"You'll always be my baby'

2 main topics here: the first is that I was very excited that David Cook won American Idol. I know, it's stupid and a TV show and who really cares? But I loved the way he was able to take older songs and make them sound current. I'm shocked that he won, so I had to mention it here.

The second topic is an article I just read about the pain a fetus feels. This is obviously a sensitive (no pun intended) subject which I don't normally address on this blog. But when I read about the fact that a fetus can definitely feel pain at 22 weeks (this is a medical study, not a political one), I had to put it on the blog. It's important to me (and, I think, to fetuses), and it's my blog. The article is a bit long, but worth it.

Disclaimer over.

Neonatal Pain: Suffering, Pain and the Risk of Brain Damage in the Fetus and Unborn" (Springer) is edited by Giuseppe Buonocore and Carlo Bellieni, who are both members of the department of pediatrics, obstetrics and reproductive medicine at the University of Siena.

The contributions from the large number of experts who contribute to the book agree in affirming that a fetus can feel pain before birth, the two editors explain in their introductory essay. "Recognizing human dignity and human suffering from life in the womb is a clinical duty in the service of better treatment," they declare.

One of the contributions, a joint effort by nine experts, looks at the evidence obtained from ultrasound techniques. The introduction of three-dimensional and four-dimensional ultrasonography has enabled a far more detailed evaluation of the fetus, thus allowing the observation of how it reacts to specific stimuli, they observe.

The uterus is a protected, but not an isolated, environment and touch is the first sense that the fetus develops. By week 10 of pregnancy an unborn child can be observed bringing hands to its head, opening and closing the mouth, and swallowing.

As well, recent experiments show that newborns have functional memory, development of which began in the period before birth. The authors note that, in fact, newborns remember tastes and odors perceived in the uterus and these perceptions might have an influence on future preferences. Sounds, also, are heard by the unborn, including the mother's voice. Newborns have even been shown to recognize music that the mother listened to during pregnancy.

Protagonist

Another joint article examines the specific question of fetal pain. The team of medical experts who authored the piece starts by noting that the unborn child is a protagonist, promoting cellular traffic with the mother, and so the fetus needs to be considered a patient, whose well-being is taken into consideration by doctors.

There is evidence, they observe, that acute or chronic pain, or even prolonged stress, can be dangerous for the fetus, especially if it happens during a critical period of brain development. Possible negative effects range from a lower pain threshold to an increase in age-related memory impairments.

Based on experiments with primates, the article hypothesizes that fetal pain can even impair the functioning of the body's immune system, with long-term implications for infections and autoimmune diseases.

Regarding stress, the authors cite a study on a group of mothers who suffered stress and compared them to a control group. The babies of the stressed mothers were characterized by a lower birth weight, smaller head circumference and a lower gestational age at birth when compared with the babies of the control group.

The authors observe that some medical experts don't consider the fetus can feel pain because it is not conscious, and also because it is normally asleep in the womb. The article on neonatal pain in Buonocore and Bellieni's book reply to this by saying there is considerable scientific evidence showing that fetuses are sensitive to a variety of sensation in the uterus: sound, changes in light, touch and pressure, and changes in balance.

Moreover, even if a fetus were not to recognize pain consciously as we do, it still remains an unpleasant experience for the unborn, they add.

Stress effects

Another chapter of the book looked at other effects of stress on the fetus. Two members of the Institute of Reproductive and Developmental Biology at Imperial College London, Kieran O'Donnell and Vivette Glover, explain that maternal stress is very much related to the development of the fetus.

In addition, in cases of medical intervention carried out on fetuses there is evidence showing a response to an invasive stimulus from the age of 16 weeks gestation. Even at the age of 12 weeks a fetus will move away if touched. Nevertheless, O'Donnell and Glover admit that we still do not know exactly when the fetus starts to feel pain or when it becomes conscious.

In a concluding chapter, Marina Enrichi urges readers to value prenatal life. A better knowledge about prenatal conditions and the development of the fetus will bring with it a perception of fetal life as something precious, resulting in greater respect for the developing embryo and the woman bearing it, she argues.

One of the consequences of this, Enrichi augurs, is that all of us and society itself will begin to wish to create a more protective environment for the unborn baby and the mother.

Nervous system

The Italian medical experts are not the only ones convinced of the need to pay more attention to the pain suffered by the unborn. On Feb. 10 the New York Times ran a major feature article reporting on the findings of other doctors on this topic.

The article started by citing the experience of Kanwaljeet Anand, who while a medical resident in a British hospital saw the significant harm caused to premature babies when they were operated on without anesthetic. At the time, 25 years ago, doctors thought the nervous systems of the babies were too underdeveloped to sense pain.

Through trials, Anand clearly showed this was not at all the case and that once the babies received anesthesia the mortality rate dropped from 25% to 10%. Pain relief for premature babies soon came to be standard, the article said. Anand continued his observations in this area and noted that babies as young as 22 weeks of gestation demonstrated a reaction to pain even when pricked by a needle.

The consequence of this observation was the consideration that the fetus might feel pain. This became an important question with the development of fetal surgery, since whether the unborn feels pain is an important consideration for the surgeon.

Anand, now a professor at the University of Arkansas for Medical Sciences and a pediatrician at the Arkansas Children's Hospital in Little Rock, told the New York Times that he believes fetuses can feel pain by the 20th week of pregnancy, and possibly even earlier.

The article also cited Nicholas Fisk, a fetal-medicine specialist and director of the University of Queensland Center for Clinical Research in Australia. Fisk has carried out research showing that fetuses as young ! as 18 weeks react to an invasive procedure with a spike in stress hormones and a shunting of blood flow toward the brain. This is a reaction also present in infants and adults and is designed to protect a vital organ from threat.

The New York Times article acknowledged that the question of whether the fetus does feel pain has obvious implications for the abortion debate. In fact, medical evidence is showing they do feel pain, and as time goes by researchers are pushing back more and more their estimation of the age at which the fetus is affected by pain.