacs calledalveoli, and increasing in capacity as he practicesbreathing movements using amniotic uid inplace of air. The unborn child of fteen toeighteen weeks continues to grow at a rapid pace

and begins to acquire increasing amounts of thesubcutaneous fat that will help him to regulate

his body temperature after birth. This is a keyperiod in brain and sensory development, during

which the senses are heightened and neurologicalconnections necessary to the formation ofthought and memory increase in complexity.At approximately 20 weeks, the unborn babyshearing becomes much more clear as the bones ofthe inner ear continue to harden. Over the next

week or so, the child takes an increasing interestin sounds outside the womb, often displayingpreferences for particular voices or types of music

(some will even move to a beat). By 22 to 23weeks, more blood vessels take root in the lungs,

and 32 permanent adult teeth wait in the gumsas buds. Children born at this age can surviveoutside the womb.2

Can unborn children feel pain? Medical research,which denes pain as a perceptive response topotential or actual tissue damage, has greatly


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enhanced our ability to answer this question, andhas shown that children can feel pain while in the

womb, with conservative estimates placing thisfaculty at 16 to 18 weeks after conception. Thiscarries unsettling implications for countries withfew restrictions on abortion.

During a 2004 federal court review of the Partial-Birth Abortion Ban Act of 2003, pediatricintensive care physician and fetal pain researcher,

Dr. Kanwaljeet S. Anand, of the University ofArkansas for Medical Sciences and the PainNeurobiology Laboratory at Arkansas ChildrensHospital Research Institute, testied before theDistrict Court of Nebraska on the matter of fetalpain. He testied that reputable research andhis own clinical experience indicate that unbornchildren are capable of feeling pain by 20 weeks

of gestation, and that babies of this age suffergreatly during abortion:

It is my opinion that the human fetuspossesses the ability to experience painfrom 20 weeks of gestation, if not earlier,and the pain perceived by a fetus is possiblymore intense than that perceived by termnewborns or older children...3

The abortion process, he continued,

...will result in prolonged and intense painexperienced by the human fetus, if the fetusis at or beyond the neurological maturityassociated with 20 weeks of gestation.Anesthetic agents that are routinelyadministered to the mother during thisprocedure would be insufcient to ensurethat the fetus does not feel pain, andhigher doses of anesthetic drugs, enoughto produce fetal anesthesia, would seriouslycompromise the health of the mother.

Thus, it is my opinion that the fetus would

be subjected to intense pain, occurringprior to fetal demise, from the abortion

procedures described in the Partial-BirthAbortion Ban Act of 2003.4

Though subject to contentious debate, these viewsare supported by substantial clinical research andreect accepted medical practice by neurologists,perinatologists, pediatricians and anesthetists, formany of whom the idea of withholding anesthesia

from their youngest patients undergoing invasiveprocedures is unthinkable.5

Fetal Development

Systematic study of fetal development withrelation to the experience of pain by unborn

children has existed for the better part of a century.In 1941, neuroanatomy researcher DavenportHooker of the University of Pittsburgh found

in tests on live unborn children that humansrespond to touch around the mouth at ve-and-a-half weeks after conception. The entire facebecomes sensitive over the following week. By


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nine weeks after conception, the baby respondsto stimulation of his or her hands, and by three

months, the entire body is sensitive.6

Subsequent research has shown that nerves formand connect with one another and that brainstructures begin to take shape during the sixth

week of life in the womb. A Working Partyof Englands Council for Science and Societyconcluded that pain perception may begin as early

as the sixth week after conception, and the BritishCommission of Inquiry into Foetal Sentiencereported that, Most scientists currently agreethat this marks the earliest possible point at

which sensation might occur.7 Electrical brainactivity can be conrmed in babies of six or seven

weeks of age.8

Between seven and twelve weeks gestation (ve

and ten weeks after conception), the unborn childalso begins to move and becomes increasinglysensitive to tactile and noxious stimulation. Thebaby will partially close his hands when his palmsare touched. In the brain, the thalamus and cor-

tex have begun development, butnerve pathways do not yet con-

nect the cortex with the low-er part of the brain. Thelower brain stem is activeat this point.9

Along with the beginningof the second trimester comes

further neurological develop-ment. Sensory receptors cover

the body surface and the hip-pocampus becomes functional.

