What do you say when

iVillage Member
Registered: 03-06-2008
What do you say when
Tue, 05-06-2008 - 2:59pm

a GUY keeps using the "Don't have sex if you're not going to be willing to go full term with a pregnancy from it " argument. I am ready to jump through the screen and strangle this guy because no matter what I say he says this back (this is from my local community forum message boards).

I thought I would come to the experts.



iVillage Member
Registered: 04-10-2003
Thu, 06-05-2008 - 4:16pm


The person who was BORN with the body, OWNS the uterus and undergoes EACH and EVEY short and long term risk and/or complication inherent in and arising form the process of gestation and childbirth. I ask who are YOU to restrict choices that may impact her body, health and life?


It is not a child until it is born. Until then, it is a zygote, blastocyst, embryo or fetus. science has pretty well defined those for us.


A fetus is not viable until roughly 24 weeks of gestation without the life support a womb provides it.


Is a hoax. Have links, will supply upon request.

<< This child knows nothing except the woman who carries it. That is the truest form of love. >>

Poppycock. An embryo and/or fetus, not to mention even a neonate are ALL incapable of love. Love is a complex emotion that requires far more neurological connections and maturity- not to mention cognizant and sentience.


Sometimes it's a death sentence. Sometimes it has a negative impact on a woman's health that lasts a lifetime. NO ONE has the right to impose a set of risks that far outweigh the risks associated with an alternative against her will. You are SEVEN times more likely to DIE giving birth than aborting. Have links upon request.


iVillage Member
Registered: 02-15-2005
Thu, 06-05-2008 - 4:19pm

<<<Who are you to decide what rights as a HUMAN being should be allotted to whom?>>>

Any human who is completley reliant on my body for life support remains only at my discretion.

<<<That by 6 weeks, brainwaves are fully functioning, and that by the time you are 9 weeks pregnant, the unborn fetus has full sensory input. She can feel pain. >>>

Resource? None of the research I'm aware of supports those statements.

<<<You Tube. "The silent scream" >>>

Been debunked.


huh? A fetus has no emotions or thought processes. And knowledge of nothing but one person has nothing to do with a true form of love. That verbiage makes no sense to me.


A fetus isn't capable of "trust".


Yes, as a matter of fact it is. For me personally, it would be medically devastating.

Even healthy women can have very serious complications which should only be undertaken by the willing.


iVillage Member
Registered: 04-01-2008
Thu, 06-05-2008 - 4:27pm
ft. lewis Photobucket This is my wonderful family that was started when our hearts joined on February 18th, 2006. Dana Elizabeth chimed in November 20, 2007. We look forward to investing in a whole peanut gallery. army army wife Photobucket scrapbooking

Edited 6/6/2008 1:57 am ET by mamaemmot
iVillage Member
Registered: 04-03-2005
Thu, 06-05-2008 - 4:33pm

"Who are you to decide what rights as a HUMAN being should be allotted to whom?"

And, who are you to decide that the rights of a fetus should supercede that of the woman who will have to gestate it?

"Do you imagine that this unborn child is not a child for the simple fact that it does not breath air?"

No, I imagine that this unborn fetus is not a child for the same reason why I do not imagine an infant to be a toddler... Or a toddler to be a teenager... Or a teenager to be an adult...

"Research shows that the fetus's heartrate increases and activity levels fluctuate everytime the child hears his mother's voice."

Want to post this research?

"That by 6 weeks, brainwaves are fully functioning, and that by the time you are 9 weeks pregnant, the unborn fetus has full sensory input. She can feel pain."

This is absolute B.S. Sorry, you can believe it if you want, but, just because you're convinced this is so, doesn't make it true. Medical research disagrees with the garbage you're spewing forth as "fact."

"You Tube. "The silent scream""

The silent scream has shown to be fake. It is purposely sped-up to give a dramatic distortion of what occurs during an abortion procedure.

"but is it really so hard to simply carry a child for 40 weeks and then allow someone else to take over from there?"

Why should a woman be reduced to the status of an incubator just to avoid upsetting someone else's sensetivities, especially when that person

Powered by Lorf!


iVillage Member
Registered: 02-15-2005
Thu, 06-05-2008 - 4:35pm

<<< Deja moo.

The feeling that I've heard this bull before. >>>

If you don't care to debate respectfully, please don't respond to my posts.


Actually, depending on usage, it is both. Regardless, an e/z/f is incapable of it.


iVillage Member
Registered: 04-03-2005
Thu, 06-05-2008 - 4:38pm

Powered by Lorf!


iVillage Member
Registered: 04-10-2003
Thu, 06-05-2008 - 4:46pm



Foetuses May Not Feel Pain in Early Months


Researchers Say Fetuses Likely Don't Feel Pain Until Late in Pregnancy


CHICAGO Aug 23, 2005 — A review of medical evidence has found that fetuses likely don't feel pain until the final months of pregnancy, a powerful challenge to abortion opponents who hope that discussions about fetal pain will make women think twice about ending pregnancies.

Critics angrily disputed the findings and claimed the report is biased.

"They have literally stuck their hands into a hornet's nest," said Dr. Kanwaljeet Anand, a fetal pain researcher at the University of Arkansas for Medical Sciences, who believes fetuses as young as 20 weeks old feel pain. "This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be. This is not the last word definitely not."

The review by researchers at the University of California, San Francisco comes as advocates are pushing for fetal pain laws aimed at curtailing abortion. Proposed federal legislation would require doctors to provide fetal pain information to women seeking abortions when fetuses are at least 20 weeks old, and to offer women fetal anesthesia at that stage of the pregnancy. A handful of states have enacted similar measures.

