Prenatal perception

Prenatal perception is the study of the extent of somatosensory and other types of perception during pregnancy. In practical terms, this means the study of fetuses; none of the accepted indicators of perception are present in embryos.

Studies in the field inform the abortion debate, along with certain related pieces of legislation in countries affected by that debate.

Prenatal hearing

Numerous studies have found evidence indicating a fetus's ability to respond to auditory stimuli. Research at Zhejiang University, China indicates that fetuses of 33–41 weeks gestational age can not only hear, but also distinguish their mothers' voices from others.^[1][2]

Prenatal pain

Pregnancy timeline

The hypothesis that human fetuses are capable of perceiving pain in the early stages of a pregnancy has not received sufficient evidence to be proven or disproven; the developmental stage of research and instrumentation is so far insufficient to this task.

Some authors,^[3] however, argue that fetal pain is possible from the second half, or even the second tremester,^[4] of pregnancy.^[5] In March 2010, the Royal College of Obstetricians and Gynecologists submitted a report,^[6] concluding that "Current research shows that the sensory structures are not developed or specialized enough to respond to pain in a fetus of less than 24 weeks", pg. 22.

The neural regions and pathways that are responsible for pain experience remain under debate but it is generally accepted that pain from physical trauma requires an intact pathway from the periphery, through the spinal cord, into the thalamus and on to regions of the cerebral cortex including the primary sensory cortex (S1), the insular cortex and the anterior cingulated cortex.3,4 Fetal pain is not possible before these necessary neural pathways and structures (figure 1) have developed. -pg. 3

The report specifically identified the anterior cingulate as the area of the cerebral cortex responsible for pain processing. The anterior cingulate is part of the cerebral cortex, which begins to develop in the fetus at week 26.

On the other extreme, in 1996, physiologist Peter McCullagh spoke on behalf of a pro-life group to the British Parliament. He said, "At what stage of human prenatal development are those anatomical structures subserving the appreciation of pain present and functional? The balance of evidence at the present time indicates that these structures are present and functional before the tenth week of intrauterine life."^[7]

The issue is considerably complicated by the usual difficulties in perceptual research of unresponsive subjects: "Though techniques such as positron electron tomography scanning might reveal those parts of the brain that respond to a painful stimulus, this does not tell us what the individual is experiencing."^[8]

Researchers from the University of California, San Francisco in the Journal of the American Medical Association concluded in a meta-analysis of data from dozens of medical reports and studies that fetuses are unlikely to feel pain until the third trimester of pregnancy.^[9][10] There is an emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections (at weeks 22-34, reliably at 29) is a critical event with regard to fetal perception of pain, as they allow peripheral sensory information to arrive at the cortex.^[11]

Because pain can involve sensory, emotional and cognitive factors, it may be difficult to know when painful experiences are perceived, even if it is known when thalamocortical connections are established.^[12] In 2006, an opinion piece by Stuart Derbyshire^[13] in the British Medical Journal proposed that pain is dependent upon cognitive and emotional developments that occur after birth:

Theories of development assume that the early human mind begins with minimal content and gradually evolves into the rich experience of older children and adults. Although the view of a neonate as a blank slate, or tabula rasa, is generally rejected, it is broadly accepted that psychological processes have content concerning people, objects, and symbols, which lay in the first instance outside the brain. If pain also depends on content derived from outside the brain, then fetal pain cannot be possible, regardless of neural development.^[14]

Electroencephalography suggests the capacity for functional pain perception in premature infants probably does not exist before 29 or 30 weeks; this study asserted that withdrawal reflexes and changes in heart rates and hormone levels in response to invasive procedures are reflexes that do not indicate fetal pain.^[9]

Also in 2005, David Mellor and colleagues reviewed several lines of evidence that suggested a fetus does not awaken during its time in the womb. Mellor notes that much of the literature on fetal pain simply extrapolates from findings and research on premature babies. He questions the value of such data:

Systematic studies of fetal neurological function suggest, however, that there are major differences in the in utero environment and fetal neural state that make it likely that this assumption is substantially incorrect.

