Earlier this year, scientists published a study that detailed the successful use of an artificial uterus to bring shark embryos to term. Once ‘birthed’ the shark pups showed no detrimental effects as a result of having gone through development in an artificial setting.
Research such as this ignites interest in the possibility of creating artificial wombs for the purpose of human reproduction. After all – artificial hearts, kidneys and lungs are all available and becoming increasingly sophisticated. It is surely only a matter of time before artificial wombs, capable of growing and developing a foetus outside the human body, are technologically feasible.
This raises the question of whether we should promote research aimed at shifting the location of foetal development to outside the human body. As a way of approaching some of the issues surrounding this prospect let’s consider a hypothetical scenario.
Imagine another world where a species exists which is identical to Humans in nearly every way – let’s call them Birmans. The major is difference between Humans and Birmans is evolutionary history. Rather than evolving from mammals, Birmans happened to have evolved from birds. As a result nearly all of the development and growth of Birman foetuses occurs outside their body in eggs. Now imagine Birman scientists are on the verge of developing an intervention which would make it feasible to shift the development of Birman foetuses from the external egg to inside their bodies in a womb. As a result of this development a group of Birman policy-makers discuss the possible costs and benefits of changing the location of foetal development to inside the body.
The first cost they identify is equality. Currently both Birman sexes have an equal role in the development of foetuses. This would be fundamentally changed if foetal development occurred inside the body. This is because, for physiological reasons, internal pregnancies would only be viable in females. Therefore all of the potential costs or benefits associated with nurturing a foetus inside the body would be available to just one sex.
The next set of concerns that the Birmans outline involves health and safety. An individual’s body would be changed significantly to accommodate a developing a foetus. Abdominal muscles would be separated, skin would be stretched, and extra strain would be placed on blood vessels. This would increase the risk of a range of mild health conditions and could cause long term damage to the muscles and skin.
More significantly – the birthing of the baby once it is fully developed would likely be difficult for some Birman women. The only way the fully developed foetus could leave the body without surgery is through the pelvis. However, as a result of evolutionary adaptations for bipedalism, the Birman pelvis is relatively small and the heads of Birman infants are relatively large. Therefore, birth is expected to be risky for some women and result in ongoing complications such as incontinence and internal tissue tearing. In fact scientists estimate that in approximately 15% of cases the baby would not be able to leave the body naturally and surgery would be required. This surgery would carry with it a small risk of paralysis and death for the mother.
The next concern identified by the Birmans involves liberty. Given foetuses are highly sensitive to disturbances, growing one inside someone’s body would restrict that individual’s ability to engage in a range of activities. For instance, a pregnant woman would not be able engage in very strenuous exercise, play certain sports, drink much caffeine or alcohol, or take certain medications – without endangering the foetus. Hormone changes at the beginning of pregnancy would sometimes result in nausea, and the extra energy requirements toward the end of pregnancy would lead to lethargy. Hence, for the 9 months while the foetus was developing, significant liberty constraints would be placed on individuals.
The final cost of internal pregnancies that the Birman identify is the safety of the foetus. Some individuals would be unlikely to stop themselves from consuming drugs and alcohol while the foetus is developing, and this could result in permanent damage. In fact it is estimated that if the intervention was widespread, individuals drinking alcohol while pregnant would become one of the leading causes of developmental problems in Birman children. The birth is also expected to be risky for Birman infants. Nerve damage, infections, and dystocia are all possible complications associated with birth from an internal pregnancy.
When considering the possible benefits of moving foetal development to inside the body, some postulate that it would increase the bond between the child and their mother. While this is a possible benefit, the extent to which a child would be more bonded to a mother as a result of an internal pregnancy is unclear. Some note that often parents who are not biologically related to their children are able to form strong bonds with them.
In this hypothetical scenario, Birman policy-makers would likely decide against endorsing research aimed at moving foetal development inside their bodies. Given the potential costs outlined above, we wouldn’t expect creatures with our biological characteristics to choose to develop their foetuses inside their bodies if this wasn’t their ‘natural’ mode of development. This suggests some reasons why we should encourage research into artificial wombs. The reason that human foetuses develop inside the body of their mothers is evolutionary history – we have evolved from a long line of species who nurtured their young internally. While this probably made sense for the first placental mammals, humans today are very different from these ancestors. We walk on two legs, have large brains, and don’t need to worry about predators eating eggs containing our young. For creatures with the characteristics of modern humans, growing babies outside the body may be a practical and sensible option.
“Do you know the way to St Ives?”
“Oh ar, but I wouldn’t start from here!”
But we do start from here when it comes to wombs.
Are we to imagine that in future all babies would be “grown” in artificial wombs? Oh brave new world! And they would be so much easier to harvest for parts, too!
Quite apart from horror story scenarios (and there’s usually someone willing to push ethical boundaries), we should not discount the social bonding of pregnancy, both for the mother, but also the parents/extended family as they see he bump grow, and start to get used to their changed circumstances. The baby is surely a member of the family at least as soon as there is a picture of it, in most cases. We need to be pretty sure about the wider implications before going down this path.
