Videos

Dr. David Prentice’s Presentation “Unborn Children Feel Pain” (Six slides attributed to Dr. Maureen Condic)

Dr. Maureen Condic, Associate Professor of Neurobiology and Adjunct Professor of Pediatrics at the University of Utah School of Medicine testifies before a Congressional Sub-committee regarding the issue of children in the womb feeling pain.

News:

Scientific Studies Show Unborn Babies Can Feel Pain as Early as 8 Weeks by Genevieve Plaster

Medical Expert Confirms Unborn Children Feel Excruciating Pain During Abortions by Charlotte Lozier Institute

Science Confirms Unborn Children Feel Intense Pain During Abortions by James Agresti

Expert Told Congress Unborn Babies Can Feel Pain Starting at 8 Weeks by Steven Ertelt

Unborn Babies Feel Pain Earlier, But at 20 Weeks It’s Excruciating by Randy O’Bannon Ph.D.

Articles:

What Science Reveals About Fetal Pain by Arina O. Grossu Director, Center for Human Dignity

In Brief: What Science Reveals About Fetal Pain by Arina O. Grossu Director, Center for Human Dignity

Fetal Pain: Can Unborn Children Feel Pain in the Womb? by Ashley Morrow Fragoso

More Information

Fact Sheet – A3452/S2026 – The NJ Pain Capable Unborn Child Protection Act (Download the PDF here, for Spanish: click here)

• There is substantial medical evidence that babies in the womb feel pain by 20 weeks, or 5 months post-fertilization.[i] (Also see Paper entitled, “Science of Fetal Pain” by the Charlotte Lozier Institute.)
• Babies as young as 20 weeks post-fertilization can survive and thrive with appropriate care and treatment. A groundbreaking New England Journal of Medicine study demonstrates that babies delivered as young as 20 weeks post-fertilization (22 weeks gestation) can survive, and active intervention for treatment greatly improves their survival.[ii]
• The U.S. is one of just seven countries that allow elective abortions after 20 weeks.[iii] The six remaining countries that allow abortions past 20 weeks are China, North Korea, Vietnam, Singapore, Canada and the Netherlands.[iv]
• 14 states have enacted limits since 2010 on the unborn child’s ability to feel pain.[v]
• The American people, especially women broadly support this legislation. Quinnipiac, November 2014: 60% support legislation limiting abortions after 20 weeks, including 56% of Independents and 46% of Democrats.[vi]
• Washington Post, July 2013: 60% of women support a 20-week limit, with just 24% opposing.[vii]
• Huffington Post, July 2013: 59% support a 20-week limit; 30% oppose.[viii]
• Late abortions are not rare, and the majority are performed on an elective basis.
• A 2014 Guttmacher Institute fact sheet revealed that there are an estimated 430 abortion businesses willing to perform abortions at 20 weeks.[ix]
• The majority of late-term abortions are performed on an elective basis, according to the testimony of the abortionists themselves. Martin Haskell, whose writing on a technique he pioneered called “partial-birth abortion” brought this issue to the attention of the nation, said that 80 percent of the abortions he performed this way were purely elective.[x]
• It is undisputed that the risk to a mother’s heath from abortion increases as gestation increases. The risk of death at 8 weeks gestation is 1 death per 1 million abortions; at 16 to 20 weeks, that risk rises to one death per 29,000 abortions; and at 21 weeks gestation or later, the risk of death is one per every 11,000 abortions.[xi] This means that a woman seeking an abortion at 20 weeks is 35 times more likely to die from abortion than she was in the first trimester. At 21 weeks or more, she is 91 times more likely to die from abortion than she was in the first trimester.
• Late abortions are a factor in increased mental[xii] and physical health problems in women.[xiii]
• A3452/S2026 explicitly does not apply in instances where the mother’s life is at risk or she would suffer “substantial and irreversible impairment of a major bodily function,” exceptions that Congress has previously enacted to address concerns about protecting a woman’s life.
• As of a September 2014 report, Children’s Hospital of Philadelphia performed more than 1,200 surgeries on children in the womb, using “tools, techniques and experience not available 30 years ago,” according to the hospital’s Surgeon-in-Chief.[xiv]
• In cases where a lethal fetal anomaly does exist, patients and their families can and should be offered the option of perinatal hospice to support them in the same way we do families with an adult member for whom treatment has become futile.[xv]
• There are now at least 185 perinatal hospices in the United States and patient and family satisfaction with them is high. Studies have shown that carrying a fatally ill child to term rather than performing a late abortion does not result in increased maternal mortality.[xvi]

