Article Review – Answering the Pain Deniers

[http://www.doctorsonfetalpain.com/answering-the-pain-deniers/]

Answering the Pain Deniers is an online article which includes several endnotes of research documenting the answers provided to debunk three claims made by those who do not want to recognize a fetus’ ability to feel pain any earlier than they can elude. The responses are good summaries of the research, yet I found reading the quotes from the research to be better than the summaries. Here are some of my favorite quotes [with additional notes from me in brackets] from the article (but without their additional references included in that article), which I recommend you read for yourself, even though I still hold the experiential truth that babies can feel the pain of their deaths at less than eight weeks after being conceived. [Read Isaac’s Personhood Story and My Baby is in Heaven.]

Response to Claim 1 “. . .there is substantial medical evidence that in the brain it is the thalamus, rather than the cerebral cortex, that is principally responsible for pain perception. . .”

Response to Claim 2 “. . .fetal surgeons have found it necessary to sedate the unborn child with anesthesia to prevent the unborn child from thrashing about in reaction to invasive surgery. . .” [Read Article Review_The First Ache.]

Response to Claim 3 “. . .the claim of such consensus [that the unborn child does not experience pain until the third trimester] is based on publications by abortion practitioners and advocates, not independent and objective scientific sources, while it ignores substantial medical evidence to the contrary. . .. these sources were produced by strong abortion advocates – indeed, by abortion practictioners.”

Endnote 2 “’Movement of the fetus in response to external stimuli occurs as early as 8 weeks gestation [6 weeks post-conception] . . .’” [Read Book Review_A Child Is Born.]

Endnote 2 “’The earliest reactions to painful stimuli motor reflexes can be detected at 7.5 weeks of gestation [5.5 weeks post-conception] (Table 2).’”
 
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Endnote 3 “’Invasive fetal procedures clearly elicit a stress response…’”

Endnote 3 “’Fetal stress in response to painful stimuli is shown by increased cortisol and β-endorphin concentrations, and vigorous movements and breathing efforts.. . . There is no correlation between maternal and fetal norepinephrine levels, suggesting a lack of placental transfer of norepinephrine…’”

Endnote 4 “’Although we do not know exactly when the fetus can experience pain, noxious stimulation during fetal life causes a stress response, which could have both short- and long-term adverse effects on the developing central nervous system.’”

Endnote 4 “’This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment.’”

Endnote 4 “’It is becoming increasingly clear that experiences of pain will be ‘remembered’ by the developing nervous system, perhaps for the entire life of the individual.. . . These findings should focus the attention of clinicians on the long-term impact of early painful experiences, and highlight the urgent need for developing therapeutic strategies for the management of neonatal and fetal pain.’”

Endnote 5 “’. . .the stress response to noxious stimulation is clear evidence that the fetal nervous system is reactive. Administration of fetal anesthesia has been the standard practice since the inception of fetal surgery more than 25 years ago, and it is practiced worldwide. The importance of fetal immobility, cardiovascular homeostasis, analgesia, and perhaps, amnesia have always been emphasized in fetal surgery practice.’”

Endnote 5 “’ The anaesthesiologist is required to provide both maternal and fetal anaesthesia and analgesia while ensuring both maternal and fetal haemodynamic stability…Since substantial evidence exists demonstrating the ability of the second trimester fetus to mount a neuroendrocrine response to noxious stimuli…fetal pain management must be considered in every case.’. . . ‘A substantial amount of. . .research demonstrated that the fetus is able to mount a substantial neuroendocrine response to noxious stimuli as early as the second trimester of pregnancy. Fetal neuroanatomical development further substantiates this research. Evidence also exists that suggests that these responses to noxious stimuli may, in fact, alter the response to subsequent noxious stimuli long after the initial insult. This is the rationale behind providing fetal anaesthesia and analgesia whenever surgical intervention is thought to potentially provide a noxious insult to the fetus.’”

