Fetal Anesthesia Expert: Unborn Children Feel Pain, Even Before Viability

National   |   Steven Ertelt   |   Sep 3, 2013   |   1:57PM   |   Washington, DC

Earlier this year, as members of Congress debated a bill to ban late-term abortions, a national debate ensued over the question of whether unborn children feel pain. Abortion activists derided studies and expert testimony confirming fetal pain.

Now, an anesthesiology professor at Vanderbilt University Medical Center, Dr. Ray Paschall, who has done more surgeries with fetal anesthesia than any doctor in the world, says babies feel pain not only before birth but before viability:

“It’s not even close,” he told a newspaper about his status as the leading surgeon with experience with fetal anesthesia surgeries, “I’ve personally done around 260 now.”

Paschall was part of a team that developed fetal surgery for myelomeningocele, a type of spina bifida, where the spine fails to close correctly, leaving it exposed to corrosive amniotic fluid. The result is severe nerve damage, partial paralysis and hydrocephalus, or water on the brain.

Pre-birth intervention has been found to significantly improve outcomes. The target age for these surgeries, Paschall said, is between 21 and 25 weeks of gestational age, which happens to be precisely the age targeted in fetal pain abortion legislation.

These fetuses are not viable outside the womb. But they do, Paschall firmly believes, feel pain. They thus are right in the target zone of fetal pain legislation.

In one of their early surgeries, Paschall says he saw, and Dr. Noel Tullipan felt, a fetus move in response to pain. Paschall said he is “absolutely convinced, 100 percent more than I was even back in 2000, that was a purposeful movement away from a neurosurgeon’s knife.”

In response, Paschall upped the doses of anesthesia for the fetus, and he has not seen one move in 200 surgeries since. “I would never go back and do less. I might do more.”

Paschall’s experience butts up against another theory offered by fetal pain skeptics, who argue that the unborn fetus is immersed in a mix of fluids that chemically induce sleep, meaning that even if the brain wiring were in place, the fetus will still be oblivious. Paschall, obviously, doubts this.

“Anyone willing to make absolute statements regarding fetal, infant or adult neural development and processing is a brave person,” Paschall said, adding that “the complexities of the brain defy absolute explanation.”

Leading researchers confirm the scientific evidence behind fetal pain:

In the early 1980s Dr. Kawaljeet Anand, then an intern at a British hospital, noticed many of his neonatal patients exhibiting stress and dying after surgery. This sparked research that led to a landmark 1987 piece published in the New England Journal of Medicine that outlined the evidence of neonatal pain, including a litany of stress and hormonal responses, key “surrogate measures” of pain. Neonatal surgery would never be the same after Anand got done with it.

Anand proved that newborns not only perceived pain, but that they were literally dying from it. In one of his studies, mortality dropped from 25 to 10 percent just through using anesthesia. By the turn of the 21st century, thanks largely to Anand, newborn anesthesia was standard. By the time the Puente twins came along, it was not even a question.

That challenge conquered, Anand’s research moved on to premature infants like the Puente twins and from there to the pre-viable fetus. It is on the latter point, of course, that the controversy really takes life.

Now with an endowed chair at the University of Tennessee Health Science Center in Memphis, the pioneering pain researcher finds himself at the center of the national abortion debate, often castigated for his insistence that the fetus and premature newborn feel pain. As ever, the politics of abortion lurk directly behind the question of fetal pain.

Anand has, in fact, argued that a fetus or premature newborn may actually feel pain more intensely than an older newborn. He asserted in 2007 congressional testimony on fetal pain legislation that “a fetus at 20 to 32 weeks of gestation would experience a much more intense pain than older infants or children or adults” because certain pain mechanisms are in play much earlier, while “fibers which dampen and modulate the experience of pain” are delayed until between 32-34 weeks.