The Truth About
Fetal Pain
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An article recently published
in the prestigious Journal of the American Medical Association (August 24, vol.
294, p.947) has caused quite a stir. The authors claim that the fetus’ neurological
pathways in its brain that allow “the conscious perception of pain”
do not function until after 28 weeks. To say that there has been an explosion
of criticism is quite an understatement. Reactions to it have centered on basically
three issues.
One is that preemie infants born prior to 29 weeks, and
as early as 22-23 weeks, do show ample evidence of feeling pain as they react
to painful stimuli, withdraw from it and cry. A second major comment has been
that the article offers no new research but merely goes over certain previous
findings. Third, much has been made of the inferred bias of the authors, one of
whom is the medical director of the abortion facility at San Francisco General
Hospital. It has been reported that this hospital commits 600 abortions a year,
done in the 5th and 6th months of pregnancy. The other author previously worked
for NARAL. These are valid comments, and in and of themselves go a long way to
destroy the scientific credibility of the article. However, it is obvious that
a more in-depth analysis would be helpful.
Having read the article carefully,
I was immediately struck by the fact that if you can change a definition to fit
your needs, then it is easy to prove your point. Changing the commonly accepted
definition of pain is the heart of the matter. Note above that the article speaks
of “conscious perception” of pain. Further, they defined pain as “a
sensory and emotional experience that requires the presence of consciousness to
permit recognition of stimulus as unpleasant.” Their definition of pain is
simply wrong.
If we define pain as being cerebral, if we define it as
only existing when there is consciousness and memory, if we define all other responses
to noxious stimuli as mere reflexes that really don’t hurt, then the article
has certain merit. But herein lies the basic falsehood of their analysis. As a
matter of fact, you do not need consciousness to react to a painful stimulus.
Furthermore, you don’t even need cerebral hemispheres. Several examples will
illustrate this.
If you put your finger on a hot stove, you will pull
it back immediately. Your finger will be off of that hot burner prior to when
your brain consciously registers pain. That is a reflex, yes, but the fact that
it is a reflex does not mean that it didn’t hurt, for your finger certainly
hurt and later developed a blister.
Anencephalic babies are born without
the higher parts of their brain. All they have is a brain stem. Therefore, they
certainly do not have consciousness. Some of them live several days or longer.
During this brief neonatal period, if you stick them with a needle, or their diapers
are wet, they will cry. Do they feel pain? I doubt if any mother, father or attending
physician would claim that this is not pain, for it obviously is.
Let’s
look at another example as early as 8 – 10 weeks of fetal age intrauterine.
If you stick this developing baby in the palm of her hand with a needle, she will
withdraw her hand. She will also open her mouth. We can compare this to a newborn
infant who is stuck with a pin while being changed in a cloth diaper. Said baby
will withdraw his little butt and complain loudly. All three of these reactions
are the same.
What then is the neural mechanism of this? A peripheral
or surface pain stimulus is carried by way of a sensory nerve to a portion of
the brain stem called the thalamus. The thalamus resembles a switchboard. It directs
the pain message down a motor nerve. This motor nerve goes to the fetus’s
palm or the diapered baby’s little butt and activates a muscular recoil,
the same as pulling your finger from the hot burner.
Until somewhat recent
years, there was a certain amount of conventional wisdom in the medical field
that very premature babies could not feel pain. Because of this, a born preemie
would be operated on without any anesthetic. That has largely been disproved in
recent years by a series of articles, which report that not only does a premature
baby (or fetus) feel pain, but also that this tiny person feels far more generalized
and severe pain than an adult.
The reason for this is the myelin sheath.
A myelin sheath is basically an insulation. It can be compared to the covering
over an electric wire. That wire receives an electric charge at one end and delivers
it out the other end without that electric charge escaping enroute because of
the insulated covering. Grown children and adults have their peripheral nerves
sheathed in myelin so that the stimulus at one end carries to the thalamus without
impacting the tissues it passes through on the way. This localizes the pain to
where the noxious stimulus is applied. It is now known that an older fetus and
premature babies do not have this protective myelin sheath or do not have it completed.
Because of this, a pain stimulus at one end is not just felt at the tip where
this stimulus is applied, but probably is felt all along the course of that exposed
nerve fiber. This being true, that tiny infant then feels far more agonizing pain
than the older child or adult subject to the same painful stimulus.
Let’s
quote a few authorities. Dr. Jean Wright at Emory University said, “Infants
at 23 weeks show very highly specific and well coordinated physiologic and behavioral
responses to pain similar to older infants.” Blechschmidt has stated, “At
7 weeks of fetal age they twitch or turn their head away from a stimulus in the
same defense maneuver seen at all stages of life.” Matviuw has said, “By
13 weeks, the fetal organic response to pain is more than a reflex. It is an integrated
physiological attempt to avert the noxious stimulus.” (See Abortion Questions
and Answers by the author, 1991, pages 65-69.)
But isn’t it true
the unborn baby cannot tell us that he or she feels pain? Good question. But there
is an answer. Pain can be detected when nociceptors (pain receptors) discharge
electrical impulses to the spinal cord and brain. They fire impulses outward telling
the muscles in the body to react, as I noted above. These can be measured. Further,
changes in heart rate and fetal movements, as well as movement of the newborn
preemie, also suggest a response to painful stimulus.
Most recently, the United
States District Court for the southern district of New York received extensive
testimony from experts on both sides regarding fetal pain during partial-birth
abortion. The testimony of one doctor, Kanwaljeet Anand, (which was not challenged)
described that fetuses undergo severe pain during abortion procedures.
One
of those who defended the controversial JAMA article was Dr. David Grimes, who
until recently was chief of the department of OB-GYN at the same San Francisco
General hospital as one of the authors. We might note that Grimes, along with
Dr. Cates, for many years did second and third-trimester abortions in Atlanta.
Cates authored an article suggesting that the financial charge for a late-term
abortion be calibrated on the length of the fetal foot. Grimes, since that time,
has been a notorious defender of unrestricted abortions.
In closing, I
note that the Unborn Child Pain Awareness Act (S51, HR356,) requires that the
mother be told a late-term abortion will cause pain and that the fetal infant
be given an anesthetic. The obvious purpose of the authors of the JAMA paper was
to damage the prospects of passage of this bill. Considering the above, we hope
their attempt will be counterproductive and that the bills will pass.
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