Or do we think that these artificial wombs would only be used in exceptional cases? What would these be? Only those rich enough, and too posh to push? Or medical needs? Which needs exactly? This is not like artificial kidneys and hearts where existing lives are at stake. Perhaps a near-full term baby might be transferred to an artificial womb to finish developing where there was serious risk of death to mother of child, but this is a long way from conception to birth development in vitro, a very diffreent level of technology.
Surely the research effort and money would be better spent on other ways to make pregnancy and birth safer.
Aside from the ethics of humans as spare parts, your assertion that there is something to be said for the value of “watching the bump grow” is still the case with an artificial womb. I can imagine a scenario in the future where a young couple waiting for their child to be born goes to the Birthing Center and visits with the growing fetus. Maybe the father-to-be reads to it, maybe the mother sings to it, but they look as valuable the time spent with their growing child, the bump is just in a different place than where it used to be.
To address your secondary concerns; this is the product cycle of all advancements. First the rich are the only ones who can afford them, then the research continues, costs go down and more and more people are able to afford it. We’ve seen this happen in everything from TV’s and microwaves to gene sequencing. I’m guessing that like with most technologies this will be seen as an option, not a right — it’s just that the option will become more and more attractive as time goes on. Given the costs of doctor visits, parental downtime and loss of income from sickness/giving birth and finally hospital costs/concerns. The option to just use an artificial womb and bypass those concerns for the delivery of a healthy baby would just be too attractive an option for a lot of couples.
As for your last quip, these sorts of statements drive me up the wall. Given that the infant mortality rate is already ~5 deaths per 1000 births (in the US), throwing more money at it is only going to make it marginally safer. You’re essentially arguing that we should make seatbelts in cars safer and ignore other safety improvements the could be made, especially given that an artificial womb would be immensely safer than a pregnancy & natural birth — 100% safe in the case of the mother. We would do best to invest research and money in all avenues of making the carrying and birthing of children safer.
At present, watching the bump grow happens all the time, rather than just when the parents can fit a trip to the birthing centre into their schedule. It makes its presence felt by wriggling later on, insisting on attention. This is a preparation for the demands of parenthood. Unless of course we want to encourage the kind of parenting which consists in dropping a child off with a child-minder early in the morning and collecting it at a convenient time when only a few minutes of attention need be given it before bed – thus avoiding all the stress and inconvenience of having children.
But giving oneself to another, even when it is stressful and inconvenient, is part of loving that other. Surely a well functioning society is based on this kind of thing.
I can’t believe this could ever be cheap enough for all in society. So the already wealthy can avoid any impact on their economic activity, whilst the already disadvantaged fall further behind. Wealth inequality grows yet further, and society grows more unhappy and unstable.
And 5 in 1000 could be lowered; that doesn’t include cases where there is harm other than death. With better monitoring and diagnosis things could be improved and made cheaper – and these improvements would have a much greater impact on the poorest parents, who cannot afford expensive pre-natal care.
An additional point – pregnancy and birth prepare the mother for breast-feeding, which is vastly superior to bottle-feeding for the physical, mental and emotional health and development of the child. Surely we want to encourage it, rater than make it harder.
I’m not really sure if argument like “in book was used XY and the society described there was bad, therefore we should avoid XY” is really useful…
Well, you can ban artificial wombs in order to prevent this. But the harvesting is already banned, so it would be illegal either.
Good point, I’ll think about it :).
As already stated, you can apply this to bicycles (rich can buy a bike and continue with their business much faster than poor people who still need to carry their products to the market by walking), books, computers or almost every invention in the last 1000 years.
Yes, this is serious concern. Let’s imagine that our Birman scientists fixed this somehow :).
Thanks for your comments Jenda.
I was of course using hyperbole in my “Brave new world” and harvesting comments, but in order to highlight the fact that the development of artificial wombs could have much more far-reaching implications then we might first think. These ought at least to be considered in an ethical discussion forum. Just because we can, doesn’t mean we should. Are the horror story scenarios more than just the product of fevered imaginations? On this I’d like to say a qualified “maybe” rather than a “no.”
You are correct that bicycles can have such an impact, as can many other things. But whereas in the UK at least a brand new bike can easily be purchased for a couple of day’s wages (about £100), I can’t imagine the technology for artificial wombs would ever be that easily accessible. A quick search found an incubator for premature babies at £25,000, and that is relatively simple technology these days. How much would a womb be, just for the equipment, without even adding all the nutrients and other stuff that would need to be put in?
And yes, of course, there might be a way to sort the breast-feeding hing, but again I ask – is this really the best way to spend the limited budgets of scientific researchers?
My sister’s womb leaked Her Baby was grossly underweight less than a pound he died in days. She died on the operating table and was revived only to watch her son die. Bernard Randall your wrong.
I would argue against the artificial womb on the basis that already where internal wombs are the only option, there is already intense agitation by religious nuts to control how women live and what they do with their bodies during gestation from even the embryonic stage. I can’t imagine what level of squabbling there would be in the Birman world over the rights of the artifically grown Birman through these stages. Which parent would have legal custody over the womb and who would be able to sue for improper housing or even murder of the external womb?