As a result, early second tri-mester babies often respond

to invasive procedureswith elevated heart rate

and secretion of stress

hormones.10 This response is nearly universal bysixteen weeks after conception.11

At 23 weeks, the nerves that transport pain signalsto the cortex are connected to the rest of the brain,and signals received through the thalamus can beprocessed in the cortex, allowing for a form ofconscious perception similar to that found in olderfetuses and infants. While researchers maintain

varying opinions about the precise nature of

unpleasant sensations experienced early in human

development, it is generally accepted that thecapacity for an experience of pain comparableto that in a newborn baby is certainly presentby 24 weeks after conception.12 A distinct keyto discussions of fetal pain, however, was madeduring expert testimony before the NebraskaDistrict Court: it is at 20 to 30 weeks gestationthat the human being has the highest number ofpain receptors per square inch of skin, more thanat any other period in development, and that thethin, tender skin of a 20 to 30 week unborn childplaces his or her nerve bers closer to the surfaceof the skin than older babies and adults.13

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The Brain and Pain

Scientic consensus seems to be that unbornchildren feel pain by ve to six months gestation,and possibly earlier. Though most assessments ofthe possibility of fetal pain emphasize the needfor active connections between the cortex andthe lower brain, thus moving the timeline forthe ability of the fetus to feel pain well into thesecond trimester, several noted researchers assert

that pain may in fact be present earlier.In her expert testimony to the BritishCommission of Inquiry into Foetal Sentience,perinatal psychobiologist Dr. Vivette Gloverof Imperial College London reected onresponsiveness in children with hydranencephaly.Children with this condition are born with afunctioning or partially-functioning brain stem,but lack cerebral hemispheres. The space wherethe middle and upper brains would be is insteadlled with uid. When exposed to noxiousstimuli, hydranencephalic infants with intacthypothalamo-hypophyseal systems have beenfound to react, despite their very limited corticalfunction.14 As a result, Swedish neuroscientist

Bjorn Merker, who tracks hydranencephalicchildren showing signs of consciousness, recordedhis observations in the journal Behavioraland Brain Sciences, writing that, [t]he tacitconsensus concerning the cerebral cortex as theorgan of consciousness may have been reachedprematurely, and may in fact be seriously inerror.15 Dr. Glover shares this view, concluding

that if hydranencephalic children can respond tostimuli in the absence of a functioning cortex,the human fetus may be aware, conscious, andcapable of pain once the brains lower structureshave taken shape at approximately eleven weeks.16

What Is Pain?

Much of the uncertainty regarding fetal painconcerns the very nature of pain itself, currentlyviewed as both a physiological and a psychologicalexperience. The International Association forthe Study of Pain denes pain as, An unpleasantsensory and emotional experience associated withactual or potential tissue damage, or described interms of such damage.17

For this reason, an inuential 2005 review offetal pain research published in the Journal of the

American Medical Association framed the questionof pain before birth as one of the presence ofconsciousness that would permit recognition of astimulus as unpleasant. If pain is a psychologicalconstruct, the belief that an unborn child canexperience pain must be borne out by evidence of

consciousness sophisticated enough to allow forthe interpretation of subjective experience.18

As University of Birmingham (UK) psychologistStuart Derbyshire, who denies the possibility offetal pain, suggests,

The undisputed discovery that the neonateand fetus launch a hormonal and neuralresponse to invasive practice cannot be


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considered proof that there is an experience

of pain. An experience implies sensationshave been interpreted in a consciousmanner. Even when combined with theobservations of behavior and improvedclinical outcome when using anesthetics,there is still no proof there is an experienceof pain.9

Derbyshire and his colleagues suggest that truepsychological pain, as experienced by adults,should thus be distinguished from nociception,the brains physiological response to invasivestimuli, which is generally present by 18 weeksof gestation.

Where Should We Go From Here?Where certainty is lacking, we would do well toerr on the side of caution. If there is a good butnot universally accepted possibility that a fetusof a particular age may experience pain duringan invasive procedure, justice and compassioncompel us to act as if that capacity is present.