But the report, appearing in Wednesday's Journal of the American Medical Association, says that offering fetal pain relief during abortions in the fifth or sixth months of pregnancy is misguided and might result in unacceptable health risks to women.

Dr. Nancy Chescheir, chairman of obstetrics and gynecology at Vanderbilt University and a board director at the Society of Maternal-Fetal Medicine, said the article "will help to develop some consensus" on when fetuses feel pain. "To date, there hasn't been any."

The researchers reviewed dozens of studies and medical reports and said the data indicate that fetuses likely are incapable of feeling pain until around the seventh month of pregnancy, when they are about 28 weeks old.

While brain structures involved in feeling pain begin forming much earlier, research indicates they likely do not function until the pregnancy's final stages, said the report's senior author, UCSF obstetric anesthesiologist Dr. Mark Rosen.

Fetal Pain
A Systematic Multidisciplinary Review of the Evidence

Susan J. Lee, JD; Henry J. Peter Ralston, MD; Eleanor A. Drey, MD, EdM; John Colin Partridge, MD, MPH; Mark A. Rosen, MD

JAMA. 2005;294:947-954.

Context Proposed federal legislation would require physicians to inform women seeking abortions at 20 or more weeks after fertilization that the fetus feels pain and to offer anesthesia administered directly to the fetus. This article examines whether a fetus feels pain and if so, whether safe and effective techniques exist for providing direct fetal anesthesia or analgesia in the context of therapeutic procedures or abortion.

Evidence Acquisition Systematic search of PubMed for English-language articles focusing on human studies related to fetal pain, anesthesia, and analgesia. Included articles studied fetuses of less than 30 weeks’ gestational age or specifically addressed fetal pain perception or nociception. Articles were reviewed for additional references. The search was performed without date limitations and was current as of June 6, 2005.

Evidence Synthesis Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing. Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks’ gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks. 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 inhibition of fetal movement, prevention of fetal hormonal stress responses, and induction of uterine atony.

Conclusions Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester. Little or no evidence addresses the effectiveness of direct fetal anesthetic or analgesic techniques. Similarly, limited or no data exist on the safety of such techniques for pregnant women in the context of abortion. Anesthetic techniques currently used during fetal surgery are not directly applicable to abortion procedures.

Author Affiliations: School of Medicine (Ms Lee), Department of Anatomy and W. M. Keck Foundation for Integrative Neuroscience (Dr Ralston), and Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Drey and Rosen), Pediatrics (Dr Partridge), and Anesthesia and Perioperative Care (Dr Rosen), University of California, San Francisco


Study: Fetus feels no pain until third trimester
Brain structures do not function until later in pregnancy, researchers say

Updated: 12:57 a.m. ET Aug 24, 2005
CHICAGO - Doctors should not be required to discuss fetal pain with women seeking abortions because fetuses likely can’t feel pain until late in pregnancy, according to a review critics say hardly settles the contentious topic.

Researchers at the University of California, San Francisco reviewed dozens of studies and medical reports and said the data indicate that fetuses likely are incapable of feeling pain until around the seventh month of pregnancy, when they are about 28 weeks old.

Based on the evidence, discussions of fetal pain for abortions performed before the end of the second trimester should not be mandatory, according to the study appearing in Wednesday’s Journal of the American Medical Association.

The review, researchers say, is an attempt to present a comprehensive, objective report on evidence to inform the debate over fetal pain laws aimed at making women think twice before getting abortions.

Critics angrily disputed the findings and claimed the report is biased.

“They have literally stuck their hands into a hornet’s nest,” said Dr. Kanwaljeet Anand, a fetal pain researcher at the University of Arkansas for Medical Sciences, who believes fetuses as young as 20 weeks old feel pain. “This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be. This is not the last word — definitely not.”

Proposed federal legislation would require doctors to provide fetal pain information to women seeking abortions when fetuses are at least 20 weeks old, and to offer women fetal anesthesia at that stage of the pregnancy. A handful of states have enacted similar measures.

The review says medical evidence shows that brain structures involved in feeling pain begin forming earlier but likely do not function until around the seventh month, when fetuses are about 28 weeks old.

Some scientists say younger fetuses show pain by moving away from a stimulus, but that likely is a reflex action and not an indication that they are actually feeling pain, said UCSF obstetric anesthesiologist Dr. Mark Rosen, the study’s senior author.

Offering fetal pain relief in the fifth or sixth month, when brains are too immature to feel pain, is misguided and might result in unacceptable health risks to women, the authors said.

Dr. Nancy Chescheir, chairman of obstetrics and gynecology at Vanderbilt University and a board director at the Society of Maternal-Fetal Medicine, said the report “will help to develop some consensus” on when fetuses feel pain. ���To date, there hasn’t been any.”

Study not politically motivated
The sponsor of the proposed federal fetal pain legislation, Sen. Sam Brownback, R-Kan., says he’s prepared for “a robust debate” on his measure in light of the new review.

He said Wednesday’s JAMA report “seems to me to fly in the face of common experience and common sense.”

Brownback, often mentioned as a potential presidential candidate in 2008, thinks discussing fetal pain is one way to curb abortions without making them illegal.

“I’m pro-life and if a woman decides not to abort her fetus with this information, that would certainly be fine by me,” Brownback said.

The measure pending in Congress would affect about 18,000 U.S. abortions a year performed in the fifth month of pregnancy or later, said Douglas Johnson, legislative director of the National Right to Life Committee. He said the review is slanted.