In the context of disaster risk reduction surely a whole population of artificially grown Birmans could be wiped out in the event of a flood or power outage? Have you considered the comparative safety of the artificial womb to the internal one?
What about Birmans grown with visible defects? On what basis would there be a right to terminate? At least in the internal womb there is a level of unknown to protect the rights of the disabled? Surely disabled Birman would face a high risk of being killed? Especially in the context of a world where growing your own foetus was so easy. If as you suggest, the human body is smart enough to look after the artificial Birman than overpopulation would be a worry and disabled Birman fetuses would be at immense risk?
GREAT post.
For xenogestation see Savulescu, J. ‘Genetically Modified Animals: Should There be Limits to Engineering the Animal Kingdom?’. In Beauchamp, T. and Frey, R. (eds) Oxford Handbook of Animals and Ethics. Oxford University Press (2011)
Thanks for your responses.
A few points:
Bernard – your point about there being some benefits to partners/families of being able to watch a child grow in the mother’s womb is a good one and these benefits should be considered when we are weighing the pros and cons of artificial wombs. Likewise – sometimes there are costs to third parties of internal pregnancies that should also be considered. Some women find pregnancy and birth difficult, and this can impact their partners/families – for example the stress placed on third parties when there are problems during the birth and long term health consequences for the mother/child as a result of this, can be significant.
Of course we should support all research aimed making birth and pregnancy safer, but some problems may be hard to solve through traditional research. For instance in the short term I can’t see a way of escaping the fact that humans have relatively small pelvises and infants have relatively large heads. This is one of the reasons why the historical maternal death rate during childbirth is so high and why rates of caesareans are so high in many countries today.
Paula – I think your comment about disaster risk is interesting, but not an insurmountable problem. At any one point in time there are countless people in hospitals whose lives are dependent on electronic devices and we seem to be able to manage these risks.
Further, I think the possibility of being able to identify foetal abnormalities early is actually a positive for artificial wombs. If we can identify problems early on, then there is more of an opportunity for early intervention. Foetal surgery is currently very difficult. We often have to wait for foetuses to be born before performing corrective heart surgery, for example. But if a foetus is housed in an artificial womb surgery may be easier to perform, which would increase his or her chance of achieving long term good health. This is another way in which artificial wombs may have health benefits for infants.
Julian – thanks for the reference!
I really like the way of argumentation in the blogpost.
I think this applies to “internal wombs” too, because without electricity, running water and some basic medical equipment we would propably return to 1800s child mortality rate.
Additionally, nobody wants to disable internal wombs. Therefore, a fallback exists in case of fatal civilization failure (global nuclear war etc.)
I would add that this problems come with “natural way” of birth too, as the prenatal screening is getting more and more advanced.
Interesting post.
I’ve previously written about artificial wombs on my blog, and touch on some of the issues raised by Paula:
http://experimentsofliving.wordpress.com/2012/03/06/artificial-wombs-infanticide-and-the-implications-for-abortion/
There seems to me to be a serious concern that artificial wombs could lead to foetuses that develop in them being granted different (greater) legal protection than those of ‘natural’ foetuses. This could in turn lead to pressure being put on women *not* to have ‘natural’ pregnancies. And those that do have natural pregnancies may be forced to undergo serious surgery in order to ‘rescue’ the foetus if the women decides she no longer wants to keep it in her womb, or if it turns out the foetus has a defect that can only be repaired outside the women’s body.
‘my comment is awaiting moderation’
hurry up and moderate it then!
Or don’t then. Whatever.
Moderation is indeed a fateful thing…
Excellent post – I think the potential benefits you describe far outweigh the negatives. I don’t see why such an approach would be any more controversial that gestational surrogacy. Funnily enough, when I was young and first heard about ‘test tube babies’, this is precicely what I thought was involved.
Interesting post , you might have read Henri Atlan “l’Uterus artificiel” and the following book ” des Embryons et des Hommes” (in french sorry!)where we adress this question. but haraway and feminist litterature adress this question as well why isnt’it taken seriously by bioethics litterature?
Mylene botbol baum
Interesting post and discussion.
With regard to the comments about social/bonding aspects of pregnancy: how much do we know about the role of pre-natal development on psychology? In this scenario, how sure are we that people who develop ‘ex vivo’ will be healthy psychologically, as well as physically? (I am not a developmental biologist, so maybe this question is moot). If we are not sure that we can induce ‘normal’ psychological development in our artificial babies, can we ever be justified in attempting such a procedure, given that the subjects cannot consent?
With artificial hearts (perhaps a more valuable anatomical part) and others available it is very likely that the “artificial” womb will be here sooner than later. Perhaps we can approach it carefully in measured steps. For example start a baby in the old usual way and in a few days or weeks transplant it to the birthing millieu with quite a few advantages, not the least the almost zero risk for the mother. The development could be carefully monitored (watch for the slippery slope of manipulations) for genetic diseases with the much easier possibility of fetal surgery.,etc. Parents would have more time to arrange work and finance and could keep close watch for bonding. And, ethically, if the conception was done the traditional way what could be the objections of the Churches et.al.??
Moderation is indeed a fatal thing…
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