[i] Testimony of Maureen L. Condic, Ph.D., Associate Professor of Neurobiology and Adjunct Professor of Pediatrics at the University of Utah, School of Medicine, Department of Neurobiology and Anatomy Before the Subcommittee on the Constitution and Civil Justice, Committee on the Judiciary, U.S. House of Representatives, May 23, 2013 on H.R. 1797..

[ii] Rysavy MA et al., Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants, N Engl J Med 372, 1801, May 7, 2015.

[iii] http://www.firstthings.com/web-exclusives/2014/02/winning-the-abortion-olympics

[iv] Ibid.

[v] AL, AR, GA, ID, KS, LA,, ND, NE, OK, SC, SD, TX, WI, WV

[vi]http://www.quinnipiac.edu/news-and-events/quinnipiac-university-poll/national/release-detail?ReleaseID=2115

[vii]http://www.langerresearch.com/uploads/1150a4Abortion.pdf

[viii]http://www.huffingtonpost.com/2013/07/11/abortion-poll_n_3575551.html

[ix] Estimate generated from the numbers Alan Guttmacher provides under the “Providers and Services” section. Note: Guttmacher is using LMP dating. http://www.guttmacher.org/pubs/fb_induced_abortion.html

[x] Sprang, M. LeRoy, and Mark G. Neerhof, 1998, “Rationale for banning abortions late in pregnancy,” Journal of the American Medical Association, 280:744-747.

[xi]L.A. Bartlett et al., Risk Factors for Legal Induced Abortion—Related Mortality in the United States, OBSTETRICS & GYNECOLOGY 103(4):729 (2004).

[xii]Coleman, P.K. (2011). Abortion and Mental Health: A Quantitative Synthesis and Analysis of Research Published from 1995-2009. British Journal of Psychiatry, 199, 180-186.)

[xiii]http://www.aul.org/wp-content/uploads/2013/12/Abortions-Medical-Risks-2013.pdf.

[xiv] http://www.chop.edu/centers-programs/center-fetal-diagnosis-and-treatment/volumes-outcomes#.VLQ-OSvF8T-

[xv] Byron Calhoun, M.D., “The Perinatal Hospice: Allowing Parents to be Parents,” at https://www.lozierinstitute.org/the-perinatal-hospice/.

[xvi] “Perinatal Hospice and Palliative Care: A Gift of Time,” U.S. Listings, at http://perinatalhospice.org/Perinatal_hospices.html#U.S._listings (January 12, 2015).

Fact Sheet: Science of Fetal Pain

Click here for a link to the Fact Sheet page (Mobile Friendly).
Click here for a PDF file of the fact sheet.

On May 13, 2015, the United States House of Representatives passed the Pain-Capable Unborn Child Protection Act. This fact sheet explains the science of fetal pain.

Babies as young as 20 weeks post-fertilization can survive and thrive with appropriate care and treatment

Groundbreaking New England Journal of Medicine study demonstrates that babies delivered as young as 20 weeks post-fertilization (22 weeks gestation) can survive, and active intervention for treatment greatly improves their survival.[1]  Doctors who consider these preterm babies as patients demonstrate that active treatment significantly benefits these young babies.

