View source for Prenatal perception

{{Short description|Study of the different types of sensory perception of fetuses during pregnancy}}
{{expert needed|biology|date=August 2009|reason=discrepancy between abortion subsection and rest of the article, and lacking scientific consensus in article overall}}
'''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 [[fetus]]es; none of the accepted indicators of perception are present in [[embryo]]s. Studies of this type inform the [[abortion debate|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.<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>

==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.<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|url-access=subscription }}</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==
[[File:Pregnancy timeline.png|thumb|400px|right|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.<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 [[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.<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 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=[[Royal College of Obstetricians and Gynaecologists]]|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}}

{{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}}}}

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."<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>

There is a consensus among [[Neural development|developmental neurobiologists]] that the establishment of [[Human thalamus|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.<ref>Johnson, Martin and Everitt, Barry.  ''[https://books.google.com/books?id=MzZRuSQ5UeEC&pg=PA235 Essential reproduction]'' (Blackwell 2000), p. 235.  Retrieved 2007-02-21.</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"/>

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]]-D<sub>2</sub> in both human and animal fetuses, indicate that the fetus is both [[sedation|sedated]] and [[anesthesia|anesthetized]] 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=[[The Journal of Maternal-Fetal & Neonatal Medicine]] |volume=25 |issue=8 |pages=1203–8 |year=2012 |last1=Bellieni |first1=Carlo Valerio |last2=Buonocore |first2=Giuseppe |pmid=22023261 |s2cid=20578842 }}</ref>

===Fetal anesthesia===
Direct fetal [[analgesia]] 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>

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|url-access=subscription}}</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>

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). [https://www.nature.com/articles/s41390-020-01170-2 "Analgesia for fetal pain during prenatal surgery: 10 years of progress"]. ''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 ''[[The Silent Scream]]''.<ref>Hearing Before the Subcommittee on the Constitution of the Committee on the Judiciary, United States Senate, Ninety-Ninth Congress. (May 21, 1985). [http://njlaw.rutgers.edu/collections/gdoc/hearings/8/86601288/86601288_1.pdf First session on: The medical evidence concerning fetal pain.] S. Hrg. 99–429; Serial No. J-99-28, pages 10 and following</ref>

In 2013 during the [[113th Congress]], [[Trent Franks|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.<ref>''[http://thomas.loc.gov/cgi-bin/query/z?d113:h.r.1797: Pain-Capable Unborn Child Protection Act of 2013]{{Dead link|date=August 2021 |bot=InternetArchiveBot |fix-attempted=yes }}'' H.R.1797, 113th Cong., 1st Sess. (2013)</ref>

In 2004 during the [[108th Congress]], [[Sam Brownback|Senator Sam Brownback]] introduced a bill named the "[[Unborn Child Pain Awareness Act]]" for the stated purpose of "ensur[ing] 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>''[http://thomas.loc.gov/cgi-bin/query/z?c108:S.2466: Unborn Child Pain Awareness Act of 2005] {{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. "[https://www.washingtonpost.com/wp-dyn/content/article/2006/12/04/AR2006120401089.html House to Consider Abortion Anesthesia Bill]", ''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 [[Nebraska]] banned abortions after 20 weeks on the basis of fetal pain.<ref>Kliff, Sarah ''[http://www.newsweek.com/blogs/the-gaggle/2010/04/13/newly-passed-fetal-pain-bill-in-nebraska-is-a-big-deal.html Newly Passed 'Fetal Pain' Bill in Nebraska Is a Big Deal]'' 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 [[Guttmacher Institute]] 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> [[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."<ref>[[Arthur Caplan|Caplan, Arthur]]. "[https://web.archive.org/web/20130611003647/http://www.nbcnews.com/id/10238840 Abortion politics twist facts in fetal pain laws]" ''MSNBC.com'', November 30, 2005</ref>

==See also==
* [[Pain in babies]]
* [[Prenatal development]]
* [[Texas Senate Bill 5]]

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

==External links==
* [https://web.archive.org/web/20070418153229/http://judiciary.house.gov/Oversight.aspx?ID=201 "Oversight Hearing on Pain of the Unborn"] 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.
* [http://www.religioustolerance.org/abo_pain.htm "Can a embryo or fetus feel pain? Various opinions and studies"] from Ontario Consultants on Religious Tolerance.  This site [http://www.religioustolerance.org/abortion.htm states]: "We feel that all women considering an abortion should be fully informed and as free as possible from outside pressure."
* [[Anti-abortion]] site presenting case for fetal pain from second month of pregnancy: [http://www.abortionfacts.com/online_books/love_them_both/why_cant_we_love_them_both_14.asp HTML version] {{Webarchive|url=https://web.archive.org/web/20080329142022/http://www.abortionfacts.com/online_books/love_them_both/why_cant_we_love_them_both_14.asp |date=2008-03-29 }}.
* Statement of National Abortion Federation Opposing H.R. 3442, the "Unborn Child Pain Awareness Act" (2008)  [http://www.prochoice.org/pubs_research/publications/downloads/public_policy/UCPAA_NAF_Position.pdf PDF version] and [http://webarchive.loc.gov/all/20061116044144/http://www.prochoice.org/policy/congress/fetal_pain.html HTML version].
* National Right to Life Committee's webpage of testimonies regarding fetal pain: [https://web.archive.org/web/20051226223517/http://www.nrlc.org/abortion/Fetal_Pain/index.html HTML version]
* [https://www.deseret.com/2013/9/2/20524928/small-survivors-how-the-disputed-science-of-fetal-pain-is-reshaping-abortion-law/ Small survivors: How the disputed science of fetal pain is reshaping abortion law] by Eric Schulzke in ''Deseret News''

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

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

[[Category:Medical ethics]]
[[Category:Pain]]
[[Category:Nociception]]
[[Category:Abortion debate]]
[[Category:Embryology]]