Fetuses and Pain

Can fetuses feel pain? The question has moved beyond the realm of science into politics, with powerful overtones for the general public's understanding of abortion itself. Regrettably, politics is trumping science in some quarters.

There have been at least two prominent medical journal articles written in response to fetal pain legislation proposed at the federal and state level over the last year. Senator Sam Brownback and Rep. Chris Smith reintroduced the Unborn Child Pain Awareness Act  in the Senate and House, which would require doctors to inform women seeking abortion after 20 weeks that the fetus can feel pain, and to provide fetal anesthesia on request. The debate surrounding the Partial Birth Abortion Ban Act, currently under review before the Supreme Court, sharpened public awareness about some of the gruesome methods used to terminate the lives of the unborn in the second and third trimester, which involve collapsing the fetal skull, sucking out the fetal brains, or actual dismemberment.

In spite of appearing in well—known medical journals, these fetal pain articles are simplistic hit pieces specifically created to counter the proposed bills. They contradict good research, as well as the clinical experience and observations of the many physicians who care for these fetuses during fetal surgery or when the fetuses are born prematurely. These articles are reminiscent of the old volumes of Williams Obstetrics still in circulation in the 1980's that stated that newborns could not feel pain because the spinal cord's myelin sheath was not fully developed at birth. This mistaken belief allowed newborns to experience circumcision and even heart surgery without pain relief.

There were physicians then, as now, capable of rationalizing obvious screams and signs of distress when newborns and fetuses undergo medical assault. There was little medical literature on the newborn response to pain before the 1980's. When the ability to measure stress hormones was developed, it was discovered that not only did newborns have similar hormonal responses to pain as older children and adults, but also that procedures on newborns had better outcomes when anesthesia was used.

The study of fetal and neonatal pain is an evolving discipline. In 1987 a landmark article in the New England Journal of Medicine, 'Pain and its effects on the human neonate and fetus,'  forever changed the perception that newborn reaction to pain was just a 'reflex' and reformed the practice of omitting anesthesia for newborn medical procedures.  

When writing about fetal pain, the classic issue of the mind—brain problem is always present. It is impossible to prove what another being perceives and difficult to ascertain which anatomic structures and physiologic processes are necessary for the experience of pain. The authors who dismiss the possibility of fetal pain not only reiterate this point, but also attempt to relate pain to the brain structures that develop very late in gestation.

The most recent of these articles by Stuart Derbyshire, a lecturer in the School of Psychology of the University of Birmingham with ties to the pro—choice movement, does not contain any new information and merely repeats what is known about neurobiological development. His article in the British Medical Journal states

The subjective experience of pain cannot be inferred from the anatomical developments because these developments do not account for subjectivity and the conscious contents of pain.

Derbyshire also makes an argument about immature circuitry that has been made in the past, and has been used in omitting of anesthesia on newborns and children. The intent of the author, as he himself states in the introduction, is a politically—motivated attempt to influence U.S. legislation.

Another of these studies, 'Fetal pain: a systematic multidisciplinary review of the evidence,' published in the Journal of the American Medical Association (JAMA) purports to be an objective review of the literature on fetal neurodevelopment and pain. It is co—authored by a medical student and director of the abortion unit at San Francisco General Hospital, among others. The article states

For fetal surgery, women may receive general anesthesia and/or analgesics intended for placental transfer, and parenteral opioids may be administered to the fetus under direct or sonographic visualization. In these circumstances, administration of anesthesia and analgesia serves purposes unrelated to reduction of fetal pain, including ...prevention of fetal hormonal stress responses ....

But, one might ask, why would surgery provoke a stress response on fetus unless it were noxious and painful?

Currently there are several centers in the U.S. doing surgery on second and third trimester fetuses, typically using general anesthesia for both mother and the unborn child for the more invasive procedures. It is clear from a study of fetal surgery that the unborn benefit from sedation and anesthesia. Vivette Glover, a researcher at the Queen Charlotte's and Chelsea Hospital in London has stated that not only third trimester fetuses should have pain relief, but also that

...between 17 and 26 [weeks] it is increasingly possible that it starts to feel something and that abortions done in that period ought to use anaesthesia'

Her studies document the beneficial effect of analgesics on the second and third trimester fetus when they are undergoing medical procedures. Moreover, premature babies, who are born at the same gestational ages as those who are aborted, are exquisitely sensitive to painful stimuli, and have many fewer severe complications such as brain hemorrhages if this sensitivity is taken into account.

