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11: Documentation

11: Consequently, there is substantial medical evidence that an unborn child is capable of experiencing pain by 20 weeks after fertilization.

DOCUMENTATION:

1. Wright, 2005, p.26, para.8 – p.27, para.3, “After 20 weeks of gestation, an unborn child has all the prerequisite anatomy, physiology, hormones, neurotransmitters, and electrical current to “close the loop” and create the conditions needed to  perceive pain…The development of the perception of pain beings at the 6th week of life.  By 20 weeks, and perhaps even earlier, all the essential components of anatomy, physiology, and neurobiology exist to transmit painful sensations from the skin to the spinal cord and to the brain.*”

*From the testimony of Dr. Jean A. Wright, Professor And Chair of Pediatrics, Mercer School of Medicine

U.S. Congress.  House of Representatives.  Committee on the Judiciary.  Pain of the Unborn: Hearing Before the Subcommittee on the Constitution. 109th Cong., 1st Sess., 2005. 

2. Anand, 2005, p.38, “My opinion is, based on evidence suggesting that the types of stimulation that will occur during abortion procedures, very likely most fetuses at 20 weeks after conception will be able to perceive that as painful, unpleasant, noxious stimulation.*”

*From the testimony of Dr. Sunny Anand, Director, Pain Neurobiology Laboratory, Arkansas Children’s Hospital Research Institute, and Professor of Pediatrics, Anesthesiology, Pharmacology, and Neurobiology, University of Arkansas College of Medicine

U.S. Congress.  House of Representatives.  Committee on the Judiciary.  Pain of the Unborn: Hearing Before the Subcommittee on the Constitution. 109th Cong., 1st Sess., 2005. 

3. Anand, 2006, p.3, col.2, “Our current understanding of development provides the anatomical structures, the physiological mechanisms, and the functional evidence for pain perception developing in the second trimester, certainly not in the first trimester, but well before the third trimester of human gestation.”

Anand KJS.  Fetal Pain?  Pain: Clinical Updates. 14:2 (2006) 1-4.

4. Glover, 1999, p.885, col.1, para.3, “Given the anatomical evidence, it is possible that the fetus can feel pain from 20 weeks and is caused distress by interventions from as early as 15 or 16 weeks.”

Glover V. Fetal pain: implications for research and practice. British Journal of Obstetrics and Gynaecology. 106 (1999) 881-886.

5. Gibbins, 2007, p.224, col.2, para.1, “Current data suggest that by 26 and even as early as 20 weeks gestation, a rudimentary pain pathway may be present.”

 Gibbins S, Golec L.  “It Will Not Hurt a Bit,” “What You Do Not Know Cannot Hurt You,” and Other Myths About Fetal Surgical Pain. Newborn & Infant Nursing Reviews. 7:4 (2007) 224-226.

6. Brusseau, 2006, p.191, col.2, para.1, “In fact there are thought to be transient cholinergic neurons with functioning synapses connecting the thalamus and cortical plate from approximately 20 weeks.  This time point could be taken as the absolute earliest time in gestation when a fetus could be aware of nociceptive stimuli, or to ‘feel pain.’”

Brusseau R, Myers L.  Developing consciousness: fetal anesthesia and analgesia. Seminars in Anesthesia, Perioperative Medicine and Pain.  25 (2006) 189-195.

7. Van Scheltema, 2008, p.320, para.3, “Neuroanatomical, neurophysiological, hormonal, haemodynamic and behavioural data indicate that a fetus is capable of reacting to noxious stimuli, implying that the fetus can experience stress and possibly even pain…It is difficult to determine from what gestation onwards fetal anaesthesia should be provided; however, we feel that it should be considered from at least mid-gestation.”

Van Scheltema PNA, Bakker S, Vandenbussche FPHA, Oepkes, D. Fetal Pain. Fetal and Maternal Medicine Review. 19:4  (2008) 311-324.

8.O’Donnell, 2008, page 60, “We suggest that the current evidence, although still limited, makes it quite likely that the fetus can feel pain from 26 weeks, and very unlikely that it can feel pain before 17 weeks. It is possible that some sensory experience of pain may start by about 20 weeks.”

K O’Donnell & V. Glover, “New Insights into Prenatal Stress: Immediate and Long-term Effects on the Fetus and Their Timing,” in Neonatal Pain, ed. Giuseppe Buonocore & Carlo V. Bellieni (Milan: Springer, 2008), 60.

9.Giuntini, 2007, “It has also been shown that fetuses feel pain from week 18. This has given rise to the practice of using fetal anesthesia for surgery or invasive diagnostic procedures in utero.”

L. Giuntini & G. Amato, Analgesic Procedures in Newborns., in NEONATAL PAIN 73 (Giuseppe Buonocore & Carlo V. Bellieni ed., 2007).

10.Van de Velde, 2012, pages 201-209, “To experience pain an intact system of pain transmission from the peripheral receptor to the cerebral cortex must be available. Peripheral receptors develop from the seventh gestational week. From 20 weeks’ gestation peripheral receptors are present on the whole body. From 13 weeks’ gestation the afferent system located in the substantia gelatinosa of the dorsal horn of the spinal cord starts developing. Development of afferent fibers connecting peripheral receptors with the dorsal horn starts at 8 weeks’ gestation. Spinothalamic connections start to develop from 14 weeks’ and are complete at 20 weeks’ gestation, whilst thalamocortical connections are present from 17 weeks’ and completely developed at 26–30 weeks’ gestation. From 16 weeks’ gestation pain transmission from a peripheral receptor to the cortex is possible and completely developed from 26 weeks’ gestation.

Marc Van de Velde & Frederik De Buck, “Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures,” Fetal Diagn Ther 31 (2012): 201–209.

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