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{{Short description|Study of the different types of sensory perception of fetuses during pregnancy}}
{{AbortionDebate}}
{{expert needed|biology|date=August 2009|reason=discrepancy between abortion subsection and rest of the article, and lacking scientific consensus in article overall}}
'''Fetal pain''', its existence, and its implications are debated politically and academically.
'''Prenatal perception''' is the study of the extent of ] and other types of ] during ]. In practical terms, this means the study of ]es; none of the accepted indicators of perception are present in ]s. Studies of this type inform the ], along with certain related pieces of legislation in countries affected by that debate. As of 2022, there is not any ] on whether a fetus can feel pain.<ref>{{Cite news |last=Belluck |first=Pam |date=2013-09-17 |title=Complex Science at Issue in Politics of Fetal Pain |language=en-US |work=The New York Times |url=https://www.nytimes.com/2013/09/17/health/complex-science-at-issue-in-politics-of-fetal-pain.html |access-date=2022-09-20 |issn=0362-4331}}</ref><ref>{{Cite web |last=Levitan |first=Dave |date=2015-05-18 |title=Does a Fetus Feel Pain at 20 Weeks? |url=https://www.factcheck.org/2015/05/does-a-fetus-feel-pain-at-20-weeks/ |access-date=2022-09-20 |website=FactCheck.org |language=en-US}}</ref><ref>{{Cite news |last=Karni |first=Annie |date=2022-09-13 |title=Graham Proposes 15-Week Abortion Ban, Splitting Republicans |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/09/13/us/politics/lindsey-graham-abortion.html |access-date=2022-09-20 |issn=0362-4331}}</ref>
Many researchers agree pain likely cannot be felt until around the seventh month of pregnancy, although some scientists disagree and a consensus has proven elusive.<ref> MSNBC</ref><ref name="Lee" /><ref name="NRLContro" /> Developmental ] suspect that the establishment of ] connections" (at about 26 weeks) may be critical to fetal perception of pain.<ref name="Johnson">Johnson, Martin and Everitt, Barry. '''' (Blackwell 2000): "The multidimensionality of pain perception, involving sensory, emotional, and cognitive factors may in itself be the basis of conscious, painful experience, but it will remain difficult to attribute this to a fetus at any particular developmental age." Retrieved ].</ref> Nevertheless, because pain can involve sensory, emotional and cognitive factors, it is difficult to know when pain can exist.<ref name="Johnson"/>


==Prenatal hearing==
Whether a ] has the ability to feel ] and to ] is part of the ] debate.<ref>White, R. Frank. "", ''American Society of Anesthesiologists Newsletter'' (October 2001). Retrieved ].</ref><ref>David, Barry & and Goldberg, Barth. "", ''Illinois Bar Journal'' (December 2002). Retrieved ].</ref> For example, legislation has been proposed by ] advocates requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and that require her to accept or decline anesthesia for the fetus.<ref>Weisman, Jonathan. "", ''Washington Post'' ]. Retrieved ].</ref>
Numerous studies have found evidence indicating a fetus's ability to respond to auditory stimuli. The earliest fetal response to a sound stimulus has been observed at 16 weeks' gestational age, while the auditory system is fully functional at 25–29 weeks' gestation.<ref>{{cite journal |last1=Graven |first1=Stanley N. |last2=Browne |first2=Joy V. |title=Auditory Development in the Fetus and Infant |journal=Newborn and Infant Nursing Reviews |date=December 2008 |volume=8 |issue=4 |pages=187–193 |doi=10.1053/j.nainr.2008.10.010 |s2cid=6361226 |url=https://www.sciencedirect.com/science/article/pii/S1527336908001347 |access-date=31 May 2022 |language=en |issn=1527-3369}}</ref> At 33–41 weeks' gestation, the fetus is able to distinguish its mother's voice from others.<ref>{{cite journal |doi=10.1016/j.infbeh.2008.10.002 |pmid=19058856 |title=Fetal sensitivity to properties of maternal speech and language |journal=Infant Behavior and Development |volume=32 |issue=1 |pages=59–71 |year=2009 |last1=Kisilevsky |first1=B.S. |last2=Hains |first2=S.M.J. |last3=Brown |first3=C.A. |last4=Lee |first4=C.T. |last5=Cowperthwaite |first5=B. |last6=Stutzman |first6=S.S. |last7=Swansburg |first7=M.L. |last8=Lee |first8=K. |last9=Xie |first9=X. |last10=Huang |first10=H. |last11=Ye |first11=H.-H. |last12=Zhang |first12=K. |last13=Wang |first13=Z. }}</ref><ref>{{cite journal |doi=10.1002/dev.20229 |pmid=17577240 |title=Estimated cardiac vagal tone predicts fetal responses to mother's and stranger's voices |journal=Developmental Psychobiology |volume=49 |issue=5 |pages=543–7 |year=2007 |last1=Smith |first1=Laura S. |last2=Dmochowski |first2=Pawel A. |last3=Muir |first3=Darwin W. |last4=Kisilevsky |first4=Barbara S. }}</ref>