Dr. Catherine DeAngelis, JAMA’s editor-in-chief, said the decision to publish the review was not politically motivated.

JAMA does not publish “politically motivated science. We publish data-based, evidence-based science,” she said.

Rosen said researchers “tried to review the literature in an unbiased fashion. This was a multidisciplinary effort by experts on anesthesia, neuroanatomy, obstetrics and neonatal development.”

Risks to mother
When doctors operate on fetuses to correct defects before birth, general anesthesia is given to the mother primarily to immobilize the fetus and to make the uterus relax. Anesthesia during fetal surgery increases the mother’s risks for breathing problems and bleeding from a relaxed uterus, the researchers said.

Rosen said those risks are medically acceptable when the goal is to save the fetus but there is not enough evidence to show any benefit from fetus-directed anesthesia during an abortion.

Administering anesthesia directly to the fetus is also sometimes done but generally to reduce the release of potentially harmful fetal stress hormones, Rosen said. There is little research on its effects.

But Anand said the study’s authors excluded or minimized evidence suggesting fetal pain sensation begins in the second trimester and wrongly assume that fetuses’ brains sense pain in the same way as adult brains.

While Anand has testified as an expert witness for the government in court cases opposing some late-term abortions, he said he is not anti-abortion and that his views are based on years of fetal pain research.


iVillage Member
Registered: 04-10-2003
Thu, 06-05-2008 - 4:47pm



There is no such thing as 'fetal pain'
Pain specialist Dr Stuart Derbyshire argues that the misguided discussion of fetal pain will have serious negative consequences for the treatment of pregnant women and for scientific practice
In June a group of anti-abortion parliamentarians published a tract asserting that fetuses experience pain from the tenth week of gestation. Such a debate seems a strange preoccupation for politicians who cannot be expected to know one end of a nerve cell from another, but it has since been the subject of questions to ministers and parliamentary debates. The issue will be re-raised when MPs and peers return from their summer recess and a self-appointed 'pro-life' committee of inquiry reports.
The agenda of those who have raised the issue of fetal pain is clear. If they can establish that fetuses feel pain it is bound to generate public unease about abortion procedures. Already the anti-abortion lobby is talking in terms of 'the pre-born' writhing in agony as they are ripped limb from limb--not a pretty thought, however pro-choice you might be.

The discussion also helps to encourage the assumption that there are no qualitative differences between fetuses and babies. It fosters the notion that fetuses are just 'pre-born' babies with the same capacities--and so are worthy of the same care and treatment. The consequence of this would be to reduce the status of the woman to that of a 'walking womb', with no right to decide what happens to her pregnancy. But then her rights tend routinely to be ignored as all eyes focus on the fetus.

It is not surprising that the anti-abortion lobby has raised this issue. But it is surprising that its views have struck a chord with the medical establishment and with 'pro-choice campaigners'. Everybody seems to agree that this is a 'difficult' issue which needs careful consideration. Even the most strongly pro-choice voices appear to concede that fetal pain experiences might be possible after 26 weeks of pregnancy. More equivocal voices suggest that the pro-choice argument should evade the issue by arguing for easier access to abortion before 10 weeks.

What needs to be said is simply this. Fetuses do not and cannot feel pain--not at 10 weeks, 26 weeks or 30 weeks--because pain-experience depends on consciousness and fetuses are not conscious.

The question of fetal pain became an issue for some of the medical profession in the mid-1980s, as a consequence of research which indicated that a fetus is capable of a behavioural response to sensory stimulation. Advances in fetal surgery, which now include placing valves into the heart and injecting red blood cells into the liver to prevent anaemia, meant that neonatal surgeons and experts in embryology were becoming increasingly concerned about the potential consequences of invasive practice, including the concern that the fetus may feel pain. This concern was given a major boost by research from Dr Anand, then a research fellow at the John Radcliffe Hospital, Oxford, which demonstrated that neonates--new-born babies--undergoing surgery had a much improved clinical outcome if they received anaesthetics of a kind usually reserved for controlling pain during adult surgery.

It may come as a shock to hear that, until very recently, it was not considered necessary to use anaesthesia with new-born babies. But the reasons are entirely rational. The use of anaesthetic is not without risk. Even in adults there is a small risk of respiratory depression which can be fatal; for a new-born baby with underdeveloped lungs this risk is heightened, becoming greater if the baby is premature. In addition, it was widely assumed that the new born lacks the biological sophistication necessary for pain-experience. Anand's work overturned these assumptions.

The work of Anand is complemented by that of Professor Maria Fitzgerald from the Department of Anatomy at University College London. For over a decade, Fitzgerald has investigated the nervous system of the rat fetus and the human fetus, with special regard to the developmental neurobiology of pain. She concludes that several basic mechanisms must be connected up in the human being in order for pain to be experienced. The peripheral nerve fibres (that is, the nerves in your outer skin and inner organs) have to be connected to your spinal cord, which in turn needs to be connected to your brain. There are then several circuits within the brain which have to be operational and connected before the biological pain system is operational. According to Fitzgerald's studies, the final link in the pain system (between a cluster of grey nuclei in the brain stem, the thalamus, and the outer rim of the brain, the cortex) is completed at approximately 26 weeks' gestation.

The suggestion that the biological system for pain is operational after 26 weeks is bolstered by studies of invasive procedures. Touching the fetus prior to 26 weeks often results in a generalised response. Repeated skin stimulation, for example, results in hyper-excitability and a generalised movement of all limbs of the body. Such behaviours are characteristic of a purely reflex response. Observations of the fetus after 26 weeks, however, indicate localised movement and avoidance responses to invasive needling. Behavioural studies with very premature babies have demonstrated that the response to noxious stimulation becomes more focused and organised, and can be better discriminated from other distress responses after 26 weeks.

