Does the baby in the womb feel pain? If yes, how does it feel it and as of what point in development? Recently, Italian national daily business newspaper Il Sole-24Ore (23 Oct 2022) revisited this question, reflecting on intrauterine life as seen from the point of view of the growing child who is an active participant, especially in the second half of the gestational period. Carlo Bellieni, a pediatrician and neonatologist at the University of Sienna and one of the world’s leading experts precisely on prenatal pain, answered important questions on the topic.
Is there a point in time from which we can say with certainty that the fetus perceives pain-like sensations upon being stimulated? Is there any evidence of this?
There are studies done on very early-born fetuses that show the presence of reactions. But even on as yet unborn fetuses, the perception of pain has been noted, and not only that: the ability to perceive sounds, smells, tastes also appears in the second half of the pregnancy. A human pregnancy typically lasts 40 weeks. It is in weeks 20-22 that the ability to feel pain begins. The first to observe the phenomenon were specialists John Fisk and Vivette Glover who worked in a team at Imperial College London: they noted how the fetus reacted during transfusions given in utero. An injection given around the 20th week of its intrauterine life caused an increase in stress hormones in the fetus. Fisk and Glover also tried administering anesthetics (morphine) to the fetus before giving the shot to it, and in this case they observed that the hormone levels did not change Therefore, the initially observed reaction was indeed a reaction to pain. Since then, it has been possible to perform surgery on the fetus by administering anesthetics and pain-relieving analgesics. And not so much for ethical or religious reasons, but because it is good medical practice to use anesthetic.
Lawyers in Mississippi have asked the federal Supreme Court to intervene because the fetus, after 12 weeks of intrauterine life, is capable of feeling pain.
This fact is not yet fully documented. It is difficult to talk about pain before the baby is 20 weeks old because it’s thalamus is not yet fully developed, which is the structure at the base of the brain that is used precisely to perceive and organize pain. To perceive pain, however, you do not need to have a well-developed cerebral cortex, and there are three reasons for this. First, even babies born with anencephaly still feel painful sensations. Second, painful sensations are felt even by children who manifest severe brain damage to the cortex. Third, the cortex is a structure that is formed gradually. It begins to form before the 24th week and will continue to form throughout the rest of the pregnancy, and even after that. Unfortunately, some mistakenly continue to claim that infants do not feel pain because they haven’t developed cerebral cortex yet. Thus it happens that they don’t receive the analgesics they are due, which is unacceptable. In the 1990s, surgeries were often performed on newborns without due and proper anesthesia. The scientific literature records frequent cases of anesthesiologists for whom the lack of a developed cerebral cortex allegedly prevented pain perception, so that infants were given only curare (a paralyzing agent) so that they would lie still before and during surgery. One of the leading scholars on childhood pain, Sunny Anand, has documented the severe brain damage that was caused in this way to children who were operated on without anesthesia. In fact, pain causes surges in blood pressure and stimulates the production of toxic substances that cause brain damage.
Does the fetus remember what is happening around it?
Of course, there is fetal memory. It always occurs in the second half of its intrauterine life, when the structures deputed to receive external stimuli have developed and the fetus can register them, carrying memory of them after birth. It is well known that a person’s food tastes are formed before birth, depending on the foods the mother takes in, passing them to the baby in her womb through the amniotic fluid that the baby eagerly sucks. So you get used to certain flavors, good or bad. Bad, if, for example, the mother is a smoker. The child will remember these data just as he or she will remember the mother’s voice.
Insisting on whether or not the fetus perceives pain has important implications in a federal country, such as the USA, where in some cases it is possible to have an abortion all the way up to term.
It is clear that suppressing a life that does not feel pain is perceived as less unpleasant than the opposite; therefore, there are those who do not like to emphasize the ability of the baby in the womb to feel pain. US law stipulates that even the death penalty must be administered while avoiding generating suffering in the condemned person. A meager consolation, certainly. And yet the baby inside its mother feels the pain very much. In what way, we do not yet know precisely: it may be a different feeling from that in a born adult, but it is still pain.
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