(LifeSiteNews) — Fetal therapy is a branch of medicine that provides pharmacologic and surgical interventions to treat diseases and birth defects in the unborn child. The emergence and continued growth of this specialty, which treats the unborn child as a person, is aligned with Catholic moral principles, and stands in stark contrast to cultural elites’ radical embrace of abortion on demand.
The Catechism of the Catholic Church speaks of the obligation to treat unborn children as persons from fertilization: “Since it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being” (n. 2274). This is how physicians in obstetrics, maternal-fetal medicine, fetal surgery and neonatal intensive care units around the world treat their unborn and/or prematurely born patients despite the pro-abortion rhetoric of several of their professional medical guilds. What follows is a brief overview of fetal therapy—the medical specialty whose mere existence challenges the ongoing depersonalization and killing of innocent, vulnerable unwanted human persons at the earliest stages of life.
Physicians caring for pregnant women often administer medications to the mother that will benefit both mother and child, or in some cases, will benefit the child alone without harming the mother. At least one author places the beginnings of fetal therapy in the late 1940s when it was discovered that treating maternal syphilis during pregnancy also prevents passage of the infection to her unborn child.[1] Prior to penicillin, congenital syphilis resulted in miscarriage, stillbirth, and/or devastating neurologic and multisystem disease in children. Prenatal vitamin use by pregnant women is another example of successfully treating both patients by medicating the mother. Nutritional needs are increased during pregnancy. Suboptimal nutrition in pregnant women is associated with both maternal complications and significant infant health problems. Promotion of prenatal vitamins for pregnant women began in the 1980s, and their importance in the prevention of birth defects was acknowledged internationally by the 1990s. Remarkably, prenatal vitamin use by pregnant women significantly reduces the risk of their babies developing brain, spine, cardiac, oro-facial, pulmonary, placental and many other abnormalities.[2]
Three examples in which pregnant women may be provided medication solely for the benefit of their unborn children include the RhoGam vaccine, corticosteroid injections, and progesterone. For over five decades, RhoGam has been given to Rh negative women to prevent Rh disease in their future Rh positive babies.[3] Once an Rh negative woman’s immune system is sensitized, usually during delivery of her first Rh positive infant, she will generate antibodies against the blood cells of future Rh positive unborn infants. These maternal antibodies can cross the placenta and destroy the red blood cells of a future Rh positive unborn child leading to the infant’s miscarriage, brain damage, or newborn death. Similarly, pregnant women at risk for preterm delivery may receive progesterone to prevent preterm labor and corticosteroid injections to accelerate the lung development of their unborn children.[4],[5]
Fetal surgery refers to surgical interventions performed on unborn infants in the womb (in utero) to treat diseases and birth defects of the infant prior to birth. Sir William Liley inaugurated the field in 1961 when he performed the first successful percutaneous fetal blood transfusion.[6] By 1964, direct transfusion of the unborn with open hysterotomy was accomplished.
Unfortunately, these pioneers were ahead of their time. Open hysterotomy was associated with high rates of morbidity and mortality, and therefore had to be abandoned by the late 1960’s. This setback, however, did not deter the compassion, imagination, and grit of Dr. Michael Harrison, a surgical intern at Massachusetts General Hospital in 1969. Dr. Harrison had assisted his mentor Dr. Hardy Hendren with a congenital diaphragmatic hernia (CDH) repair in a newborn infant. Despite receiving the best surgical and post-operative care available and the young Dr. Harrison’s all night vigil in the neonatal intensive care unit, the baby died the next day. Losing that baby ignited his belief that these disorders must be repaired before birth and eventually led him to University of California San Francisco (UCSF) where he made correction of CDH central to the development of modern fetal surgery. Diagnostic prenatal imaging, anesthesia and other supportive measures, as well as animal models for treatment of human fetal defects, developed in tandem throughout the 1970s and were optimal for fetal surgery to emerge in the early 1980s.6 Within the first six months of 1982, Harrison and surgical colleagues at UCSF inaugurated that institution’s Fetal Treatment Program by successfully repairing two cases of lower urinary tract obstruction and a case of hydrocephalus in utero.6
Harrison and his UCSF team were keen to ensure that this newly conceived specialty was not merely promising, but also proven. In July of 1982, they convened the first international meeting of physicians and scientists engaged in researching the promise of fetal surgery. This multidisciplinary group included 24 experts from 13 centers representing 5 countries and was entitled “Unborn: Management of the fetus with a correctable congenital defect.” The group successfully shared research, facilitated the creation of national registries for outcomes, led to the publication of the first textbook in the field, led to the eventual foundation of a professional journal (Fetal Diagnosis and Therapy), and published a set of ethical guidelines. These guidelines remain the foundation for the ethical practice of fetal surgery today. [cf Table 2 from citation #6] By 1987 this group formally incorporated as the International Fetal Medicine and Surgery Society (IFMSS).6
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Today fetal treatment centers around the world possess the expertise to treat a wide variety of previously debilitating birth defects including but not limited to amniotic band syndrome, bronchopulmonary sequestration of the lung, congenital cystic adenomatoid malformation of the lung, congenital diaphragmatic hernia, congenital high airway obstruction syndrome, fetal anemia, lower urinary tract obstruction, mediastinal teratoma, neck mass, sacrococcygeal teratoma, spina bifida, twin anemia-polycythemia sequence, twin reversed arterial perfusion sequence, and twin-twin transfusion syndrome.[7],[8]