It is now also clear that the fetus of post-26 weeks' gestation launches a stress response to invasive needling, entirely analogous to the response shown by Anand in new-born babies. In 1994 a team at Queen Charlotte's Hospital in London successfully demonstrated that intrauterine needling to obtain a blood sample from fetuses of 20-34 weeks' gestation resulted in a hormonal stress response, as indicated by increased cortisol and ß-endorphin concentrations in fetal plasma.

As a consequence of this research, the previous objections to the use of anaesthetics in the new born and the fetus, on the grounds of danger and minimal biological development, are now untenable. After 26 weeks, the human fetus has the necessary biological apparatus for pain, shows a localised behavioural response to stimulation, and launches a hormonal stress response to needling. But is this sufficient evidence to conclude that the fetus can experience pain?

Whether or not the fetus feels what we understand as pain hinges not on its biological development, but on its conscious development. Unless it can be reasonably demonstrated that the fetus has a conscious appreciation of pain after 26 weeks' gestation, then its responses to noxious stimulation are still essentially reflex responses, exactly as those prior to 26 weeks. This is appreciated in varying degrees by the experts.

Xenophon Giannakoulopoulos and his colleagues at Queen Charlotte's admitted that 'a hormonal response cannot be equated with the perception of pain'. In a paper written for the Department of Health, Fitzgerald even went so far as to say that 'true pain-experience postnatally along with memory, anxiety and other cognitive brain functions' ('Fetal pain: an update of current scientific knowledge', May 1995). In other words, to claim that a fetus feels pain makes as little sense as suggesting that it has kept a mental diary of its time in the womb.

As Fitzgerald has pointed out, pain-experience is now widely seen as a consequence of an amalgam of cognition, sensation and affective processes, described under the rubric of the 'biopsychosocial' model. Pain has been understood as a multi-dimensional phenomenon for some time, and this understanding is reflected in the current International Association for the Study of Pain (IASP) definition of pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage' (H Merskey, 'The definition of pain', European Journal of Psychiatry, Vol6, 1991).

If this 'multi-dimensionality' is the basis of conscious pain-experience, it makes no sense to attribute this experience to the neonate or fetus which is naive as to all the cognitive, affective and evaluative experiences necessary for pain-awareness. This is accepted in the current IASP definition of pain, which is further extended to state that 'pain is always subjective, each individual learns the application of the word through experiences related to injury in early life'. Pain does not somehow spring forth 'from the depths of the person's mind' prior to any experience. That would be an essentially metaphysical view of pain, which logically suggests that all the higher mental functions should be present at, or before, birth.

In other words, the experience of pain is a consequence of developmental processes through which the fetus and new-born baby have yet to pass. According to one developmental model of pain, stimulus information is eventually organised and elaborated in the central nervous system with respect to three hierarchical mechanisms. The first two mechanisms in the hierarchy are perceptual-motor processing followed by schematic processing. Both these mechanisms are considered pre-conscious. Perceptual-motor processing involves the activation of innate motor reactions to stimulation. Schematic processing involves the automatic encoding in memory of these stimuli and associated reactions to produce a categorical structure representing the general informational and sensory aspects of aversive stimuli. In addition, it is suggested that a set of conscious abstract rules about emotional episodes and associated voluntary responses arise only over time, as a consequence of self-observation and conscious efforts to cope with aversive situations.

While far from ideal, this model does outline how the pressure of interacting with others gradually forces the subordination of our instinctive, unconscious biology to our developing conscious will. The model shifts us away from a static interpretation of pain towards one in which the reflexive responses to stimulation are developed, and subordinated, according to the dynamics of developing awareness. Pain can then logically be understood as a conscious, developed response which a fetus could never be capable of experiencing.

The failure of the medical and scientific community to tackle the issue has allowed the idea that a fetus can feel pain to gain momentum, strengthening the anti-abortionists' hand. The emotive notion of fetal pain has gone largely unchallenged in the medical journals, the newspapers and in the House of Commons. Last year, anti-abortion crusader David Alton MP introduced an adjournment debate in which he insisted that information on fetal pain should be issued to women considering abortion (Hansard, 136, 1995). This debate was followed by an early day motion calling on the Department of Health to disseminate information 'to medical staff and mothers' and to 'come forward with proposals for avoiding pain in pre-term surgery and abortion' (Hansard, 140, 1995).

It has also been proposed that the Abortion Act and the Criminal Justice Act be amended to make it a crime to inflict pain on the fetus. The Rawlinson committee (a noted anti-choice organisation set up in 1993 to examine the implications of the 1967 Abortion Act) was recently resurrected to examine the question of fetal pain. Although, in the interests of balance, I was invited to give evidence to the committee, it seems likely that it will eventually come out in support of the existence of 'fetal pain' and recommend further restrictions on access to abortion.

The attempt to undermine public confidence in the provision of abortion is only one negative consequence of the misguided discussion around fetal pain. The discussion is also encouraging researchers to take an anti-scientific stance, which denies the possibility of answering the question 'do fetuses feel pain?' and undermines the current, well-supported model of pain.