Endnote 5 “’Despite ongoing debate regarding fetal capacity for pain perception, fetal anesthesia and analgesia are warranted for fetal surgical procedures.’”

Endnote 6 “’The evidence and functional arguments reviewed in this article are not easily reconciled with an exclusive identification of the cerebral cortex as the medium of conscious function… The tacit consensus concerning the cerebral cortex as the “organ of consciousness” would thus have been reached prematurely, and may in fact be seriously in error.’”

Endnote 7 “’Indeed, there is evidence that hydranencephanic children responds to painful and pleasurable stimuli in a coordinated manner similar to other children.11’”

Endnote 7 “’ My impression from this first-hand exposure to children with hydranencephaly confirms. . . .[T]hese children are not only awake and often alert, but show responsiveness to their surroundings in the form of emotions or orienting reactions to environmental events… They express pleasure by smiling and laughter, and aversion by “fussing,” arching of the back and crying (in many gradations), their faces being animated by these emotional states.’”

Endnote 8 “’ Penfield and Jasper note that cortical removal even as radical as hemispherectomy does not deprive a patient of consciousness, but rather of certain forms of information, discrimination capacities, or abilities, but not of consciousness itself… What impressed Penfield and Jasper was the extent to which the cerebral cortex could be subjected to acute insult without producing so much as an interruption in the continuity of consciousness. Their opinion in this regard bears some weight, in that their magnum opus of 1954 – Epilepsy and the Functional Anatomy of the Human Brain – summarizes and evaluates experience with 750 such operations.’”

Endnote 8 “It seems that consciousness can persist even when great quantities of the cortex are absent.’”

Endnote 9 “’Newborn infants show strong pain behaviour, but the study of the development of nociceptive pathways shows that their pain involves functional signaling pathways that are not found in the mature nervous system in healthy individuals.’”

Endnote 9 “’Clinical and animal research shows that the fetus or neonate is not a “little adult,” that the structures used for pain processing in early development are unique and different from those of adults, and that many of these fetal structures and mechanisms are not maintained beyond specific periods of early development. The immature pain system thus uses the neural elements available during each stage of development to carry out its signaling role.’”

Endnote 9 ‘”[P]ain perception during fetal and neonatal development does not necessarily involve the same structures involved in pain processing as those in adults, meaning that the lack of development of certain connections is not sufficient to support the argument that fetuses can not feel pain until late gestation.. . . Some say even that the structures used for pain processing in the fetus are completely different from those used by adults and that many of these structures are not maintained beyond specific periods of early development.. . .’”

 

Article Review – The First Ache

The First Ache by Annie Murphy Paul on 2/10/2008, Discussed here: http://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html

This article was shared with me on Facebook by a poster who had researched more into the topic of fetal pain. It is one thing to experience something for oneself and declare it to be true in spite of the naysayers. It is another thing to begin to realize that there are others out there who are beginning to discover these truths scientifically. The First Ache is not totally one-sided, but it is (somewhat) reassuring to begin receiving scientific validation for what we experience. In the hopes of encouraging you to read the article for yourself, here are some of my favorite quotes:

“Merker included his observations of these children in an article, published last year in the journal Behavioral and Brain Sciences, proposing that the brain stem is capable of supporting a preliminary kind of awareness on its own. ‘The tacit consensus concerning the cerebral cortex as the “organ of consciousness,”’ Merker wrote, may ‘have been reached prematurely, and may in fact be seriously in error.’”

“The possibility of consciousness without a cortex may also influence our opinion of what a fetus can feel. Like the subplate zone, the brain stem is active in the fetus far earlier than the cerebral cortex is, and if it can support consciousness, it can support the experience of pain. … Anand praises Merker’s work as a “missing link” that could complete the case for fetal pain.” [Read Book Review_A Child Is Born.]

