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5 Things to Know About A Touchy Issue: Fetal Pain

5 Things to Know About A Touchy Issue: Fetal Pain

One of the first reproductive rights issues out of the gate in 2013 was fetal pain, with a last-minute successful attempt to temporarily block Georgia’s fetal pain bill, set to take effect on January first. Fetal pain is a particularly touchy issue in the abortion debate, because no one likes the thought of causing pain if it can possibly be avoided, but science doesn’t support many anti-choice claims made about fetal sensory perception and abortion procedures.

Researching fetal pain is made difficult by the fact that fetuses cannot communicate, so researchers are forced to rely on reflex responses as well as examination of fetal material donated to science, and analysis of neural pathways to see whether fetuses are capable of feeling pain and at what stage of development. This also requires an understanding of pain and sensory perception as emotional, physiological and philosophical concepts.

What is fetal pain? Speaking neutrally, it would be pain experienced by a developing fetus as a result of external stimuli or developmental problems. The term has become charged, however, because it’s often used in anti-choice legislation designed to discourage abortions. Some states have passed fetal pain laws, for example, requiring doctors to notify women that a fetus “may” feel pain and to offer analgesia during abortion procedures. Reproductive rights advocates argue this language is coercive and is designed to persuade women to change their minds before an abortion.

So, can fetuses feel pain? Yes, they can, but not right from the start. Pain is a complex sensation, and it requires the formation of nocioceptors (nerve cells that react specifically to pain) along with pathways to convey pain signals to the brain. This level of development doesn’t occur right away. And reflex responses aren’t necessarily an indicator of pain, because a reflex response doesn’t necessarily mean that a signal has traveled all the way into the cerebral cortex and been processed. Also, many argue, pain is an emotional experience, not just a physical one, which makes it a complex subject to study in this case; when we talk about “fetal pain,” do we purely mean a release of stress hormones and reflex responses related to a noxious stimulus, or do we also mean emotional distress, and how do we measure that in a fetus?

When can fetuses feel pain? This is, as one might imagine, a subject of heated debate; anti-choice groups argue that this occurs early in development, while reproductive rights advocates, as well as many scientists, doctors and researchers, believe it doesn’t occur before the third trimester of development, because the anatomical pathways simply aren’t there. In a review of available literature published in the Journal of the American Medical Association, researchers noted that: “Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks’ gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks.”

It’s important to distinguish between awareness and reflex reactions. Researchers have observed releases of stress hormones as well as other reflex responses prior to 23 weeks, indicating that some neural pathways are present. These pathways do not, however, travel all the way to the part of the brain that mediates awareness, which means that while the body responds, the complex parts of the brain do not.

So fetuses don’t feel pain at 20 weeks? It’s not likely, although this is the cutoff point chosen for many so-called “fetal pain laws” banning or restricting access to abortion. While fetal development has made tremendous progress at 20 weeks, the awareness of pain, versus reflex responses from a developing nervous system, is highly improbable, given the available scientific information. This is also, notably, well before the threshold of viability at 24 weeks; though advances in medicine mean that survival rates for preemies are constantly improving, chances are very slim for fetuses delivered before 24 weeks of gestation.

Is it possible to manage fetal pain? Absolutely — in fact, practitioners of neonatal medicine use anesthesia when they need to perform procedures in much the same way they use it on adults and children. These anesthetics can include muscle relaxers to reduce the risk of surgical complications, prevent reflex responses and limit developmental complications. It is also possible to administer medications designed specifically to limit the transmission of pain signals, and anesthesiologists use these when appropriate in consultation with patients and surgeons.

Medical practitioners argue that decisions about where, when and how to use anesthesia should be based on medical evidence and consultation with the patient along with the care team, rather than being dictated by law. Their ethical obligation to do no harm includes the careful management of cases in which they feel a procedure may cause distress.

Notably, for those concerned about fetal pain and abortion, 1.4% of abortions in the US are conducted at or after 21 weeks, meaning that the vast majority of pregnancy terminations occur well before there is any chance of pain awareness. Such procedures are typically performed in instances of dire medical necessity, such as critical pregnancy complications, or fetal anomalies incompatible with life. They can require the services of a specialist to ensure that the procedure is performed safely, and anesthesia may be used for both mother and fetus to reduce the risk of complications, making it unlikely that fetal pain occurs in these rare instances.

Related articles:

3 Looming Abortion Battles in 2013

DC Fetal Pain Ban Fails In House

Fetal Pain Law Takes Effect

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Photo credit: Phalinn Ooi

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226 comments

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10:10AM PDT on May 6, 2013

this article gave me a headache

just DO the right thing- please!