This position is afrmed by noted academicsand practitioners such as fetal medicine professorand prenatal surgeon Kypros Nicolaides of KingsCollege School of Medicine and the HarrisBirthright Research Centre for Fetal Medicine(London), who told the British Commission ofInquiry into Foetal Sentience that because science

does not denitively indicate the exact moment atwhich a fetus becomes able to feel pain, fetuses

should be treated as capable of experiencingpain well before the end of the rst trimester.Dr. C.J. Hull, former Vice President of BritainsRoyal College of Anaesthetists, has also statedthat the fetus should be given the benet of thedoubt.20 Preference for minimizing the painthe unborn may suffer is further maintained ininformational materials produced by centers forfetal surgery, which emphasize the importance ofanesthesia, often mentioning a meeting with thefetal anesthesia team as one of the earliest steps inplanning a prenatal operation.21

Scientic uncertainty neither compels norprecludes medical practice. Decisions madeconcerning fetal anesthesia should operate arounda principle expressed by Dr. Vivette Glover:

I think I would like to make a distinctionbetween scientic and medical caution. Asa scientist, one always has to be very carefulnot to overstate ones case, but in this area,I am a bit concerned that if we just say we


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dont know, we may be causing quite a lot ofsuffering. I would rather err on the safe side

and say, Well the fetus may be sufferingand so we ought to do something about it.22

Legislative ActionIn the United States, the issue of fetal pain hasbeen addressed legislatively at both the federal

and state levels. In recent years, the legislaturesof 26 states and the U.S. Senate have debatedthe matter.23 Arkansas, Georgia, Louisiana,Minnesota and Oklahoma have been sufcientlypersuaded of the unborn childs capacity to feelpain such that they have passed laws requiringdoctors to inform mothers requesting abortions at

20 weeks gestation or more that their child is ableto feel pain, and to offer anesthesia administereddirectly to the unborn child.24 Since September2004, parallel legislation - the Unborn ChildPain Awareness Act - has been introduced in the

U.S. Senate nearly every year.25 In a similar vein,Alaska, South Dakota and Texas discuss fetal

pain in their state-issued abortion counselingmaterials, and Nebraska has passed the Pain-Capable Unborn Child Protection Act of 2010,prohibiting most abortions after 20 weeks post-conception due to the ability of a child of thatage to suffer pain.26 This most recent law, whichprovides exception when a mothers pregnancyso complicates her medical condition as to

necessitate the abortion of her pregnancy to averther death or to avert serious risk of substantialand irreversible physical impairment of a majorbodily function, challenges decades of legalprecedent that accepts the unborn childs viabilityas the primary justication for laws signicantlyrestricting abortion.27

The question of fetal pain has also been treated inthe United Kingdom, where a 2008 review of the1967 liberalization bill, The Abortion Act, along

with the Human Fertilisation and EmbryologyAct of 1990, brought the unborn childs capacityto feel pain to the fore. As the British House ofCommons debated whether the upper limit forlegal abortion should be reduced from 24 weeks of

pregnancy to an earlier gestational age, Universityof Arkansas pediatrician and fetal pain researcherDr. Kanwaljeet Anand testied that the pain anunborn child of 20 or more weeks experiences

when being dismembered by an abortion iscertain to be excruciating.28 As such, he urgedthat abortion in England should be restrictedto that gestational age or earlier.29 Despite this

testimony and public support for a revision of thelaw, the 24-week limit remains unchanged.30

The matter of fetal pain has rarely factored intothe abortion laws of other nations, as few providefor unrestricted abortion at gestational ages at

which pain perception is medically veriable.31


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Conclusion

Advances in the medical sciences tell us a greatdeal about the development of the unborn child.We now know that babies respond stronglyto noxious stimulation by sixteen weeks afterconception, and that many academics andphysicians who specialize in fetal pain believethat the capacity for physical suffering sets inbetween eleven and eighteen weeks of life. In

view of this range of opinion, we are compelledto err on the side of caution in our treatmentof the unborn child, be it in the provision ofinvasive medical procedures or with regard tothe unjust circumstance of abortion. While it isencouraging to see that some states have takenlegislative measures to protect the unborn againstpain, and while provisions of this sort should be

expanded, there is a long way to go in pursuit ofjustice and compassion for the unborn, whosevery lives deserve full protection, regardless oftheir gestational age.

Glossary of Terms

Brain stem - The lower extension of the brainthat is connected to the spinal cord and is thesource of most cranial nerves. Neurologicalfunctions needed for breathing, digestion,maintenance of heart rate and blood pressure,and arousal to alertness are located in the brainstem.

Conception - The moment of fertilization, atwhich the male sperm cell unites with the femaleovum, creating a brand new human being who isgenetically distinct from his or her parents.

Cortex or cerebral cortex- The sheet of neural

tissue overlaying the cerebrum or forebrain. Itplays a key role in attention, memory, language,and perceptual awareness.

Fetus - The medical term for an unborn childfrom eight weeks after conception to birth. Achild in this developmental stage has acquired

the organs and basic structures he or she willpossess as a newborn.

