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When Can A Fetus Feel Pain In The Womb?
Medical professionals are largely convinced a fetus can feel pain. However, finding out when they can first experience pain has proven both difficult
and controversial. The biological system allowing a fetus to feel pain develops early in pregnancy, but it takes weeks to fully connect the complex system
of neurons and cerebral structures that allow sensory organs to send pain messages that can be decoded by the brain. Although there is some
ambiguity and variation to how all of these pieces fit together, there is a broad consensus on when pain pathways are mature enough for a fetus
to feel pain. Luckily for most expecting parents, the issue only becomes pertinent in the rare cases where fetal surgery may be necessary, or when considering the ethics of abortion
What Science Says About When a Fetus Can Feel Pain
A 2005 multidisciplinary review of evidence published in the Journal of the American Medical Association (JAMA) looked into the subject
of fetal pain. Led by the University of California San Diego, researchers looked at 360 articles published in medical journals and concluded,
“Pain is a subjective sensory and emotional experience that requires the presence of consciousness to permit recognition of a stimulus as
unpleasant.” In other words, pain stimulus requires recognition. And recognition arrives at a very specific moment in fetal development.
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Touch is the first sense to develop, with receptors present in the fetus’ face by week 8. But it takes until week 12 for sensory receptors to develop in
palms and soles, and it’s not until week 17 that receptors are present in the abdomen. However, the fetus still needs to develop communication pathways to the brain.
Those pathways are long and complex, the JAMA study notes. Before week 24 nerves aren’t typically developed enough to carry information to
the spinal cord, and eventually, the brain’s cortex. The cortex that people perceive the feeling of pain.
But there’s a final piece to the puzzle: the connection between the cortex and the thalamus. That connection, according to researchers does not begin
to develop until around week 23 of pregnancy. The authors of the JAMA conclude that the fetal experience of pain likely becomes possible around
the 23rd week, but it’s more of a progression than an instantly realized ability.
A more recent Italian study, published in the journal Pediatric Research in 2020, analyzed 10 years of fetal pain studies and reached a similar conclusion.
However, that study links the ability to feel pain to the production of stress hormones. Researchers note, “The fetus in the second half of pregnancy,
in reaction to a potentially painful stimulus, produces stress hormones.”
So, based on available research, a fetus is likely able to start feeling some semblance of pain around week 23 of pregnancy.
Do Fetuses Feel Pain?
The law assumes that a fetus may be able to feel pain at that stage in development; how
ever, doctors groups and other critics of the law argue
that a fetus cannot feel pain at 20 weeks gestational age. Indeed, the American College of Obstetricians and Gynecologists (ACOG) said it
considers the case to be closed as to whether a fetus can feel pain at that stage in development.
“The science shows that based on gestational age, the fetus is not capable of feeling pain until the third trimester,” said Kate Connors, a spokesperson
for ACOG. The third trimester begins at about 27 weeks of pregnancy.
To find out more, Live Science dug into the research and spoke with a leading expert on fetal pain. Here’s a look at what we found.
The problem with pain
One reason the question of fetal pain is so controversial is because pain is always a subjective experience, said Dr. Anne Davis, an OB/GYN and
the consulting medical director for Physicians for Reproductive Health. Davis is an abortion provider.
Unlike with blood pressure or body temperature, for example, there’s no definitive way to measure pain, Davis said. People do have ways of
communicating how much pain they’re feeling; for example, doctors often ask people to rate their pain on a scale of 1 to 10. But the experience
of pain is fundamentally subjective, Davis said. In other words, what might be very painful to one person may cause very little pain to someone else.
Still, even though doctors can’t objectively measure pain, research has revealed much about how pain is experienced in the body and, more importantly, in the brain.
“Pain occurs in [the] brain,” Davis said. When a person is injured — say, you stub your toe, for example — a signal travels from the foot up
through the nerves in the leg to the spinal cord, and then from spinal cord up to the brain, Davis said. Once that signal gets into the brain,
the information is transmitted through a complex web of neurons to an area of the brain called the cortex, she said.
It’s in this sophisticated part of the brain that a person actually perceives the feeling of pain, Davis said.
“We know that there are a lot of steps in between the thing that could cause pain and the actual experience of pain,” Davis said. For the system to work
— whether in an adult or a fetus — all of the pathways of the nerves need to be connected and functioning, she said.
“What we can say about the fetal nervous system is that based on the best science we have” on the neurons that carry pain signals is that the
“system isn’t developed until the third trimester of pregnancy,” Davis told Live Science.
Scientists’ knowledge of the fetal nervous system was summed up in a 2005 review in the journal JAMA. The authors of that review outlined
in detail the evidence on how this system develops, based on a number of previous studies on the anatomy of the fetus at various stages of development.
Davis, who was not involved with that review, noted that though it was published in 2005, the research is still valid, because the scientific
community’s understanding of fetal development is “pretty much stable.” Indeed, since the publication of the review, “no research has
contradicted its findings,” said a recent statement from ACOG.
In the review, the researchers highlighted several key points in fetal development that are required in order for a fetus to perceive pain. One is that the receptors in the skin that sense an injury must be developed. Research has shown that this happens between 7.5 and 15 weeks of pregnancy, depending on the location of the receptors on the body, according to the review. For example, receptors in the skin around the mouth develop at around 7.5 weeks, whereas receptors in the skin on the abdomen develop at around 15 weeks, according to the review.