The success of fetal surgery, however, would not be what it is today without concomitant advances in another medical specialty: anesthesia and pain management. Shockingly, prior to the late 1980s, surgeries on newborns less than one month old (neonates) were mostly performed without anesthesia because, their cries notwithstanding, neonates were thought to lack the neurological maturity to perceive pain.[9] Fortunately, in 1987 Drs. Anand and Hickey published an article in the New England Journal of Medicine that disabused the field of pediatrics of this cruel practice. They documented the growing body of research that demonstrated painful procedures in both preterm and full-term neonates elicit significant negative physiological changes which also had potentially long-term negative implications. Hence, they recommended changing the standard of care in favor of providing local and general anesthesia to all neonates during invasive procedures.[10]
There was still some question about the need to provide anesthesia to children in utero, however, because the intrauterine environment contains a group of endocrine neuroinhibitors and was believed to provide natural anesthesia to the fetus. In 2001 this question was definitively answered for fetuses 25 weeks and older by Dr. Gitau and colleagues who documented the physiologic responses of unborn children who required in-utero blood transfusions. They found that unborn children who received their transfusions through the placental cord insertion site which lacks nerves had no increase in physiologic stress hormones or markers. In contrast, unborn children who received their transfusions into their hepatic vein, which required piercing their abdomen with a needle, had significant increases in their stress hormones and markers.[11]
By 2020, experts in fetal pain research agreed that a preponderance of evidence suggests that pain perception does not require the cortex. Consequently, unborn children as young as 12 weeks gestation have a brain and nervous system which can experience pain and produce an immediate non-reflexive pain response.9 Were it not for the worldwide ideologically driven and hugely profitable abortion industry this fact would be common knowledge. Instead, the masses, including too many physicians, remain ignorant of this. What is worse is that scientists have known for at least the last decade that unborn children and preterm infants have a lower pain threshold than adults. Far from being less vulnerable to noxious stimuli, the immature nervous system of the unborn (and born premature infants) is hypersensitized to painful interventions due to an imbalance between inhibitory and excitatory supraspinal controls among other factors.[12],[13]
Fortunately, anesthesiologists at fetal therapy centers are keenly aware of the importance of pain and sedation management for both mothers and their unborn children during fetal surgery. These anesthesiologists play a crucial role in the risk assessment of both patients, facilitate multidisciplinary coordination, and maintain maternal and fetal homeostasis which optimizes conditions for their surgical colleagues.[14]
To recapitulate, fetal therapy is a branch of medicine that provides pharmacologic and surgical interventions to treat diseases and birth defects in unborn children. Physicians and health professionals in this field care for and strive to heal unborn children, as far as possible, just as they would all other human persons. In practice, this is aligned with Catholic moral principles and stands in stark contrast to the radical abortion on demand zeitgeist of Western elites. Professionals and laypeople alike would do well to educate themselves and others of this medical specialty whose existence challenges the ongoing depersonalization and killing of innocent unwanted human persons at the earliest stages of life.
This article was originally published in the John Paul II Academy for Human Life and the Family’s Academy Review in November 2024. Republished here with permission
[1] Queenan, J. “The Fetus as a Patient: The Origin of the Specialty.” National Academy of Sciences (1994). Accessed 10/3/24. Available at: https://www.ncbi.nlm.nih.gov/books/NBK231999/#:~:text=Before%20the%20last%20half-century%2C%20the%20fetus%20in%20the,congenital%20effects%20of%20the%20disease%20in%20their%20offspring
[2] Adams, J.B., Kirby, J.K., Sorensen, J.C. et al. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. matern health, neonatol and perinatol 8, 4 (2022).
[3] Neighbor, J.”RhoGam at 50: a Columbia Drug Still Saving Lives of Newborns.”(Feb. 2018) Accessed 10/3/24 Available at: https://www.cuimc.columbia.edu/news/rhogam-50-columbia-drug-still-saving-lives-newborns
[4] Di Renzo GC, Tosto V, Tsibizova V, Fonseca E. Prevention of Preterm Birth with Progesterone. J Clin Med. 2021 Sep 29;10(19):4511.
[5] McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020 Dec 25;12(12):CD004454.
[6] Evans L. and Harrison M. Modern fetal surgery—a historical review of the happenings that shaped modern fetal surgery and its practices. Transl Pediatr 2021;10(5):1401-1417.
[7] Mayo Clinic. “Overview of Fetal Surgery.” (March 2021). Accessed 10/4/24. Available at: https://www.mayoclinic.org/tests-procedures/fetal-surgery/about/pac-20384571
[8] Yale Medicine. “Fetal Therapy.” Accessed 10/4/24. Available at: https://www.yalemedicine.org/conditions/prenatal-diagnosis
[9] Derbyshire SW, Bockmann JC. Reconsidering fetal pain. J. Med. Ethics. 2020: 46(1):3.
[10]Anand KJS, Phil D, Hickey PR. Pain and its effects in the human neonate and fetus. NEJM. 1987;317:1321-1329.
[11]Gitau R, Fisk NM, Teixeira JM, et al. Fetal hypothalamic-pituitary-adrenal stress responses to invasive procedures are independent of maternal responses. J. Clinc. Endocrinol & Metab. 2001;86(1):104-9.
[12] Hatfiled L. Neonatal pain: What’s age got to do with it? Surgical Neurology International. 2014; 5(14): 479.
[13] Fitzgerald M, Walker SM. Infant pain management: A developmental neurobiological approach. Nat. Clin. Pract. Neurol. 2009; 5(1):35-50.
[14] Nath G, Subrahmanyam M, Jayanthi R, Singh R, Ramesh S, Ahuja V. Recent advances in anaesthesia for intrauterine and foetal surgery. Indian J Anaesth. 2023 Jan;67(1):11-18.