==Prenatal pain==
== Medical studies and reviews ==
]
====United Kingdom====
The hypothesis that human fetuses are capable of perceiving ] during the first trimester has little evidence, although fetuses at 14 weeks may respond to touch.<ref>{{Cite journal|last1=Marx|first1=Viola|last2=Nagy|first2=Emese|date=2015-06-08|title=Fetal Behavioural Responses to Maternal Voice and Touch|journal=PLOS ONE|volume=10|issue=6|pages=e0129118|doi=10.1371/journal.pone.0129118|issn=1932-6203|pmc=4460088|pmid=26053388|bibcode=2015PLoSO..1029118M|doi-access=free}}</ref>{{Additional citation needed|date=May 2022|reason=Source is just a single article and not a review; The 8-week figure was only mentioned in passing as a figure from a popular book instead of being an experimental result.}} A multidisciplinary ] from 2005 found limited evidence that thalamocortical pathways begin to function "around 29 to 30 weeks' gestational age", only after which a fetus is capable of feeling pain.<ref name="Lee">{{cite journal|last1=Lee|first1=Susan J.|last2=Ralston|first2=Henry J. Peter|last3=Drey|first3=Eleanor A.|last4=Partridge|first4=John Colin|last5=Rosen|first5=Mark A.|year=2005|title=Fetal Pain|journal=JAMA|volume=294|issue=8|pages=947–54|doi=10.1001/jama.294.8.947|pmid=16118385|doi-access=free}}</ref><ref>{{cite journal |doi=10.1136/bmj.332.7546.909 |pmid=16613970 |pmc=1440624 |title=Can fetuses feel pain? |journal=BMJ |volume=332 |issue=7546 |pages=909–12 |year=2006 |last1=Derbyshire |first1=S. W G }}</ref>
In ], an opinion piece published in the ''British Medical Journal'' concluded that pain is dependent upon cognitive and emotional developments that occur after birth: {{quote|"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." <ref name="Derby">Derbyshire, S.W.G. (2006). . ''British Medical Journal'', 332 (7546), 909-12. Retrieved ]. </ref>}}


In March 2010, the Royal College of Obstetricians and Gynecologists submitted a report,<ref name="royalcollege">{{Cite web|date=March 2010|title=Fetal Awareness – Review of Research and Recommendations for Practice|url=http://www.rcog.org.uk/files/rcog-corp/RCOGFetalAwarenessWPR0610.pdf|url-status=dead|archive-url=https://web.archive.org/web/20111002222748/http://www.rcog.org.uk/files/rcog-corp/RCOGFetalAwarenessWPR0610.pdf|archive-date=2011-10-02|publisher=]|via=Internet Archive|access-date=2019-03-27}}</ref> 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",<ref name="royalcollege" />{{rp|22}}
In ], a working group of the ] in the United Kingdom suggested that doctors should consider the use of analgesia and sedation for fetuses over 24 weeks of age undergoing surgery.<ref>Medical Research Council, '''' (]). Retrieved ].</ref> Eve Johnstone, the chair of that working group, told '']'' that a fetus was aware of pain by 24 weeks,<ref>Highfield, Roger. "," The Telegraph (]). Retrieved ].</ref> because "onnections from the thalamus to the cortex begin to form at about 20 weeks gestation."<ref>Medical Research Council, '''' (]). Retrieved ].</ref> Dr. Susan Dudley of the National Abortion Federation in the U.S. responded: "The obvious and most important thing to say is most abortions take place before 20 weeks."<ref>Beaucar, Kelley. , ''Fox News'' (]). Retrieved ].</ref>