The emotional hype around fetal pain is also likely to have a detrimental impact upon medical research and practice beyond the cry for restricting abortion. Earlier this year, the Daily Express ran a headline suggesting that babies may feel pain during childbirth. This view was based on the research from Queen Charlotte's Hospital and was endorsed by one of its principal researchers. It seems unlikely, however, that a process which the overwhelming majority of people has passed through--being born--is having long-term detrimental consequences, and there is some evidence to suggest that the increased hormonal release around birth is important in stimulating growth and regulating development. Such work is likely to be overlooked if fetal pain becomes an accepted view. Acceptance of fetal pain will mean that anaesthetic practice may be introduced when there is no clear rationale for its use and where it is likely to be at least uncomfortable, if not dangerous, for the mother-to-be. How long will it be before someone calls for an increase in Caesarian sections to avoid fetal/neonatal 'pain'?

Good clinical research into the effects of anaesthesia on the fetus and the new-born baby is clearly required. But misguided sentimentality about the possibility of fetal pain can only have negative consequences--including undermining the very basis of the clinical research itself.


iVillage Member
Registered: 04-10-2003
Thu, 06-05-2008 - 4:48pm



1. Introduction
The recent ability to diagnose and treat the fetus in utero resulted from developments in invasive procedures, in understanding of fetal pathophysiology, and in technical advances in imaging. These procedures, ranging from ultrasound-guided needle aspiration through to open fetal surgery, are invasive, leading to the obvious question: does the fetus feel pain?
The concept that the fetus is a patient in its own right has led to increasing interest in the subject of fetal pain. A justification for providing fetal analgesia and anaesthesia has arisen not only because of a moral obligation to prevent suffering, but also because pain and stress may affect survival and have long-term neurodevelopmental sequelae.

However, the evidence base for this is limited, largely because research in human fetuses is hampered by ethical constraints, but also due to problems defining satisfactory outcome measures.

2. Fetal pain
There is no objective measurement of `pain'; it is a subjective experience. The fetus is unable to tell us if it feels pain, so other evidence must be used to decide at what gestation it is likely that the fetus starts to feel pain. Sensory innervation of the skin and neuronal connections between the periphery and spinal cord have begun by 8 weeks, with C fibres growing into the spine at about 10 weeks. The cerebral cortex starts to form at this stage, with differentiation into neurones, fibres, glia and blood vessels starting at about 17 weeks, and continuing long after birth. Pain fibres pass through the thalamus en route to the cortex. The timing of these thalamo-cortical connections is crucial in deciding when the fetus first becomes capable of feeling pain; this is an area of considerable controversy. Rapid Golgi-staining techniques have shown the ingrowth of afferent fibres into the cortical plate between 26 and 34 weeks of gestation , which has led some to conclude the fetus is incapable of feeling pain prior to 26 weeks . However, between 20 and 26 weeks the subplate zone of the cortex contains an abundant mixture of cholinergic, thalamo-cortical and corticocortical waiting neurones, and there are transient fetal synaptic circuits between the subplate and cortical plate neurones . Awareness of pain is considered to require connections between the cortex and periphery, although, this presumption would render animals lacking a cortex such as reptiles incapable of perceiving pain. It is not known at what point in the maturation from transient, possibly single, connections to permanent multiple connections the fetus may become capable of feeling pain, and it may be a gradual rather than sudden transition. In summary, prior to 22 weeks the fetus does not have the neuroanatomical pathways in place to feel pain, between 22 and 26 weeks thalamo-cortical connections are forming, and after 26 weeks the fetus has the necessary connections to feel pain.
3. Neonatal experience
Until the last decade, the neonate was treated as if it were incapable of feeling pain. However, studies showed that neonates, even when preterm, mounted a sizeable stress response to cardiac surgery , with rises in adrenaline, noradrenaline, and cortisol. Some of these changes were reduced by opioid analgesia . In one randomised study, opioid anaesthesia was associated with a reduction in peri-operative mortality . Since then, use of analgesia during neonatal surgery has become the standard of care.
Neonates also have behavioural responses to pain, for example, by facial expression or by crying. The response to heel lancing by facial action varies depending on the sleep/wake state of the neonate, suggesting that the behavioural context of pain affects behavioural expression, even before the opportunity for learned response occurs .

4. Fetal stress
Because of the obvious difficulties in studying fetal behaviour, activation of the hypothalamo-pituitary-adrenal axis (a `stress response') has been proposed as a surrogate indicator of fetal pain. This has limitations: stress responses do not necessarily imply pain (for example, during exercise), and stress responses do not involve the cortex. However, the converse is the null hypothesis, i.e. in the absence of a stress response the fetus is unlikely to experience pain. Also, one could argue that the stress response is more relevant in terms of immediate and long-term sequelae, whether or not associated with pain in the fetus.
Studies in humans are limited by the need for an ethically-acceptable model, namely those fetuses undergoing clinically-indicated procedures for diagnostic or therapeutic reasons. We have studied fetuses undergoing intravascular blood transfusion, which allows collection of serial blood samples at the beginning and end of the procedure. Procedures at the placental cord insertion (PCI), which is not innervated, can be compared with transfusions at the intrahepatic vein (IHV), which involves transgressing the fetal trunk (Fig. 1). In our unit, the site of approach is based on technical access dependent on fetal and placental position, with each site used approximately 50% of the time. While the IHV approach may have a lesser risk of complication due to cord tamponade and arterial spasm, the PCI approach is technically easier.

4.1. Hormonal response
Activation of the fetal hypothalamo-pituitary-adrenal axis can be assessed by measuring stress hormones such as noradrenaline, cortisol, and -endorphin. Studying samples obtained at fetal blood transfusion allows comparison of levels of these hormones before transfusion (immediately after access to the fetal circulation is established), with levels at the end of transfusion (just before the needle is removed). After transfusion at the PCI there is little change in fetal noradrenaline, cortisol, or -endorphin .
However, as illustrated in Fig. 2, piercing the fetal abdomen to access the IHV for transfusion is associated with substantial rises in these hormones from as early as 18 weeks gestation. The median increase in -endorphin levels was 590%, in cortisol levels was 183%, and in noradrenaline levels was 196% . Shorter procedures such as blood sampling without transfusion were not associated with rises in cortisol and -endorphin, but there was a variable rise in the more rapid noradrenaline response.