Unborn babies are treated as patients by fetal surgeons, and receive pain medication

Fetal surgeons recognize unborn babies as patients.  Perinatal medicine now treats unborn babies as young as 16 weeks post-fertilization (18 weeks gestation).  Pain medication for unborn patients is routinely administered as standard medical practice.^[2]

• One of the premier fetal surgeons makes the obvious point: “Fetal therapy is the logical culmination of progress in fetal diagnosis.  In other words, the fetus is now a patient.”[3]
• A European fetal surgery team states: “The administration of anesthesia directly to the fetus is critical in open fetal surgery procedures.”[4]
• The leading textbook on clinical anesthesia says: “It is clear that the fetus is capable of mounting a physiochemical stress response to noxious stimuli as early as 18 weeks gestation.”[5]
• Here is what is told to the mother before fetal surgery by a group who have done many such surgeries:[6]
  “You will be given general anesthesia, and that anesthesia will put your baby to sleep as well. In addition, during the prenatal surgery, your unborn baby will be given an injection of pain medication and medication to insure that the baby doesn’t move.”

Unborn babies can feel pain by 20 weeks post-fertilization or earlier

Previous uninformed notions that unborn and newborn babies could not feel pain, or misinformation on ability of preterm infants to survive, are refuted by a growing body of scientific evidence.  Legislation should reflect the scientific facts.

Brain responses and connections.  A new 2015 study used functional magnetic resonance imaging (fMRI) to measure pain response in newborns (1-6 days old) vs. adults (23-36 years old).[7]  The authors found that “the infant pain experience closely resembles that seen in adults.”  Babies had 18 out of 20 brain regions respond like adults, also showing much greater sensitivity to pain, responding at a level four times as sensitive as adults.

In 2013 a study used that same fMRI technique to study the brains of healthy human babies still within the womb, from 22-37 weeks post-fertilization (24-39 weeks gestation).  They found that functional neuronal connections sufficient to experience pain already exist by 22 weeks post-fertilization (24 weeks gestation).[8]

Increased sensitivity to pain.  In 2010 one group noted that “the earlier infants are delivered, the stronger their response to pain.”[9]  This increased sensitivity is due to the fact that the neural mechanisms that inhibit pain sensations do not begin to develop until 32-34 weeks post-fertilization (34-36 weeks gestation), and are not complete until a significant time after birth.[10]  This means that unborn, as well as newborn and preterm infants, show “hyperresponsiveness” to pain.[11]

Fetal reactions provide evidence of pain response.  The unborn baby reacts to noxious stimuli with avoidance reactions and stress responses.  As early as 6 weeks post-fertilization (8 weeks gestation) the baby exhibits reflex movement during invasive procedures.[12]  There is extensive evidence of a hormonal stress response by unborn babies as early as 16 weeks post-fertilization (18 weeks gestation)[13] including “increases in cortisol, beta-endorphin, and decreases in the pulsatility index of the fetal middle cerebral artery.”[14]

Two independent studies in 2006 used brain scans of the sensory part of unborn babies’ brains, showing response to pain.[15]  They found a “clear cortical response” and concluded there was “the potential for both higher-level pain processing and pain-induced plasticity in the human brain from a very early age.”

Dr. Ruth Grunau, a pediatric psychologist at the University of British Columbia, said, “We would seem to be holding an extraordinary standard if we didn’t infer pain from all those measures.”[16]

Embryological development shows presence of pain sensory mechanisms.  The basic organization of the human nervous system is established by 4 weeks (28 days) post-fertilization (6 weeks gestation).[17]  The earliest neurons in the cortical brain (the part responsible for thinking, memory and other higher functions) are established during the fourth week.[18]  Nerve synapses for spinal reflex are in place by 8 weeks post-fertilization (10 weeks gestation).[19]  Sensory receptors for pain (nociception) develop first around the mouth at 5 weeks post-fertilization (7 weeks gestation), and are present throughout the skin and mucosal surfaces by 18 weeks post-fertilization (20 weeks gestation).[20]  Connections between the spinal cord and the thalamus (which functions in pain perception in fetuses as well as adults) are relatively complete by 18 weeks post-fertilization (20 weeks gestation).[21]

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[1] Rysavy MA et al., Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants, N Engl J Med 372, 1801, May 7, 2015