Gestation - Pregnancy, counted from the startof the mothers last menstrual period. Becauseconception typically occurs approximately two

weeks after the mothers last menstruation, a

babys gestational age is generally two weeksgreater than his or her post-conception age ornumber of weeks of life.


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Hippocampus - A horseshoe-shaped sheet ofneurons located in the medial temporal lobe of

the brain. Involved in memory, emotion, andspatial perception.

Hydranencephaly- A rare condition in whichthe brains cerebral hemispheres are absentand the remaining space is lled with sacs ofcerebrospinal uid.

Hypothalamo-hypophyseal system - Thenetwork of blood vessels that link thehypothalamus to the anterior lobe of thepituitary gland.

Nociception - The brains physiological responseto invasive stimuli, generally present by 16 weeksafter conception.

Noxious stimulation - An actual or potentialtissue damaging event, such as prodding with aneedle.

Pain - Dened by the International Associationfor the Study of Pain and many clinicians as, Anunpleasant sensory and emotional experienceassociated with actual or potential tissue damage,or described in terms of such damage.

Thalamus - A large mass of brain tissueseated deep within the forebrain. It coordinatessensory information and communicates messagesfrom other parts of the brain to the cortex. It isthought that conscious awareness of sensationsbegins in this region.

16

Trimester- A unit devised by the U.S. SupremeCourt in Roe v. Wadeto divide the full-term

pregnancy into three roughly three-monthparts. It is now widely accepted in medical use.

The American College of Obstetricians andGynecologists includes weeks 0 to 13 from thelast menstrual period in the rst trimester, weeks14 to 27 in the second trimester, and weeks 28to 40 in the third. The Society of Obstetricansand Gynaecologists of Canada ends the rst

trimester at 12 weeks and the second at 27weeks, while Englands Royal College ofObstetricians and Gynaecologists denes therst trimester as 0 to 12 weeks, the second as 12to 24 weeks, and the third as 24 to 40 weeks.

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footnotes

1 For an accessible account of life in the womb provided

by the founder of Londons Harris Birthright ResearchCentre for Fetal Medicine, see Professor StuartCampbell, MDs Watch Me Grow!(New York: St.Martins Grifn, 2004).

2 Ibid.

3 Kanwaljeet S. Anand, Expert Report to UnitedStates District Court, Lincoln, Nebraska, January 15,2004, 5, http://www.nrlc.org/abortion/fetal_Pain/AnandPainReport.pdf.

4 Ibid.

5 For example: W. Huang, J. Deprest, C. Missant andM.Van de Velde, Management of Fetal Pain duringinvasive fetal procedures,Acta AnaesthesiologicaBelgica55 (2004): 119-123; N.M. Fisk, R. Gitau,

J.M. Texeira, X. Giannakoulopoulos, et al, Effect ofDirect Fetal Opioid Analgesia on Fetal Hormonaland Hemodynamic Stress Response to IntrauterineNeedling,Anesthesiology95(2001): 828-835; X.

Giannakoulopoulos, W. Sepulveda, P. Kourtis, et al,Fetal Plasma Cortisol and Beta-Endorphin Responseto Intra-Uterine Needling, Lancet344 (1994): 77-81;Dr. Ray Paschall (Director of Anesthesia, VanderbiltUniversity Fetal Surgery Program) qtd. in AnnieMurphy Paul, The First Ache,New York Times,February 10, 2008;Dr. Kypros Nicolaides, Dr. C.J.Hull,Dr. Vivette Glover, Expert Testimony to Commissionof Inquiry into Foetal Sentience, Human SentienceBefore Birth, (CARE and the House of Lords, 2001),http://www.care.org.uk.

6 Davenport Hooker, The Origin of Overt Behavior(AnnArbor: University of Michigan Press, 1944), 20. Videoavailable at: http://virtualhumanembryo.lsuhsc.edu/

videos/Fetal_activity_index.html.

7 Human Sentience Before Birth, The Commission ofInquiry into Foetal Sentience, (CARE and The Houseof Lords, 2001): 3, 36.

8 Ibid.9 Ibid.

10 N.M. Fisk, R. Gitau, J.M. Texeira, X.Giannakoulopoulos, et al, Effect of DirectFetal Opioid Analgesia on Fetal Hormonal andHemodynamic Stress Response to Intrauterine

Needling,Anesthesiology95 (2001): 828-835; X.Giannakoulopoulos, W. Sepulveda, P. Kourtis, et al,Fetal Plasma Cortisol and Beta-Endorphin Responseto Intra-Uterine Needling, Lancet344 (1994): 77-81.