10:33AM PDT on May 3, 2013

"Right" now there are legislators in many state legislatures in the US working hard on their pet project: anti-abortion legislation. They know that Roe v Wade is an established precedent, making abortion up until the time of fetal viability a matter between a woman and her doctor, but anti-abortion got them elected, and chipping away at Roe v Wade is their priority.

One strategy is to pass ridiculously strict laws like Kansas or North Dakota, banning abortions so early that many women don't know they're pregnant yet, clearly in conflict with Roe v Wade, and litigate these cases with taxpayers' money.

The other strategy is to chip away at abortion rights with little restrictions like zoning and construction laws for clinics, making them outfit with wide halls, saying it's for women's health, or requiring treating physicians to have attending privileges at a local hospital for the same reason, when neither of these are necessary for quality patient care. The same is true of this fetal pain statute. All of these are designed to chip away at the availability of reproductive health care for women. If they were really concerned about quality health care for women, or decreasing the pain to fetuses, they wouldn't be trying to stop physicians from following up medication abortion patients by webcam, so that more abortions could be done very early, while the fetus has no nerves. Or they wouldn't be trying to close Planned Parenthood, or stop it from doing sex education.

10:10AM PDT on May 3, 2013

if one's religion says they cannot watch Doctor Who, that means that THEY can't watch it. Not that they must force the entire world to give it up. So if your religion tells you abortion is wrong, don't have one. If it tells you homosexuality is wrong, don't engage in sexual relations with the same sex. It really is that simple. In the Bible it says very plainly that one should not judge others unless they are perfect, so until your life is 100% in order and you are 100% without "sin", shut your cry hole and let others lead the lives they want to lead. Religion is not law, PERIOD. Otherwise I'd have been married off at 12, forced to marry my rapist, and have very strict rules on how my slaves ought to behave. Keep your Bible out of my vagina, or I will shove my literature into your privates -_-

9:00PM PST on Jan 30, 2013

shirley b, you are far from decent. you are such the bigot, passing judgment on those that do not agree with you and attempting to force them to live as you believe. being the religious zealot that you are, i am sure jesus christ would have to question why you are attemtping to usurp his dad's role in passing judgement over people. don't you realize that you are violating one of the ten commandments? hypocrisy in all of its finest forms exists in the facade of you.

5:37PM PST on Jan 25, 2013

Isn't taking away the right to control my body a SLIPPERY SLOPE to taking away ALL my rights? Is that the real plan of the right? What does it take to put reality into their heads? A woman died recently because they would not take the fetus because it would be a late-term abortion. She and her husband begged and pleaded, to no avail. She DIED !! These people really scare me and are trying to rig elections to be the superpower and take over the U.S.

5:29PM PST on Jan 25, 2013

O.K. If women are forced to carry a fetus for nine months, birth, and raise the child, what are you going to do to punish the man who got her pregnant? The woman is punished for having sex, so why not the man? I have posed this question many times and have never gotten an answer from a politician.

4:22PM PST on Jan 25, 2013

some of these comments are making my brain hurt. Shirley's more than others. thanks for the article. pro-choice, baby.

3:06PM PST on Jan 25, 2013

Pro-choice is pro-democracy.

11:42AM PST on Jan 23, 2013

This whole point of this issue is NOT a scientific problem.
It is NOT a religious problem.
It is a PERSONAL FREEDOM/RIGHTS issue.
Stop with the arguing over that which is YOUR PERSONAL IDEAOLOGY versus anything.
The point is...do we have a RIGHT to live according to own INDIVIDUAL PERSONAL ideaology ????
The pro-choice folks say yes...the pro-life folks say NO.
The crux of the issue.
Simple...to the point...clear and UNDENIABLE... no matter what science or the bible says.
I am NOT pro-choice for abortion, I am most certainly NOT pro-abortion.
I AM PRO-FREEDOM to live MY LIFE as MY IDEAOLOGY dictates
AND...
I want EVERYONE to be able to do so.

1:42PM PST on Jan 22, 2013

How sadly typical. IF you really want to end abortion make birth control freely available. Pass laws that mandate harsh penalties for men who insist on no birth control and walk away from resulting children.

Offer real sex education. Abstinence only is totally unworkable, unsafe and unsound. Teach males they are responsible for their actions all of them and there will be consequences to their actions. See also http://www.democraticunderground.com/10022231120

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