4.2. Circulatory response
The fetus in late gestation has a remarkable capacity to redistribute its blood flow in response to stressors to protect its more vital organs, such as brain and myocardium, at the expense of other organs such as gut, kidneys and the extremities . Numerous experimental studies have confirmed such responses to acute hypoxaemia , haemorrhage , and reduced uterine blood flow . Similarly, Doppler studies of human fetuses with intrauterine growth restriction (IUGR) have found decreased resistance indices in cerebral and adrenal blood flow velocity waveforms (FVW) consistent with vasodilatation, and increased indices in FVW from peripheral organ beds such as the renal , femoral and pulmonary arteries consistent with vasoconstriction.
Using Doppler ultrasound, our group has shown a fall of 1¯2.5 standard deviations in middle cerebral artery pulsatility index, consistent with this fetal brainsparing response, after procedures involving transgression of the fetal trunk, from as early as 16 weeks. The mechanism for this is not clear, but is compatible with an increase in cerebral flow. There is also an increase in renal and femoral artery resistance indices after procedures involving transgression of the fetal trunk, similarly compatible with fetal brainsparing (manuscript in preparation). These changes are not seen after procedures at the PCI. This redistribution in blood flow may be mediated by the sympathetic system, or by other undetermined mechanisms.

5. Long-term sequelae
There is increasing evidence that early painful or stressful events can sensitise an individual to later pain or stress. Evidence from animal studies indicates that a stressful perinatal event can have long-term effects on hippocampal development and stress behaviour. In rats, which are born at a stage equivalent in development to the late human fetus, early postnatal handling causes an increase in glucocorticoid receptor density in the hippocampus and a lifelong modification in behavioural stress responses . Rats stressed perinatally secrete more corticosterone and show a slower return to basal levels in stressful situations .
The primate model has also been used to study the effects of stress hormones and stress. Administration of dexamethasone to pregnant rhesus monkeys in the latter third of pregnancy at a dose similar to that used in humans is associated with degenerative changes in the fetal hippocampus . Exposure to a 2-week period of exogenous ACTH is associated with impaired motor coordination and muscle tonicity, reduced attention span, and greater irritability . Exposure to stress in the latter third of pregnancy is associated with higher levels of ACTH and cortisol in the neonate when stressed . Exposure to stress in utero, especially during the first third of pregnancy, is also associated with lower scores of attention and neuromotor maturity after birth .

In humans, neonatal circumcision without analgesia has been shown to increase subsequent pain behaviour (measured objectively from videotape by an independent observer) following vaccination 4¯6 months later when compared to uncircumcised controls . This suggests that a single stressful event early in life, when the nervous system is still developing, can influence neurodevelopment and may have a lifelong effect on stress responses. Furthermore, preoperative treatment with local anaesthetic cream attenuated the response to vaccination, suggesting that analgesia can alter the effect of stress on neurodevelopment .

In response to vaccination in infancy, we have found that babies born by instrumental delivery have a greater rise in salivary cortisol and cry for longer than those born normally, while those born by elective Caesarean section have a smaller rise and cry less than the normal group .

Whether pain or stress in utero has long-term implications is not known, and studies are limited by the ethical need to confine invasive procedures to those for which there is a diagnostic or therapeutic indication. Many such fetuses will be abnormal, making it difficult to correct for confounding factors when comparing them to control fetuses not undergoing invasive procedures. Further, the number of invasive procedures continues to decline with the advent of rapid molecular methods of chromosomal analysis, and a fall in the incidence of Rh disease due to antenatal prophylaxis.

6. Fetal analgesia
Awareness of the need for fetal analgesia increased following Anand's work on opiates in neonates . The rationale was that if a premature infant was capable of feeling pain then there is no reason why a fetus of the same gestation should not also feel pain . The case strengthened following the demonstration that human fetuses mount sizeable biochemical and circulatory stress responses to invasive procedures .
Potential indications include any procedure from which the fetus could probably experience pain. These can be grouped into `open' fetal surgical procedures via laparotomy, and `closed' percutaneous procedures via endoscopes and needles. Fetal surgery is now being offered in highly selected circumstances where fetal prognosis is otherwise poor . Such circumstances are rare, and include fetal lung lesions (congenital cystic adenomatoid malformation and bronchopulmonary sequestration), congenital diaphragmatic hernia, sacrococcygeal teratoma, and myelomeningocele. As well as IHV fetal blood sampling and transfusion discussed earlier, other `closed' surgical and needling techniques may be used on the fetus. These include vesicoamniotic shunting, fetal cystoscopy, thoraco-amniotic shunting, and fetal tissue biopsy.

Fetal analgesia for open fetal surgery is facilitated by maternal anaesthesia. The potent inhalational agents all cross the placenta, with fetal uptake depending on uterine blood flow, the solubility of the drug in fetal blood, and its distribution in the fetal compartment . Isoflurane is rapidly taken up by the fetus and both maternal and fetal anaesthesia can theoretically be achieved. Work in sheep suggests that the fetus requires a lower concentration of isoflurane to achieve the same level of anaesthesia as the adult , so concentrations, which provide maternal anaesthesia, are likely to provide adequate fetal anaesthesia. Inhalational agents also provide uterine relaxation, which allows handling of the uterus without contractions and the risk of placental separation. High levels of isoflurane may reduce uterine blood flow, although, in contrast work in pregnant ewes has shown that at lower concentrations uterine blood flow increases slightly . Direct fetal administration of fentanyl and pancuronium is reserved for cases where the fetus moves during the procedure .