{{blockquote|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. Fetal pain is not possible before these necessary neural pathways and structures have developed.<ref name="royalcollege" />{{rp|3}}}}
Also in ], a "Working Party" appointed by the ], a medical group in the ], stated that "very early in pregnancy fetuses will react to stimuli, but that reaction does not in itself provide any evidence that the fetus experiences those stimuli."<ref> RCOG Press. October 1997.</ref> The Working Party further stated that, "Little sensory input" reaches the brain of the developing foetus before 26 weeks, and "therefore reactions to noxious stimuli cannot be interpreted as feeling or perceiving pain."<ref> BBC.co.uk. 29 August, 2000. Accessed ]. A British government report said in 2007 (shortly before the RCOG report) that signals from the thalamus begin to reach the cortex between "22-34 weeks" after conception. See Parliamentary Office of Science and Technology,'''' (February 1997). Retrieved ].</ref>


The report specifically identified the ] as the area of the ] responsible for processing of pain. The anterior cingulate is part of the cerebral cortex, which begins to develop in the fetus at week 26. A co-author of that report reviewed the evidence in 2020, specifically the functionality of the thalamic projections into the cortical ], and posited "an immediate and unreflective pain experience...from as early as 12 weeks."<ref>{{Cite journal|last1=Derbyshire|first1=Stuart WG|last2=Bockmann|first2=John C.|date=2020-01-01|title=Reconsidering fetal pain|url=https://jme.bmj.com/content/46/1/3|journal=Journal of Medical Ethics|language=en|volume=46|issue=1|pages=3–6|doi=10.1136/medethics-2019-105701|issn=0306-6800|pmid=31937669|doi-access=free}}</ref>
⚫ ====United States====
In ], Mellor and colleagues reviewed several lines of evidence that suggested a fetus does not awaken during its time in the womb. If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimized. <ref>Mellor D.J., Diesch T.J., Gunn A.J., & Bennet L. (2005). . ''Brain Research Reviews, 49(3)'', 455-71. Retrieved December 23, 2006.</ref>


There is a consensus among ] that the establishment of ] 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.<ref>Johnson, Martin and Everitt, Barry. '''' (Blackwell 2000), p. 235. Retrieved 2007-02-21.</ref>
Later in ], a ] (or "review") of existing experiments published in the ] (JAMA) concluded that the limited available evidence indicates fetal perception of pain is unlikely before the third trimester, and that 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.<ref name="Lee">Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). . ''Journal of the American Medical Association, 294 (8)'', 947-954. Retrieved ].</ref> The report has been highly criticized by pro-life activists, who claim that the results may have been biased by the undisclosed ties to pro-choice activism of 2 out of the 5 authors.<ref>{{cite web |url=http://www.nytimes.com/2005/08/26/health/26pain.html?_r=1&oref=slogin |title=Study Authors Didn't Report Abortion Ties |accessdate=2008-04-03 |format= |work=New York Times }}</ref>