Preterm infants in NICU returning from operations “came back in terrible shape: their skin was gray, their breathing shallow, their pulses weak. Anand spent hours stabilizing their vital signs, increasing their oxygen supply and administering insulin to balance their blood sugar. . .. ‘That’s when I discovered that the babies were not getting anesthesia,’ he recalled recently. Infants undergoing major surgery were receiving only a paralytic to keep them still. . .. Doctors were convinced that newborns’ nervous systems were too immature to sense pain, and that the dangers of anesthesia exceeded any potential benefits.”

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“In a series of clinical trials, he demonstrated that operations performed under minimal or no anesthesia produced a “massive stress response” in newborn babies, releasing a flood of fight-or-flight hormones like adrenaline and cortisol. Potent anesthesia, he found, could significantly reduce this reaction. Babies who were put under during an operation had lower stress-hormone levels, more stable breathing and blood-sugar readings and fewer postoperative complications. Anesthesia even made them more likely to survive. Anand showed that when pain relief was provided during and after heart operations on newborns, the mortality rate dropped from around 25 percent to less than 10 percent. These were extraordinary results, and they helped change the way medicine is practiced. Today, adequate pain relief for even the youngest infants is the standard of care. . .”

“Recent research. . .. It shows that pain may leave a lasting, even lifelong, imprint on the developing nervous system. . .. Infants, and perhaps fetuses, may do something different with pain: some research suggests they take it into their bodies, making it part of their fast-branching neural networks, part of their flesh and blood.”

“In a study of 87 baby boys, Taddio found that those who had been circumcised soon after birth reacted more strongly and cried for longer than uncircumcised boys when they received a vaccination shot four to six months later. Among the circumcised boys, those who had received an analgesic cream at the time of the surgery cried less while getting the immunization than those circumcised without pain relief.”

“Early encounters with pain may alter the threshold at which pain is felt later on, making a child hypersensitive to pain — or, alternatively, dangerously indifferent to it. Lasting effects might also include emotional and behavioral problems like anxiety and depression, even learning disabilities (though these findings are far more tentative).”

“But research. . .showed that fetuses as young as 18 weeks react to an invasive procedure with a spike in stress hormones and a shunting of blood flow toward the brain — a strategy, also seen in infants and adults, to protect a vital organ from threat. . .. He selected 45 fetuses that required a potentially painful blood transfusion, giving one-third of them an injection of the potent painkiller fentanyl. As with Anand’s experiments, the results were striking: in fetuses that received the analgesic, the production of stress hormones was halved, and the pattern of blood flow remained normal.” [Read Article Review_We Treat Babies Before They’re Born.]

“When the surgeon lowered his scalpel to the 25-week-old fetus, Paschall saw the tiny figure recoil in what looked to him like pain. . .. ‘I don’t care how primitive the reaction is, it’s still a human reaction,’ Paschall says. ‘And I don’t believe it’s right. I don’t want them to feel pain.’” [Read Article Review_Answering the Pain Deniers.]

“The fetus’s undeveloped state, in other words, may not preclude it from feeling pain. In fact, its immature physiology may well make it more sensitive to pain, not less: the body’s mechanisms for inhibiting pain and making it more bearable do not become active until after birth.” [Read My Baby is in Heaven.]

“The capacity to feel pain has often been put forth as proof of a common humanity. Think of Shylock’s monologue in ‘The Merchant of Venice’: Are not Jews ‘hurt with the same weapons’ as Christians, he demands. ‘If you prick us, do we not bleed?’ Likewise, a presumed insensitivity to pain has been used to exclude some from humanity’s privileges and protections.”

It is also interesting to note that a reader’s comment to this article shared a personhood experience the mother, W. S., had with her child: “As a mother, I was disappointed to read that “the starts and kicks felt by a pregnant woman” are mere reflexes, according to David Mellor. Doesn’t he realize that babies in the womb sometimes play with their mothers? Mother pokes baby, baby kicks back. Mother pokes twice, baby kicks twice….” [Read more Personhood Stories.]