He and his team detected the presence of such chemicals as adenosine, pregnanolone, and prostaglandin-D₂ in both human and animal fetuses, indicating that the fetus is both sedated and anesthetized when in the womb. These chemicals are oxidized with the newborn's first few breaths and washed out of the tissues, allowing consciousness to occur. If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimized.^[15] “A fetus,” Mellor told The New York Times, “is not a baby who just hasn’t been born yet.”^[16]

In 2001, a working group of the Medical Research Council (UK) in the United Kingdom called for more research regarding fetal pain.^[17] According to the Daily Telegraph, Eve Johnstone, the chair of that working group "makes a strong case for additional research." Ms. Johnstone told the newspaper, "We ought to study this carefully."^[18]

Fetal anesthesia

Direct fetal analgesia is used in only a minority of prenatal surgeries.^[19]

Some caution that unnecessary use of fetal anesthetic may pose potential health risks to the prospective mother. "In the context of abortion, fetal analgesia would be used solely for beneficence toward the fetus, assuming fetal pain exists. This interest must be considered in concert with maternal safety and fetal effectiveness of any proposed anesthetic or analgesic technique. For instance, general anesthesia increases abortion morbidity and mortality for women and substantially increases the cost of abortion. Although placental transfer of many opioids and sedative-hypnotics has been determined, the maternal dose required for fetal analgesia is unknown, as is the safety for women at such doses.^[9]

Anesthesia researcher Laura Myers has suggested that fetal pain legislation may make abortions harder to obtain, because abortion clinics lack the equipment and expertise to supply fetal anesthesia. Currently, anesthesia is administered directly to fetuses only while they are undergoing surgery.^[20]

Wendy Savage, press officer of Doctors for a Woman’s Choice on Abortion, pointed out that the majority of surgical abortions in Britain are already performed under general anesthesia, which also affects the fetus. In a letter to the British Medical Journal in April 1997, she deemed the discussion "unhelpful to women and to the scientific debate".

United States legislation

Federal legislation

In 2013 during the 113th Congress, Representative Trent Franks introduced a bill called the "Pain-Capable Unborn Child Protection Act" (H.R. 1797). It passed in the House on June 18, 2013 and was received in the U.S. Senate, read twice, and referred to the Judiciary Committee.^[21]

In 2004 during the 108th Congress, Senator Sam Brownback introduced a bill called the "Unborn Child Pain Awareness Act" for the stated purpose of "ensur[ing] that women seeking an abortion are fully informed regarding the pain experienced by their unborn child.", which was read twice and referred to committee.^[22][23]

State legislation

Subsequently, 25 states have examined similar legislation related to fetal pain and/or fetal anesthesia,^[20] and in 2010 Nebraska banned abortions after 20 weeks on the basis of fetal pain.^[24] Eight states – Arkansas, Georgia, Louisiana, Minnesota, Oklahoma, Alaska, South Dakota, and Texas – have passed laws which introduced information on fetal pain in their state-issued abortion-counseling literature, which one opponent of these laws, the Guttmacher Institute founded by Planned Parenthood, has called "generally irrelevant" and not in line "with the current medical literature".^[25] Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said laws such as these "reduce... the process of informed consent to the reading of a fixed script created and mandated by politicians not doctors."^[26]

See also

• Pain in babies
• Prenatal development
• Texas Senate Bill 5

References

External links

• "Oversight Hearing on Pain of the Unborn" from U.S. Congress, House Judiciary Committee, Subcommittee on the Constitution, Civil Rights, and Civil Liberties (2005). This includes testimony both for and against proposed legislation dealing with fetal pain.
• "Can a embryo or fetus feel pain? Various opinions and studies" from Ontario Consultants on Religious Tolerance. This site states: "We feel that all women considering an abortion should be fully informed and as free as possible from outside pressure."
• Pro-life site presenting case for fetal pain from second month of pregnancy: HTML version.
• Statement of National Abortion Federation Opposing H.R. 3442, the "Unborn Child Pain Awareness Act" (2008) PDF version and HTML version.
• National Right to Life Committee's webpage of testimonies regarding fetal pain: HTML version
• Small survivors: How the disputed science of fetal pain is reshaping abortion law by Eric Schulzke in Deseret News

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