[2] See, e.g., Ramirez MV, Anesthesia for fetal surgery, Colombian Journal of Anesthesiology40, 268, 2012; Tran KM, Anesthesia for fetal surgery, Seminars in Fetal & Neonatal Medicine15, 40, 2010; Schwarz U and Galinkin JL, Anesthesia for fetal surgery, Semin Pediatr Surg 12, 196, 2003

[3] Adzick NS, Prospects for fetal surgery, Early Human Development 89, 881, 2013

[4] Mayorga-Buiza MJ et al., Management of fetal pain during invasive fetal procedures. Lessons learned from a sentinel event, European Journal of Anaesthesiology 31, 88, 2014

[5] Brusseau R and Bulich LA, Anesthesia for fetal intervention, in Essential Clinical Anesthesia, Charles Vacanti, Pankaj Sikka, Richard Urman, Mark Dershwitz, B. Scott Segal, Eds., Cambridge University Press, NY; July 2011; 772-776

[6] Adzick NS et al., A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele, N Engl J Med 364, 993, 2011 (from the Informed Consent section of the supplementary Protocol to the paper)

[7] Goksan S et al., fMRI reveals neural activity overlap between adult and infant pain, eLife4:e06356, 2015

[8] Thomason ME et al., Cross-Hemispheric Functional Connectivity in the Human Fetal Brain, Sci Transl Med 5, 173ra24, 2013

[9] Badr LK et al., Determinants of Premature Infant Pain Responses to Heel Sticks, Pediatric Nursing 36, 129, 2010

[10] Brusseau R and Bulich LA, Anesthesia for fetal intervention, in Essential Clinical Anesthesia, Charles Vacanti, Pankaj Sikka, Richard Urman, Mark Dershwitz, B. Scott Segal, Eds., Cambridge University Press, NY; July 2011; 772-776

[11] Greco C and Khojasteh S, Pediatric, Infant and Fetal Pain, Case Studies in Pain Management, Alan David Kaye and Rinoo V. Shah, Eds., (Cambridge: Cambridge University Press, 2014), 379

[12] Ohashi Y et al., Success rate and challenges of fetal anesthesia for ultrasound guided fetal intervention by maternal opioid and benzodiazepine administration, J Maternal-Fetal Neonatal Medicine 26, 158, 2013

[13] Myers LB et al., Fetal endoscopic surgery: indications and anaesthetic management, Best Pract Res Clin Anaesthesiol 18, 231, 2004; Brusseau R and Mizrahi-Arnaud A, Fetal Anesthesia and Pain Management for Intrauterine Therapy, Clinics in Perinatology 40, 429, 2013

[14] Lin EE and Tran KM, Anesthesia for fetal surgery, Seminars in Pediatric Surgery 22, 50, 2013

[15] Slater R et al., Cortical Pain Response in Human Infants, J Neuroscience 25, 3662, 2006; Bartocci M et al., Pain Activates Cortical Areas in the Preterm Newborn Brain, Pain 122, 109, 2006

[16] Qiu J, Does it hurt?, Nature 444, 143, 2006

[17] Carlson BM, Patten’s Foundations of Embryology, Sixth Edition, McGraw-Hill, Inc., New York; 1996.

[18] Bystron I et al., The first neurons of the human cerebral cortex, Nature Neuroscience 9, 880, 2006.

[19] Okado N et al., Synaptogenesis in the cervical cord of the human embryo: Sequence of synapse formation in a spinal reflex pathway, J. Comparative Neurol. 184, 491, 1979; Okado N, Onset of synapse formation in the human spinal cord, J. Comparative Neurol. 201, 211, 1981

[20] Brusseau R, Developmental Perspectives: Is the Fetus Conscious?, International Anesthesiology Clinics 46, 11, 2008; Lowery CL et al., Neurodevelopmental Changes of Fetal Pain, Seminars in Perinatology 31, 275, 2007

[21] Van de Velde M and De Buck F, Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures, Fetal Diagnosis and Therapy 31, 201, 2012; Van Scheltema PNA et al., Fetal Pain, Fetal and Maternal Medicine Review 19, 311, 2008