During `closed' endoscopic or needling procedures, administration of safe and effective analgesia presents difficulties. The risks of maternal (and consequently fetal) general anaesthesia are unlikely to be justified by the degree of pain inflicted on the fetus. Similar procedures in adults involving cutaneous puncture are usually performed using no analgesia or local analgesia, depending on the size of needle. Local anaesthesia is not practical in the fetus: it would be difficult to administer to the fetal skin accurately, and the fetus may move before the needle is advanced into the target organ. Opioids cross the placenta, but fetomaternal ratios are low, only about 0.3:1 for fentanyl . Thus, to provide fetal analgesic levels, the higher maternal levels required would expose the mother to a risk of sedation and respiratory depression. Intra-amniotic opioids have been tried in experimental animal models but not surprisingly result in subtherapeutic fetal levels due to impermeability of the fetal skin . Administering drugs to the fetal IHV or intramuscularly would itself involve fetal puncture and thus potentially pain.

Accessing the PCI to administer analgesia before proceeding to the fetus would increase the procedure-related risks, and cannot be justified at least until analgesia has been shown to be beneficial in closed procedures.

Our group is currently investigating the effects of direct opioid analgesia during closed procedures at the IHV. One problem with this approach is that the fetus is punctured before analgesia is administered. Even if shown efficacious, the optimal drug, dose, and route of administration remain to be determined.

7. Conclusion
Evidence in neonates of stress responses to surgical insults and their prevention with analgesia has led to increased awareness of pain and the need for analgesia in newborns. This raises the obvious question if and when the fetus can feel pain. The critical thalamo-cortical connections for nociception form from 20¯26 weeks, while substantial hormonal and circulatory stress responses to invasive procedures are observed by 20 weeks. Although, there is yet no evidence that analgesia works in the human fetus, fetal analgesia warrants investigation, both because of a moral imperative to prevent possible suffering, and because of the increasing evidence in animals and humans suggesting that exposure to perinatal stress has long-term neurodevelopmental sequelae.
During open fetal surgery under maternal general anaesthesia, inhalational agents are considered to provide adequate fetal anaesthesia. In contrast, the more common closed needling and shunting procedures are usually performed using only maternal local anaesthesia. Fetal analgesia provides a challenge in such circumstances, due to the desire to avoid both maternal sedation, and the procedure-related risk of accessing the fetal circulation. Research is needed into safe, efficacious methods of administering analgesia to the human fetus in utero.

Our work in this area is supported by the Henry Smith Charity, WellBeing, and the Women & Children's Welfare Fund. We acknowledge equipment support from the Children Nationwide Medical Research Fund.

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Do Fetuses Feel Pain During An Abortion?
by Stuart Derbyshire Research fellow in neuropsychology, Rheumatic Diseases Centre, University of Manchester
This issue was the subject of four articles in the Britsh Medical Journal 27 September 1996

The issue of whether fetuses feel pain has recently been raised repeatedly as a cause of concern by anti-choice parliamentarians (see Abortion Review no 56).

In July, David Alton MP (Lib Dem: Liverpool Mossley Hill) secured an adjournment debate during which he argued that the Department of Health should take action on the matter. `First,' he suggested, `a circular could be issued to health authorities and to doctors, drawing their attention to the conclusions of latest research and recommending action to anaesthetise foetuses before any invasive procedure, such as needling or uterine surgery liable to cause trauma to the fetus. Secondly, in the interest of a fully informed decision, any parents who are considering giving permission for such procedures should be alerted to the possibility that pain will be inflicted on their unborn child.' Failing the introduction of such measures Alton warned that `legislation may be the only way to ensure that the suffering and the pain currently inflicted on the foetus will be alleviated'.

This debate was accompanied by an Early Day Motion, eventually signed by eleven MPs calling on the Department of Health to disseminate information `to medical staff and mothers and come forward with proposals for avoiding pain in pre-term surgery and abortion'.

Alton has suggested that it should be made a criminal offence to inflict pain on the unborn child and has announced his intention to seek legislative amendments and changes in codes of practice to secure this.

Currently the Government does not appear to accept that there is a need for legislation, although in replying to David Alton's motion, Health Minister, the Hon Tom Sackville MP (Con: Bolton W) suggested that there may be a need for more research on abortions after 24 weeks gestation. Nor does the Government appear to accept the anti-choice interpretation of current research. It was notable that Sackville used the opportunity of the adjournment debate to stress that the conclusions of a recent report commissioned by the Department of Health `do not support the view that before 26 weeks, foetuses feel or perceive pain.'

However, this is unlikely to be the final word on the matter. Following this statement a Department of Health spokesperson reportedly told the Catholic Herald that the Government was aware of `considerable diversity of opinion within society and the medical profession. The Government does not have one view on foetal sentience; they listen to a whole range of opinions-personal, medical and scientific.' Newspapers have reported that Alton is determined to make legislation on fetal pain an issue for the next parliamentary term.

The anti-choice concern about fetal sentience or pain is clearly a tactic to undermine public confidence in the current abortion legislation and to exploit understandable concern that the abortion procedure should not cause suffering. It is a rather disingenuous stance, as those who promote it-being opposed to abortion in principle-would not support abortion even if it were clearly established that the fetus were incapable of any awareness.