The foremost authority in fetal and neonatal pain, K.J.S Anand, was a researcher at Harvard when he co—authored the 1987 landmark study on neonatal and fetal pain, and now holds an endowed chair in critical care medicine, pediatrics, anesthesiology, pharmacology, neurobiology and developmental sciences at the University of Arkansas. Anand was critical of the JAMA article, stating that even though it purported to be a 'systematic multidisciplinary review,' the authors utilized ambiguous scientific methodology in selecting only the articles that supported their point of view.

Unlike the authors of the articles dismissive of fetal pain, Anand actually takes care of babies at the same gestational ages as the fetuses under discussion. He has done extensive research in the area, authoring dozens of articles, and has no axe to grind in the abortion debate. He has testified before Congressional committees in the debates on the Partial Birth Abortion Act and, more recently, in relation to the Unborn Child Pain Awareness Act.

The main point he makes is that pain perception is not a hard—wired system and has multiple layers. He believes that the structures for pain in fetuses are not the same as in older children and adults, and the lack of mature structures should not lead to the conclusion that fetuses do not feel pain. Anand states that pain is an integral part of the nervous system and that fetuses will use whatever structures are available.

The recent reviews in the British Medical Journal and Journal of the American Medical Association were written to deliberately dehumanize second and third trimester unborn human beings, not only to justify aborting them but to deny them even the pain relief that animals are allowed. It is distressing to see these distinguished journals publish articles of limited scientific merit that are motivated solely by attempts to influence legislation.

They illustrate the success of radical abortion advocates in achieving elite positions of influence in medical practice, as well as the collusion or ignorance of journal editors who allow abortion politics to interfere with scientific discourse.

Mary L. Davenport, M.D is a practicing obstetrician/gynecologist and a Fellow of the American Collge of Obsterics and Gynecology

Can fetuses feel pain? The question has moved beyond the realm of science into politics, with powerful overtones for the general public's understanding of abortion itself. Regrettably, politics is trumping science in some quarters.

There have been at least two prominent medical journal articles written in response to fetal pain legislation proposed at the federal and state level over the last year. Senator Sam Brownback and Rep. Chris Smith reintroduced the Unborn Child Pain Awareness Act  in the Senate and House, which would require doctors to inform women seeking abortion after 20 weeks that the fetus can feel pain, and to provide fetal anesthesia on request. The debate surrounding the Partial Birth Abortion Ban Act, currently under review before the Supreme Court, sharpened public awareness about some of the gruesome methods used to terminate the lives of the unborn in the second and third trimester, which involve collapsing the fetal skull, sucking out the fetal brains, or actual dismemberment.

In spite of appearing in well—known medical journals, these fetal pain articles are simplistic hit pieces specifically created to counter the proposed bills. They contradict good research, as well as the clinical experience and observations of the many physicians who care for these fetuses during fetal surgery or when the fetuses are born prematurely. These articles are reminiscent of the old volumes of Williams Obstetrics still in circulation in the 1980's that stated that newborns could not feel pain because the spinal cord's myelin sheath was not fully developed at birth. This mistaken belief allowed newborns to experience circumcision and even heart surgery without pain relief.

There were physicians then, as now, capable of rationalizing obvious screams and signs of distress when newborns and fetuses undergo medical assault. There was little medical literature on the newborn response to pain before the 1980's. When the ability to measure stress hormones was developed, it was discovered that not only did newborns have similar hormonal responses to pain as older children and adults, but also that procedures on newborns had better outcomes when anesthesia was used.

The study of fetal and neonatal pain is an evolving discipline. In 1987 a landmark article in the New England Journal of Medicine, 'Pain and its effects on the human neonate and fetus,'  forever changed the perception that newborn reaction to pain was just a 'reflex' and reformed the practice of omitting anesthesia for newborn medical procedures.  

