The Emerging Reality of Fetal Pain in Late Abortion

By Paul Ranalli, M.D.

The disturbing concept that an unborn child feels pain while being destroyed in an abortion has once again entered the public consciousness in England, after a self-described "pro-choice" fetal researcher suggested that anesthesia should be given to comfort the fetus from pain from abortions performed as early as 17 weeks' gestation.

Dr. Vivette Glover, a researcher at the Queen Charlotte's and Chelsea Hospital in London, told the British Broadcasting Corporation that, while it is unlikely the fetus can feel anything before 13 weeks, "after 26 weeks it is quite probable. But between 17 and 26 [weeks] it is increasingly possible that it starts to feel something and that abortions done in that period ought to use anaesthesia."

Her comments triggered another round of controversy in England, one of the few places in the world where the subject of fetal pain has been honestly addressed. Although the medical and science establishment on this side of the Atlantic has largely ignored mounting evidence of the early development of fetal pain perception for the better part of a decade, Britain's Royal College of Obstetricians and Gynecologists (RCOG) established a Working Party to study the issue three years ago.

Its report, issued in October 1997, startled the world by recommending that the evidence for fetal pain perception in the late second trimester was convincing enough that the doomed fetus should be sedated with its own specific anaesthesia during all abortions performed from 24 weeks onward. The RCOG panel actually concluded that pain perception was not possible before 26 weeks, but it moved back its anaesthesic recommendation to 24 weeks because of the uncertainty of estimating gestational age.

It also suggested an alternative to anaesthesia: stabbing the fetus through the heart with a needle to inject potassium chloride, a technique it stated, dryly, "that stops the heart rapidly." This had the double benefit (for the abortionist) of ensuring the delivery of a dead baby, since many abortions around 24-26 weeks are likely to result in a viable birth.

Dr. Glover's statement was especially controversial for the RCOG, as it followed the appearance of an internal argument within the doctors' group about how to deal with the findings of the 1997 report it commissioned. Media reports earlier this summer suggesting that the group would officially endorse a policy of fetal anaesthesia during late-term abortion were quickly denied - - too quickly in the eyes of some observers. Dr. Glover's public statement appears to have blown the lid off attempts to bottle up the controversy. Leaders in the field took issue with her statement, although their denials were carefully couched.

Dr. Gillian Penney of the Aberdeen [Scotland] Maternity Hospital and chairman of the Royal College's induced abortion guideline group, claimed that, until 26 weeks, "the fetus would not be capable of experiencing what we would perceive as pain" (emphasis added). Professor Peter Hepper of the fetal behaviour research center at Queen's University in Belfast, Northern Ireland, said there was not enough evidence to say that the unborn child experienced pain before 26 weeks, but he allowed that it was " better to be safe than sorry."

The authority Dr. Glover brings to the debate makes it difficult for the RCOG, and the general public, to ignore her concerns. The RCOG Working Party referenced one of the key fetal pain research projects she published in 1994 with Dr. Nicholas Fisk and colleagues.

Their research revealed that, in response to a painful procedure, fetuses as early as 19 weeks release large amounts of pain and stress hormones into the fetal bloodstream, the same hormonal surge that occurs in adults. An earlier study by German researcher Dr. Joachim Partch detected similar hormones in the surrounding amniotic fluid as early as 16 weeks into the pregnancy.

Although some have criticized the notion that such a finding implies that the fetus is experiencing pain, there is, in fact, no direct objective method of assessing pain in any subject, adult or fetus, human or animal. Conclusions about the experience of pain must be based on what is considered to be reasonable from the available evidence, a point that is made in another British study, the Commission of Inquiry into Fetal Sentience.

Those who can self-report, like conscious adults, may cry out, give elaborate descriptions of their pain, or rate its intensity, either verbally or on an analog scale, such as the 1- to-10 scale (think of any headache commercial on TV). For those who are unable to articulate their pain, such as infants, unconscious adults, or unborn children, the perception of pain must be deduced, indirectly, by observing other biological responses, such as a physical withdrawal of limbs from painful stimulus, a change in vital signs (blood pressure and pulse rate go up), or a release of stress hormones (cortisol beta- endorphin).