Electroencephalography indicates that the capacity for functional pain perception in premature infants does not exist before 29 or 30 weeks; a 2005 meta-analysis states that withdrawal reflexes and changes of heart rates and hormone levels in response to invasive procedures are reflexes that do not indicate fetal pain.<ref name="Lee"/>
The ] (NRLC) criticized the study, claiming that two of the five authors of the study had done abortion work or abortion related work. <ref name="NRLContro">Grady, Denise ''New York Times'' August 26, 2005 Retrieved March 15, 2008.</ref> Catherine DeAngelis, editor-in chief of JAMA, said that the journal would have published the affiliations if they had known about them at the time of publishing. She also said any disclosure would not have prevented her from publishing the article.<ref name="NRLContro"/> DeAngelis went on to say, "It is a peer-reviewed article. They are not reporting their own findings. It's a review article based on what's in the literature."<ref name="DNC"></ref> Arthur Caplan, chair of the department of medical ethics at the ], said about the NRLC criticisms, "As a scientist, if you think I'm wrong, you probe my data, question my findings and do a critical study -- not point your finger and talk about my politics."<ref name="DNC"/>


Several types of evidence suggest that a fetus does not awaken during its time in the womb. Much of the literature concerning fetal pain simply extrapolates from findings and research of premature babies. The presence of such chemicals as ], ], and ]-D<sub>2</sub> in both human and animal fetuses, indicate that the fetus is both ] and ] when in the womb. These chemicals are oxidized with the newborn's first few breaths and washed out of the tissues, increasing consciousness.<ref>{{Cite journal|last1=Lagercrantz|first1=Hugo|last2=Changeux|first2=Jean-Pierre|date=March 2009|title=The Emergence of Human Consciousness: From Fetal to Neonatal Life|journal=Pediatric Research|volume=65|issue=3|pages=255–260|doi=10.1203/PDR.0b013e3181973b0d|pmid=19092726|s2cid=39391626|issn=0031-3998|quote=The delivery from the mother's womb thus causes arousal from a "resting," sleeping, state in utero. After birth, electrophysiological signs on EEG scalp recordings indicate an intense flow of novel sensory stimuli after birth… In addition, arousal is enhanced by the release from endogenous analgesia possibly caused by removal of the mentioned placental "suppressors" which in utero selectively inhibit neural activity of the fetus…. The catecholamine surge triggered by vaginal delivery may also be critical for the arousal at birth.|doi-access=free}}</ref> If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimized,<ref name="Diesch">{{cite journal |doi=10.1016/j.brainresrev.2005.01.006 |pmid=16269314 |title=The importance of 'awareness' for understanding fetal pain |journal=Brain Research Reviews |volume=49 |issue=3 |pages=455–71 |year=2005 |last1=Mellor |first1=David J. |last2=Diesch |first2=Tamara J. |last3=Gunn |first3=Alistair J. |last4=Bennet |first4=Laura |s2cid=9833426 }}</ref><ref>{{cite news|last=Paul|first=AM|title=The First Ache|url=https://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html|newspaper=The New York Times|date=2008-02-10}}</ref> although some studies found that the adenosine levels in third-trimester fetuses are only slightly greater than those in adults' blood.<ref>{{cite journal |doi=10.3109/14767058.2011.632040 |title=Is fetal pain a real evidence? |journal=] |volume=25 |issue=8 |pages=1203–8 |year=2012 |last1=Bellieni |first1=Carlo Valerio |last2=Buonocore |first2=Giuseppe |pmid=22023261 |s2cid=20578842 }}</ref>
In ], Stanislav Reinis and Jerome M. Goldman wrote that, "The first detectable brain activity in response to noxious stimuli occurs in the thalamus between the ninth and tenth weeks."<ref>Reinis, Stanislav and Goldman, Jerome. '''' (Charles C. Thomas 1980).</ref>


==Abortion Debate== ===Fetal anesthesia===
Direct fetal ] is used for only a minority of prenatal surgeries.<ref>{{cite journal |doi=10.3109/14767058.2012.718392 |title=Use of fetal analgesia during prenatal surgery |journal=The Journal of Maternal-Fetal & Neonatal Medicine |volume=26 |pages=90–5 |year=2012 |last1=Bellieni |first1=Carlo V. |last2=Tei |first2=M. |last3=Stazzoni |first3=G. |last4=Bertrando |first4=S. |last5=Cornacchione |first5=S. |last6=Buonocore |first6=G. |issue=1 |pmid=22881840 |s2cid=46355976 }}</ref>
===United Kingdom===
In ], physiologist Peter McCullagh spoke on behalf of a ] group to the British Parlament. 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."<ref name="McCullagh">McCullagh Peter. ". London: All-Party Parliamentary Pro-Life Group (1996). Dr. McCullagh is a Senior fellow in developmental physiology at the John Curtin School of Medical Research, Australian National University. This report was reprinted in the Catholic Medical Quarterly, XLV11 no 2, November 1996, p6. Retrieved ].</ref>