The anti-choice movement do not primarily oppose abortion on the grounds that the fetus feels pain any more than the pro-choice movement support a woman's right to abortion on the grounds that the fetus does not feel pain. Both perspectives are informed by other concerns.

However, given the claims by those who oppose abortion on principle that science supports their views, it is useful to examine the relevant research closely. Such an examination supports Sackville's assertion that before 26 weeks gestation (and arguably after this time), fetuses do not feel pain.

The research to which Sackville referred in the Adjournment Debate was commissioned by the Department of Health, and presented to them in May 1995 by Maria Fitzgerald, Professor of Developmental Neurobiology in the Department of Anatomy and Developmental Biology at University College London. Fitzgerald had been asked to review the current medical knowledge in this area.

Through an examination of the biological development of the fetus, Fitzgerald first rules out the possibility of fetal pain prior to 26 weeks gestation. Those who argue that a fetus can feel pain early in gestation point to experiments which show that a fetus responds to touching at 7.5 weeks. At this point touching the mouth or the surrounding region results in the fetus bending its head away. Similar responses can be observed with the hands at 10.5 weeks and the rest of the body and lower limbs at approximately 13.5 weeks. Shortly after the development of touch sensitivity repeated skin stimulation results in a generalised movement of all limbs, which gives the impression that the fetus is stressed and is taken by some as experience of pain.

This movement is however, understood to be a reflex response, not dependent on a conscious appreciation of pain. Fitzgerald states that, prior to 26 weeks gestation, `any discussion of "perception" or "conscious" reaction to stimuli is inappropriate'. She writes that: `t is important to emphasise the movements evoked at this stage are of a reflex or spontaneous nature only, even if they involve extensive body regions and therefore inter-segmental and brainstem connections. The cortex is not a functional unit at this stage ... and therefore any discussion of "perception" or "conscious reaction" is inappropriate.'

Summarising her paper she clearly states that `evidence shows that little sensory input reaches the developing cortex before 26 weeks and therefore these reactions to noxious stimuli cannot be interpreted as feeling or perceiving pain.'

This is important as it undermines the broader aim of those who oppose abortion to use this research to challenge the provision of abortion at earlier gestations.

Abortions later than 26 weeks gestation are very uncommon. In 1992 just 60, of more than 150,000 abortions in England and Wales were carried out at gestations later than 24 weeks. Nevertheless, the possible fetal response in these few late terminations warrants attention, particularly as almost all of these abortions are carried out for reasons of fetal handicap and are of wanted pregnancies in circumstances where the putative parents are often very emotionally vulnerable.

Fitzgerald becomes more equivocal regarding the possibility of fetal pain once the fetus passes 26 weeks gestation. This is because the nerve fibres which are believed to be responsible for passing `pain messages' begin to reach the higher brain areas at 26-34 weeks gestation. Fitzgerald's suggestion that responses to noxious stimuli prior to 26 weeks cannot be interpreted as pain because the brain `is not a functional unit' begs the question of whether the biological development of the fetus is so advanced after this time that it may now be able to experience pain. This point remains controversial among those who work in pain research.

It can be argued that the capacity of the fetus to feel pain hinges not on its biological development but on its conscious development, and that unless it can be demonstrated that the fetus has a conscious appreciation of pain post-26 weeks gestation, then the responses to noxious stimulation are still essentially reflex responses, exactly as those prior to 26 weeks. Fitzgerald does not address this point. However, the suggestion that there is a direct relationship between stimulus and pain-even in adults-is hugely controversial.

The idea that pain occurs as a direct consequence of an injury in the same way that a bell rings as a direct result of pulling a bellrope is one that is accepted by many lay-people, but no longer holds much currency with those researching into pain mechanisms. Those working with, or researching into pain have largely rejected the concept of a specific `pain line' associated with a `pain centre'. This `specificity theory' has been rejected because the definition of pain based on a direct relationship between injury and response failed to resolve many issues in pain research. Interpretations of injury based on a direct relationship between stimulus and pain are inadequate because they fail to account for the variable link between stimulus and pain experience. Specificity theory cannot explain, for example, why soldiers wounded in battle rarely ask for analgesia in comparison with civilians wounded in accidents, why patients after amputation complain of pain in their `phantom-limb', or why people can sometimes sustain major injury without experiencing pain. The variable link between pain and injury suggests that pain is a multidimensional experience incorporating emotional and cognitive factors.

Many pain specialists believe that in its later stages of development the fetal brain begins gradually to organise and elaborate stimulus information by encoding the memory of the activation of reflex motor responses. At this point the fetus may begin to show evidence of knowledge as to which things may result in reflex aversive movement. This `knowledge' however, is still unconscious. Conscious sensory experience and associated voluntary response is proposed to arise over time as a result of self-observation and efforts to cope with arousing situations. While some biological development is obviously necessary for this stage to be realised, it is a mistake to say that biological development is sufficient. The capacity to experience pain is part of a developmental process which the fetus is yet to experience. Many specialists believe that the final necessary stages in the experience of pain can only develop after a child has been born and it is mistaken to refer to `fetal pain' at any stage of development. Dr Fitzgerald suggests in her paper that `true pain experience' develops `postnatally along with memory, anxiety, and other cognitive brain functions'.

David Alton obviously disputes this interpretation and anticipated it in his adjournment debate speech claiming that it was `bunkum' and relied on an understanding of pain as a `metaphysical experience' and not as he believes `a physical fact'. It should be noted that in this interpretation he is relying on outdated theories which are at odds with the theories of those who are currently working in this field.