By every measure, the fetus from 16-19 weeks reacts to a painful stimulus in a manner consistent with the perception of pain. Support for Dr. Glover's position came from Canadian researcher Dr. Ken Craig who has spent over 15 years studying pain in premature babies at the University of British Columbia.

Craig told the Vancouver Province [Aug. 30], "at 24-25 weeks post-conception, a fetus displays all of the physiological and behavioural reactions you observe in children and adults. My experience is that they do experience pain. I say we should give the babies the benefit of the doubt."

Dr. Glover also touched on the political nature of the abortion controversy. When asked what she thought about her scientific conclusions lending support to those who oppose abortion, she stated, "I am pro-choice, but one should not muddle the two."

The direction of this debate will not surprise readers of NRL News, where research into fetal pain has been discussed for many years. An independent analysis of the original research reviewed by the 1997 RCOG panel concluded that the panel may have misinterpreted the data when it concluded that pain signals do not reach the highest levels of brain cortex until 26 weeks. (See NRLNews, 11/18/97, p. 24.)

Careful anatomical studies reveal, in fact, that the ascending pain fibers reach the cortex by 20 weeks. They then "sit" briefly, for days to a few weeks, before making their final push upward to establish their ultimate connections ("synapses") with the surface gray matter neurons that register a conscious awareness of pain. Allowing some room for individual variability, the brain of an unborn child will begin to register pain impulses just after 20 weeks, with ever-increasing amounts of pain reception reaching millions of surface cortical neurons between 20 and 24 weeks.

In fact, as revealed by other work, the late second-trimester fetus, like the similar-aged premature newborn, likely develops the capacity to be more sensitive to pain than a full-term baby, or even an adult. This is because the inhibitory, pain-modifying network lags in embryologic development behind the establishment of the pain system.

Neurons from the higher reaches of the brain send fibers down to synapse with the thalamus (a key pain-relay station deep in the brain) and the spinal cord, where incoming pain signals from the trunk and limbs are directed upward to the brain. These neurons secrete brain chemicals (serotonin, norepinephrine, and dopamine) which inhibit pain in adults.

Yet, while the pain system is up and running by 20-24 weeks' gestation, this pain-modifying system does not begin to make its appearance until later in pregnancy, continuing to develop until full term and beyond. Thus there is a key period of mismatch, from 20 weeks onward: raw pain impulses from the body may roar through unchecked by the modifying inhibitory mechanism that helps to blunt pain in adults, leaving the unborn child at this stage vulnerable to a degree of pain that is truly unimaginable. Dr. Glover has now raised concerns that this dreadful period of potential vulnerability to pain may extend as far back as 17 weeks' gestation.

The implications for the abortion debate are stark. Even using the conservative fetal pain date of 20 weeks, as many as 14,000 U.S. abortions every year may cause horrific pain as well as death.

If some pain is perceived at 17 weeks, then 42,000 abortions may be implicated annually, including hundreds, perhaps thousands, of partial-birth abortions. A clinical description of this procedure has already been sickening enough to fracture the ranks of abortion advocates, even without considering that the nearly born child may feel massive pain before death. Now the concept of fetal pain in late abortion, long derided by mainstream commentators as a pro-life construct, is being discussed as a scientific reality by pro-choice researchers and the community of abortion doctors themselves.

Unable to contain the controversial subject, the British medical establishment has announced a conference to discuss the issue at the prestigious Royal Institute in November. It will be chaired by Dr. Vivette Glover.

Dr. Ranalli is a neurologist at the University of Toronto and Advisory Board member of the deVeber Institute for Bioethics and Social Research. In 1995 he testified on fetal pain before the House Judiciary Committee for the state of Ohio. He is a frequent contributor to NRL News.