The Triple Helix @ UChicago

Fall 2018

"Artificial Wombs: What Happens If We Expand Fetal Viability?" By Clare Booth

 

Within the last century, scientific advancements have begun to dramatically change the process of human reproduction. Pregnancy can now be reliably prevented with contraception. With artificial insemination and in vitro fertilization, pregnancy can now be initiated in non-sexual ways. Now, the process of pregnancy itself may be revolutionized by new research into artificial wombs.

The goal of artificial womb development research is to create a more effective means of care for premature infants. In the United States, 9.85% of babies born in 2016 were born preterm, before 37 weeks gestation.[1] Preterm births are the most common cause of death for newborn infants.[2] Currently, the main components of care for preterm infants are incubators to keep temperatures stable and ventilators to provide oxygen. The earlier an infant is born, the more at risk she is, and though only 0.68% of babies were born before 28 weeks in 2016[1], an artificial womb could allow these infants to continue growth in an environment more similar to a mother’s womb. 

A 2017 study published in the journal Nature has shown such promising research into this technology. Researchers successfully grew premature lamb fetuses in an extra-uterine support system, colloquially referred to as an artificial womb.[3] Seven lamb fetuses ranging from 105 to 120 days of gestation, the equivalent to 23 to 24 weeks of human gestation, were kept alive for up to four weeks using this system. While many of the lamb fetuses were stable at four weeks, the experiment was terminated at this point due to animal protocol regulations. 

The artificial womb consisted of two essential components: a closed fluid environment to mimic the amniotic fluid in the womb and a tube through the umbilical cord that allowed researchers to provide nutrients and oxygen to the blood stream like the placenta would. Tubes were connected to the arteries and veins inside the fetus’ umbilical cord to construct a circuit through which the blood flowed. The blood moved through this circuit due to the beating of the fetus’ heart, just as it would naturally move through the umbilical cord and the placenta inside a mother’s womb. An oxygenator was placed here in the circuit to oxygenate the blood. Medicines and other nutrients were added to the blood through this exterior circuit as well. The closed fluid environment, termed a ‘biobag,’ was meant to mimic the amniotic fluid, containing electrolytes and nutrients. It was completely sealed after insertion of the fetus to prevent infection. 

The artificial womb was remarkably successful at not only keeping the lamb fetuses alive but also helping them develop. The lamb fetuses had normal cardiac function and levels of oxygenation, and they even continued to grow. The fetuses opened their eyes, were more active, exhibited breathing and swallowing movements, grew wool, and got bigger. They had no hemorrhages or other brain injuries, and their brains grew as expected. Though these results do not definitively prove that fetal development was exactly as it would have been within the mother’s womb, there were no obvious signs of abnormal development.

The authors of this study state that their goal was: “not to extend the current limits of viability but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units.”[3] Despite the scientists’ intentions, as the technology becomes increasingly sophisticated, it could allow younger and younger fetuses to be cared for outside a mother’s womb. Changing the point at which a fetus can survive outside a mother’s womb has important implications for discussions of abortion.

In the United States, current abortion law derives from Supreme Court cases Roe v. Wade and Planned Parenthood v. Casey. The first, Roe v. Wade, a 1973 case in which a Texas woman took issue with state laws prohibiting abortion, resulted in the decision that, based on her right to privacy, a woman has the right to an abortion for any reason up to the end of the first trimester.[4] In 1992, Planned Parenthood v. Casey amended this decision, affirming the right of a woman to have an abortion before the point of “viability” but did not rigidly define the time period in which abortion must be legal (like Roe v. Wade did with a trimester model).[5] Thus, “viability” currently is not clearly defined by federal law, allowing it to be defined by state laws or simply left to the discretion of doctors. 

Development of artificial wombs could change the definition of “viability.” If a fetus can survive outside a mother’s womb earlier in pregnancy, the time at which a fetus becomes viable would be earlier, allowing states to ban abortion at an earlier stage of pregnancy. 

Alternatively, transfer to an artificial womb could become a third option to pregnancy and abortion. Transfer to an artificial womb would relieve women of the burden of pregnancy (though not of the burden of being a mother) without ending of the life of the fetus. In this scenario, transfer to an artificial womb might be allowed during a certain stage of pregnancy but outright abortion banned. 

Fundamentally, the development of artificial wombs would change the way we discuss abortion. As lawyer and bioethicist I. Glenn Cohen puts it, “the abortion right has been most vigorously defended as a right not to be a gestational parent, not as a right not to be a legal or genetic parent […] Defending a right to abortion when transfer is possible would change the moral terrain.”[6] Should people have the right not to become parents even if it means “killing” a fetus that could survive outside a mother’s womb, albeit only with advanced technology like the artificial womb? This is the essential question we must answer as technology improves. 

Current artificial womb research offers a promising future for increasing survival rates of premature infants. It also has the potential to give women more bodily autonomy in terminating their pregnancies without terminating the life of the fetus. However, it is certainly not clear cut how it may impact our abortion laws and cause us to reevaluate the nature of our arguments for and against abortion. 

References

[1] United States. Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics Reports. By Joyce A. Martin, Brady E. Hamilton, Michelle J. K Osterman, Anne K. Driscoll, and Patrick Drake. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf.

[2] Azad, Kishwar, and Jiji Mathews. "Preventing Newborn Deaths Due to Prematurity." Best Practice & Research Clinical Obstetrics & Gynaecology 36 (2016): 131-44. doi:10.1016/j.bpobgyn.2016.06.001.

[3] Partridge, Emily A., Marcus G. Davey, Matthew A. Hornick, Patrick E. Mcgovern, Ali Y. Mejaddam, Jesse D. Vrecenak, Carmen Mesas-Burgos, et. al. "An Extra-uterine System to Physiologically Support the Extreme Premature Lamb." Nature Communications 8 (2017): 15794. doi:10.1038/ncomms15794.

[4] Roe v. Wade, 410 U.S. 113 (1973)

[5] Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992)

[6] Cohen, I. Glenn. "Artificial Wombs and Abortion Rights." Hastings Center Report 47, no. 4 (2017). doi:10.1002/hast.730.

 
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