Some caution that unnecessary use of fetal anesthetic may pose potential health risks to the 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.<ref name="Lee"/> Given the maternal risk involved and the lack of evidence of any potential benefit to the fetus, administering fetal anesthesia for abortion is not recommended.<ref>{{Cite journal|last1=Society for Maternal-Fetal Medicine|last2=Society of Family Planning|last3=Norton|first3=Mary E.|last4=Cassidy|first4=Arianna|last5=Ralston|first5=Steven J.|last6=Chatterjee|first6=Debnath|last7=Farmer|first7=Diana|last8=Beasley|first8=Anitra D.|last9=Dragoman|first9=Monica|date=2022-02-01|title=Society for Maternal-Fetal Medicine Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures|url=https://www.contraceptionjournal.org/article/S0010-7824(21)00441-8/abstract|journal=Contraception|language=English|volume=106|pages=10–15|doi=10.1016/j.contraception.2021.10.003|issn=0010-7824|pmid=34740602|s2cid=243477250|doi-access=free}}</ref>
===United States===
In ], Dr. Robert J. White, director of the Division of Neurosurgery and Brain Research Laboratory at ] School of Medicine and a member of the ]'s ], gave testimony before the House Constitution Subcommittee of the ]. He stated that, at 20 weeks' gestation, the fetus "is fully capable of experiencing pain...Without question, all of this is a dreadfully painful experience for any infant subjected to such a surgical procedure."<ref>White, Robert. Testimony to U.S. House Judiciary Committee, Subcommittee on the Constitution (]). Quoted in . Retrieved ].</ref>


Fetal pain legislation may make abortions more difficult 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.<ref name="paul">{{cite news |last=Paul |first=Annie Murphy |url=https://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html |title=The First Ache |work=New York Times |date=February 10, 2008}}</ref>
In ], anesthesiologist Vincent J. Collins wrote: "because the requisite neurological structures are present at that time and because they are functioning, as evidenced by the aversive response of the human fetus, it may be concluded with reasonable medical certainty that the fetus can sense pain at least by 13 ½ weeks."<ref>Collins, Vincent et al."Fetal Pain and Abortion: the Medical Evidence", ''Studies in Law and Medicine'', No 18 (1984).</ref> Dr. Collins was one of several scientists who wrote an open letter to President Reagan, asserting that, "The ability to feel pain and respond to it is clearly not a phenomenon that develops de novo at birth....by the close of the first trimester the fetus is a sentient, moving being."<ref>Schmidt, Richard et al., "" (]). Retrieved ].</ref>

Doctors for a Woman's Choice on Abortion state that the majority of surgical abortions in Britain are already performed with general anesthesia, which also affects the fetus. In a letter to the ''British Medical Journal'' in April 1997, they deemed the discussion "unhelpful to women and to the scientific debate"<ref>{{cite journal |doi=10.1136/bmj.314.7088.1201 |title=Do fetuses feel pain? |journal=BMJ |volume=314 |issue=7088 |pages=1201 |year=1997 |last1=Savage |first1=W. |last2=Wall |first2=P. D |last3=Derbyshire |first3=S. W. |pmc=2126513 |pmid=9146414 }}</ref> despite a report in the ''British Medical Journal'' that "the theoretical possibility that the fetus may feel pain (albeit much earlier than most embryologists and physiologists consider likely) with the procedure of legal abortion".<ref>{{cite journal |doi=10.1136/bmj.314.7076.302a |title=Do fetuses feel pain? |journal=BMJ |volume=314 |issue=7076 |pages=302–3 |year=1997 |last1=McCullagh |first1=P. |last2=Saunders |first2=P J |pmc=2125716 |pmid=9022510 }}</ref> Yet if mothers' general anesthesia were enough to anesthetise the fetus, all fetuses would be born sleepy after a cesarean section performed in general anesthesia, which is not the case.<ref>{{cite journal |doi=10.1097/ACO.0000000000000185 |title=General anesthesia for caesarean section |journal=Curr Opin Anesthesiol |volume=28 |issue=3 |pages=240–246 |year=2015 |last1=Devroe |first1=S.|pmid=25827280 |s2cid=38558311 }}</ref> Dr. Carlo V. Bellieni also agrees that the anesthesia that women receive for fetal surgery is not sufficient to anesthetize the fetus.<ref>Bellieni, Carlo V. (2021-05). . ''Pediatric Research'' '''89''' (7): 1612-1618. {{ISSN|1530-0447}}. {{doi|10.1038/s41390-020-01170-2}}.</ref>

