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2: Documentation

2: By 8 weeks after fertilization, the unborn child reacts to touch.  After 20 weeks, the unborn child reacts to stimuli that would be recognized as painful if applied to an adult human, for example by recoiling.

DOCUMENTATION:

a. By 8 weeks after fertilization, the unborn child reacts to touch.

1. Gupta, 2008, p.74, col.2, para.2, “Movement of the fetus in response to external stimuli occurs as early as 8 weeks gestation…”

Gupta R, Kilby M, Cooper G. Fetal surgery and anaesthetic implications. Continuing Education in Anaesthesia, Critical Care & Pain. 8:2 (2008) 71-75.

2. Glover, 2004, p.36, para.4, “The fetus starts to make movements in response to being touched from eight weeks, and more complex movements build up, as detected by real time ultrasound, over the next few weeks.”

Glover V. The fetus may feel pain from 20 weeks; The Fetal Pain Controversy. Conscience. 25:3 (2004) 35-37.

3. Myers 2004, p.241, para.6, “A motor response can first be seen as a whole body movement away from a stimulus and observed on ultrasound from as early as 7.5 weeks’ gestational age. The perioral area is the first part of the body to respond to touch at approximately 8 weeks, but by 14 weeks most of the body is responsive to touch.”

Myers LB, Bulich LA, Hess, P, Miller, NM. Fetal endoscopic surgery: indications and anaesthetic management. Best Practice & Research Clinical Anaesthesiology. 18:2 (2004) 231-258.

4. Derbyshire, 2008, p.119, col.2, para.4, “Responses to touch begin at 7–8 weeks gestation when touching the peri-oral region results in a contralateral bending of the head. The palms of the hands become sensitive to stroking at 10-11 weeks gestation and the rest of the body becomes sensitive around 13-14 weeks gestation.35

Note: Derbyshire’s other published works indicate that he believes pain requires subjective human experience, not possible until after birth; nonetheless, he acknowledges this finding.

Derbyshire SW. Fetal Pain: Do We Know Enough to Do the Right Thing? Reproductive Health Matters. 16: 31Supp. (2008) 117-126.

35Fitzgerald M. Neurobiology of fetal and neonatalpain. In:Wall P, Melzack R, editors. Textbook of Pain. Oxford Churchill Livingstone, 1994. p.153–63.

5. Kadić, 2012, page 3, “The earliest reactions to painful stimuli motor reflexes can be detected at 7.5 weeks of gestation (Table 2).”

Salihagić Kadić, A., Predojević, M., Fetal neurophysiology according to gestational age, Seminars in Fetal & Neonatal Medicine. 17:5 (2012) 1–5, 3.

b. After 20 weeks, the unborn child reacts to stimuli that would be recognized as painful if applied to an adult human, for example by recoiling.

1. Gupta, 2008, p. p.74, col.2, para.2, “Behavioural responses… Response to painful stimuli occurs from 22 weeks gestation [= 20 weeks post-fertilization].”

Gupta R, Kilby M, Cooper G. Fetal surgery and anaesthetic implications. Continuing Education in Anaesthesia, Critical Care & Pain. 8:2 (2008) 71-75.

2. Giannakoulopoulos, 1994, p.77, col.2, para.3, “We have observed that the fetus reacts to intrahepatic vein needling with vigorous body and breathing movements, which are not present during placental cord insertion needling.”

Giannakoulopoulos X, Sepulveda W, Kourtis P, Glover V, Fisk NM. Fetal plasma cortisol and β-endorphin response to intrauterine needling. Lancet. 344 (1994) 77-81.

3. Lowery, 2007, p.276, col.2, para1, “Fetuses undergoing intrauterine invasive procedures, definitely illustrative of pain signaling, were reported to show coordinated responses signaling the avoidance of tissue injury.15

Lowery CL, Hardman MP, Manning N, Clancy B, Hall RW, Anand KJS.  Neurodevelopmental Changes of Fetal Pain. Seminars in Pernatology. 31 (2007) 275-282.

15Williams C.  Framing the fetus in medical work: rituals and practices. Social Science & Medicine.  60 (2005) 2085-2095.

4. Mellor, 2005, p.457, col.1, para.2, “For instance, the human fetus responds to intrahepatic needling (versus umbilical cord sampling) by moving away and with an increase in the levels of circulating stress hormones. . .71,72,74,75

Note: Mellor et al. believe that the unborn child is kept ‘asleep’ in utero, and therefore does not perceive pain; nonetheless, they recognize this finding.

Mellor DJ, Diesch TJ, Gunn AJ, Bennet L. The importance of ‘awareness’ for understanding fetal pain. Brain Research Reviews.  49 (2005) 455-471.

71 Giannakoulopoulos X, Sepulveda W, Kourtis P, Glover V, Fisk NM. Fetal plasma cortisol and β-endorphin response to intrauterine needling. Lancet. 344 (1994) 77-81.

72Giannakoulopoulos X, Teixeira J, Fisk N. Human fetal and maternal noradrenaline responses to invasive procedures. Pediatric Research.  45 (1999) 494-499.

74Gitau R, Fisk NM, Teixeira JM, Cameron A, Glover V. Fetal hypothalamic–pituitary–adrenal stress responses to invasive procedures are independent of maternal responses.  Journal of Clinical Endocrinology and Metabolism.  86 (2001) 104-109.

75Gitau R, Fisk NM, Glover V. Human fetal and maternal corticotrophin releaseing hormone responses to acute stress. Archives of Disease in Childhood – Fetal Neonatal Edition. 89 (2004) F29-F32.

5. Bocci, 2007, page 31-32, “By week 14, the repertoire of movements is complete. Fetal movements may be spontaneous, reflecting individual needs of the fetus, or may be evoked, reflecting fetal sensitivity to its environment.”

C. Bocchi et al, Ultrasound and Fetal Stress: Study of the Fetal Blink-Startle Reflex Evoked by Acoustic Stimuli. Neonatal Pain, ed. Giuseppe Buonocore & Carlo V. Bellieni (Milan: Springer, 2007), 31–32.

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