When writing about fetal pain, the classic issue of the mind—brain problem is always present. It is impossible to prove what another being perceives and difficult to ascertain which anatomic structures and physiologic processes are necessary for the experience of pain. The authors who dismiss the possibility of fetal pain not only reiterate this point, but also attempt to relate pain to the brain structures that develop very late in gestation.

The most recent of these articles by Stuart Derbyshire, a lecturer in the School of Psychology of the University of Birmingham with ties to the pro—choice movement, does not contain any new information and merely repeats what is known about neurobiological development. His article in the British Medical Journal states

The subjective experience of pain cannot be inferred from the anatomical developments because these developments do not account for subjectivity and the conscious contents of pain.

Derbyshire also makes an argument about immature circuitry that has been made in the past, and has been used in omitting of anesthesia on newborns and children. The intent of the author, as he himself states in the introduction, is a politically—motivated attempt to influence U.S. legislation.

Another of these studies, 'Fetal pain: a systematic multidisciplinary review of the evidence,' published in the Journal of the American Medical Association (JAMA) purports to be an objective review of the literature on fetal neurodevelopment and pain. It is co—authored by a medical student and director of the abortion unit at San Francisco General Hospital, among others. The article states

For fetal surgery, women may receive general anesthesia and/or analgesics intended for placental transfer, and parenteral opioids may be administered to the fetus under direct or sonographic visualization. In these circumstances, administration of anesthesia and analgesia serves purposes unrelated to reduction of fetal pain, including ...prevention of fetal hormonal stress responses ....

But, one might ask, why would surgery provoke a stress response on fetus unless it were noxious and painful?

Currently there are several centers in the U.S. doing surgery on second and third trimester fetuses, typically using general anesthesia for both mother and the unborn child for the more invasive procedures. It is clear from a study of fetal surgery that the unborn benefit from sedation and anesthesia. Vivette Glover, a researcher at the Queen Charlotte's and Chelsea Hospital in London has stated that not only third trimester fetuses should have pain relief, but also that

...between 17 and 26 [weeks] it is increasingly possible that it starts to feel something and that abortions done in that period ought to use anaesthesia'

Her studies document the beneficial effect of analgesics on the second and third trimester fetus when they are undergoing medical procedures. Moreover, premature babies, who are born at the same gestational ages as those who are aborted, are exquisitely sensitive to painful stimuli, and have many fewer severe complications such as brain hemorrhages if this sensitivity is taken into account.

The foremost authority in fetal and neonatal pain, K.J.S Anand, was a researcher at Harvard when he co—authored the 1987 landmark study on neonatal and fetal pain, and now holds an endowed chair in critical care medicine, pediatrics, anesthesiology, pharmacology, neurobiology and developmental sciences at the University of Arkansas. Anand was critical of the JAMA article, stating that even though it purported to be a 'systematic multidisciplinary review,' the authors utilized ambiguous scientific methodology in selecting only the articles that supported their point of view.

Unlike the authors of the articles dismissive of fetal pain, Anand actually takes care of babies at the same gestational ages as the fetuses under discussion. He has done extensive research in the area, authoring dozens of articles, and has no axe to grind in the abortion debate. He has testified before Congressional committees in the debates on the Partial Birth Abortion Act and, more recently, in relation to the Unborn Child Pain Awareness Act.

The main point he makes is that pain perception is not a hard—wired system and has multiple layers. He believes that the structures for pain in fetuses are not the same as in older children and adults, and the lack of mature structures should not lead to the conclusion that fetuses do not feel pain. Anand states that pain is an integral part of the nervous system and that fetuses will use whatever structures are available.

The recent reviews in the British Medical Journal and Journal of the American Medical Association were written to deliberately dehumanize second and third trimester unborn human beings, not only to justify aborting them but to deny them even the pain relief that animals are allowed. It is distressing to see these distinguished journals publish articles of limited scientific merit that are motivated solely by attempts to influence legislation.

They illustrate the success of radical abortion advocates in achieving elite positions of influence in medical practice, as well as the collusion or ignorance of journal editors who allow abortion politics to interfere with scientific discourse.

Mary L. Davenport, M.D is a practicing obstetrician/gynecologist and a Fellow of the American Collge of Obsterics and Gynecology