⚫ ==United States legislation==

===Federal legislation===
In 1985, questions about fetal pain were raised during congressional hearings concerning the movie '']''.<ref>Hearing Before the Subcommittee on the Constitution of the Committee on the Judiciary, United States Senate, Ninety-Ninth Congress. (May 21, 1985). S. Hrg. 99–429; Serial No. J-99-28, pages 10 and following</ref>

In 2013 during the ], ] introduced a bill named the "]" (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.<ref>''{{Dead link|date=August 2021 |bot=InternetArchiveBot |fix-attempted=yes }}'' H.R.1797, 113th Cong., 1st Sess. (2013)</ref>

In 2004 during the ], ] introduced a bill named the "]" for the stated purpose of "ensur that women seeking an abortion are fully informed regarding the pain experienced by their unborn child", which was read twice and referred to committee.<ref>'' {{Webarchive|url=https://web.archive.org/web/20081014160455/http://thomas.loc.gov/cgi-bin/query/z?c108:S.2466: |date=2008-10-14 }},'' S.2466, 108t Cong., 2nd Sess. (2004)</ref><ref>Weisman, Jonathan. "", ''Washington Post'' 2006-12-05. Retrieved 2007-02-06.</ref>

===State legislation===
Subsequently, 25 states have examined similar legislation related to fetal pain and/or fetal anesthesia,<ref name="paul"/> and in 2010 ] banned abortions after 20 weeks on the basis of fetal pain.<ref>Kliff, Sarah '''' The Daily Beast Apr 13, 2010</ref> 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 ] founded by Planned Parenthood, has termed "generally irrelevant" and not in line "with the current medical literature".<ref>{{cite journal |author1=Gold Rachel Benson |author2=Nash Elizabeth | year = 2007 | title = State Abortion Counseling Policies and the Fundamental Principles of Informed Consent | url = http://www.guttmacher.org/pubs/gpr/10/4/gpr100406.html | journal = Guttmacher Policy Review | volume = 10 | issue = 4 }}</ref> ], 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."<ref>]. "" ''MSNBC.com'', November 30, 2005</ref>

==See also==
* ]
* ]
* ]


==References== ==References==
{{reflist|2}} {{Reflist|30em}}


==External links==
* 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.
* from Ontario Consultants on Religious Tolerance. This site : "We feel that all women considering an abortion should be fully informed and as free as possible from outside pressure."
* ] site presenting case for fetal pain from second month of pregnancy: .
* Statement of National Abortion Federation Opposing H.R. 3442, the "Unborn Child Pain Awareness Act" (2008) and .
* National Right to Life Committee's webpage of testimonies regarding fetal pain:
* by Eric Schulzke in ''Deseret News''

{{Pain}}
{{Neuroscience}}
{{Mental processes}}

{{abortion}}
{{Pregnancy}}
{{Humandevelopment}}


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Latest revision as of 11:52, 12 December 2024

Study of the different types of sensory perception of fetuses during pregnancy
This article needs attention from an expert in biology. The specific problem is: discrepancy between abortion subsection and rest of the article, and lacking scientific consensus in article overall. WikiProject Biology may be able to help recruit an expert. (August 2009)

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 of this type inform the abortion controversy, along with certain related pieces of legislation in countries affected by that debate. As of 2022, there is not any scientific consensus on whether a fetus can feel pain.