11 J.M. Texeira, R. Fogliani, X. Giannakoulopoulos, V.Glover, N. Fisk, Fetal Haemodynamic Stress Responseto Invasive Procedures, Lancet347 (1996): 624.

12 Human Sentience Before Birth, 23.

13 Anand, Expert Report to the United States DistrictCourt, 8.

14 F.A.Van Assche, Anencephalics as organ donors,American Journal of Obstetrics and Gynecology163 (1990):599-600.

15 B. Merker, Consciousness without a Cerebral Cortex:A Challenge for Neuroscience and Medicine,Behavioral and Brain Science, 0 (1): 63-81, 2007.


17 IASP Pain Terminology, International Association forthe Study of Pain Council, November 30, 2007, http://

www.iasp-pain.org/AM/Template.cfm?Section=Pain_Denitions&Template=/CM/HTMLDisplay.cfm&ContentID=1728#.

18 S. J. Lee, H. Ralston, E.A. Drey, et al, Fetal Pain: ASystematic Multidisciplinary Review of the Evidence,Journal of the American Medical Association 294 (2005):948-949. It is of note that the authors of this study latercame under re for failing to report their professionaland nancial ties with the abortion industry. See, for

instance, Emily Bazar, Two Authors of Fetal-PainPaper Accused of Bias, USA Today, August 24, 2005,http://www.usatoday.com/news/health/2005-08-24-fetal-pain-bias_x.htm.

19 S. Derbyshire, Fetal Pain: A Look at the Evidence,American Pain Society Bulletin 13, no. 4 (2003), http://www.ampainsoc.org/pub/bulletin/jul03/article1.htm.


21 The Fetal Care Center of Cincinnati, http://www.

fetalcarecenter.org/surgery/fetal-surgery-anesthesia.htm; The Childrens Hospital of Philadelphias Centerfor Fetal Diagnosis and Treatment, http://www.chop.edu/service/fetal-diagnosis-and-treatment/home.html?team=true; the Fetal Diagnosis and Therapyprogram of the Vanderbilt University Medical Center,and the University of California at San Franciscos


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21

Fetal Treatment Center, http://fetus.ucsfmedicalcenter.org/our_team/anesthesiologists.asp; involve pediatricanesthesiologists in all plans for fetal surgery.


23 Annie Murphy Paul, The First Ache,New YorkTimes, February 10, 2008, http://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html?_r=1&pagewanted=all.

24 Ark.Code Ann. 20-16-903 (West 2009); Georgia:31 Ga. Code Ann., 9A-3 (West 2009); La. Rev. Stat.Ann. 40:1299.35.6 (West 2009); Minnesota M.S.A.

145.4242 ( West 2009); Okla. Stat. Ann. tit. 63 1-738c (West 2009).

25 Unborn Child Pain Awareness Act (S.51), accessedat http://thomas.loc.gov/cgi-bin/bdquery/D?d109:3:./temp/~bdZGHB::|/bss/d109query.html|.

26 Alaska Stat. 18.05.032 (2009); S.D. Codied Laws 34-23A-10.1 (2009); Tex. Health & Safety CodeAnn. 171.012 (Vernon 2009); Pain-Capable UnbornChild Protection Act (LB1103), accessed at http://

nebraskalegislature.gov/FloorDocs/Current/PDF/Slip/LB1103.pdf.

27 Pain-Capable Unborn Child Protection Act (LB1103),accessed at http://nebraskalegislature.gov/FloorDocs/Current/PDF/Slip/LB1103.pdf.

28 Daniel Martin, Abortion Time Limit Should BeReduced as Foetuses Feel Pain Before 24 Weeks, MPs

Told, UK Daily Mail, January 29, 2008, http://www.dailymail.co.uk/health/article-510975/Abortion-time-

limit-reduced-foetuses-feel-pain-24-weeks-MPs-told.html.

29 Ibid.

30 Abortion ght will go on after next election, as MPsdefy public opinion to keep 24-week limit, UK DailyMail, May 25, 2008, http://www.dailymail.co.uk/news/article-1020610/Abortion-ght-election-MPs-defy-public-opinion-24-week-limit.html#ixzz0ccJHtI00;Abortion Laws Around the World, The Pew Forumon Religion in Public Life, September 30, 2008, http://pewforum.org/docs/?DocID=167.

31 Abortion Laws Around the World, The Pew Forumon Religion in Public Life, September 30, 2008, http://pewforum.org/docs/?DocID=167.

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fetal pain can unborn children feel pain in the womb?

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