Prenatal hearing

Numerous studies have found evidence indicating a fetus's ability to respond to auditory stimuli. The earliest fetal response to a sound stimulus has been observed at 16 weeks' gestational age, while the auditory system is fully functional at 25–29 weeks' gestation. At 33–41 weeks' gestation, the fetus is able to distinguish its mother's voice from others.

Prenatal pain

Pregnancy timeline.

The hypothesis that human fetuses are capable of perceiving pain during the first trimester has little evidence, although fetuses at 14 weeks may respond to touch. A multidisciplinary systematic review from 2005 found limited evidence that thalamocortical pathways begin to function "around 29 to 30 weeks' gestational age", only after which a fetus is capable of feeling pain.

In March 2010, the Royal College of Obstetricians and Gynecologists submitted a report, 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",

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. Fetal pain is not possible before these necessary neural pathways and structures have developed.

The report specifically identified the anterior cingulate as the area of the cerebral cortex responsible for processing of pain. The anterior cingulate is part of the cerebral cortex, which begins to develop in the fetus at week 26. A co-author of that report reviewed the evidence in 2020, specifically the functionality of the thalamic projections into the cortical subplate, and posited "an immediate and unreflective pain experience...from as early as 12 weeks."

There is a 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.

Electroencephalography indicates that the capacity for functional pain perception in premature infants does not exist before 29 or 30 weeks; a 2005 meta-analysis states that withdrawal reflexes and changes of heart rates and hormone levels in response to invasive procedures are reflexes that do not indicate fetal pain.

Several types of evidence suggest that a fetus does not awaken during its time in the womb. Much of the literature concerning fetal pain simply extrapolates from findings and research of premature babies. The presence of such chemicals as adenosine, pregnanolone, and prostaglandin-D2 in both human and animal fetuses, indicate 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, increasing consciousness. If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimized, although some studies found that the adenosine levels in third-trimester fetuses are only slightly greater than those in adults' blood.

Fetal anesthesia

Direct fetal analgesia is used for only a minority of prenatal surgeries.

Some caution that unnecessary use of fetal anesthetic may pose potential health risks to the 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. Given the maternal risk involved and the lack of evidence of any potential benefit to the fetus, administering fetal anesthesia for abortion is not recommended.

Fetal pain legislation may make abortions more difficult 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.

Doctors for a Woman's Choice on Abortion state that the majority of surgical abortions in Britain are already performed with general anesthesia, which also affects the fetus. In a letter to the British Medical Journal in April 1997, they deemed the discussion "unhelpful to women and to the scientific debate" despite a report in the British Medical Journal that "the theoretical possibility that the fetus may feel pain (albeit much earlier than most embryologists and physiologists consider likely) with the procedure of legal abortion". Yet if mothers' general anesthesia were enough to anesthetise the fetus, all fetuses would be born sleepy after a cesarean section performed in general anesthesia, which is not the case. Dr. Carlo V. Bellieni also agrees that the anesthesia that women receive for fetal surgery is not sufficient to anesthetize the fetus.

United States legislation

Federal legislation

In 1985, questions about fetal pain were raised during congressional hearings concerning the movie The Silent Scream.

In 2013 during the 113th Congress, Representative Trent Franks introduced a bill named 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.

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

State legislation

Subsequently, 25 states have examined similar legislation related to fetal pain and/or fetal anesthesia, and in 2010 Nebraska banned abortions after 20 weeks on the basis of fetal pain. 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 termed "generally irrelevant" and not in line "with the current medical literature". 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."

See also

References

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  2. Levitan, Dave (2015-05-18). "Does a Fetus Feel Pain at 20 Weeks?". FactCheck.org. Retrieved 2022-09-20.
  3. Karni, Annie (2022-09-13). "Graham Proposes 15-Week Abortion Ban, Splitting Republicans". The New York Times. ISSN 0362-4331. Retrieved 2022-09-20.
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