Pain

"Can the baby be given pain relief? No. Current research shows that the sensory structures are not developed enough or specialized enough to respond to pain in a fetus of less than 24 weeks. See question on ‘Will the fetus/baby feel pain?’ In later pregnancy, when the fetus/baby is over 24 weeks, we do not yet have enough knowledge to know if providing pain relief would be beneficial. This means that it is extremely difficult to know what kind of pain relief should be used, how any pain relief should be given and whether it would be safe and effective. If pain relief was to reach the baby inside the womb, this would mean giving the mother larger and potentially dangerous doses to try and make sure enough crossed the placenta to the baby. This may cause more harm than benefit. Injecting pain relief drugs directly into the baby would increase the risk of miscarriage."

"Will the baby suffer/feel pain? No, the fetus does not experience pain. In addition, increasing evidence suggests that the fetus never enters a state of wakefulness inside the womb and that the placenta produces chemicals that suppress nervous system activity and awareness. Feticide is always offered when an abortion is carried out after 21 weeks and 6 days, unless the fetal abnormality is lethal and will cause death of the fetus during or immediately after delivery. A doctor who is specially trained in fetal medicine carries out feticide. To ensure the baby is not born alive, the doctor will inject a solution of potassium chloride directly into the fetal heart. Before anything else is done, the fetal heart will be checked to ensure it has stopped. Death is extremely quick after feticide."

"Will the baby be in pain in the womb because of the condition that has been diagnosed? This is very unlikely. Current research shows that the sensory structures are not developed or specialised enough to respond to pain in a fetus of less than 24 weeks. Even after 24 weeks it is difficult to say that the fetus experiences pain, because this, like all other experiences, develops postnatally along with memory and other learned behaviours. Moreover, the environment of the womb is usually protective with the fetus floating in the warm amniotic fluid."

"The experience of pain needs cognitive, sensory, and affective components, as well as the necessary anatomical and physiological neural connections. Nociceptors first appear at 10 weeks of gestation in the fetus but they are not sufficient for the experience of pain in themselves. That requires that electrical activity is conducted from the receptors into the spinal cord and to the brain. Fibers to nociceptor terminals in the spinal cord have not been demonstrated before 19 weeks of gestation, although it is known that the fetus withdraws from a needle and may exhibit a stress response from about 18 weeks. At this stage, it is apparent that activity in the spinal cord, brain stem and mid-brain structures are sufficient to generate reflex and humoral responses but not sufficient to support pain awareness. At the same time, completion of the major neural pathways from the periphery to the cortex, at around 24 weeks of gestation, heralds the beginning of further neuronal maturation. The proliferation of cortical neurons and synaptic contacts begins prenatally but continues postnatally. Magnetic imaging techniques have recorded fetal auditory and visual responses from 28 weeks but it has not been possible to record directly when cortical neurons first begin to respond to tissue damaging inputs, although there is evidence of neural activity in primary sensory cortex in premature infants (around 24 weeks). It has been suggested that subcortical regions can organise responses to noxious stimuli and provide for the pain experience complete within itself but there is no evidence (or rationale) that the subcortical and transient brain regions support mature function. Thus, although the cortex can process sensory input from 24 weeks, it does not mean that the fetus is aware of pain. There is sound evidence for claiming the cortex is necessary for pain experience but this is not to say that it is sufficient."

"[N]one of us has any memory of the pain of being born, which is not to say that birth, from the fetus’ point aaof view, could not still have been a painful process."

"[I]n the previous report, it was recommended that the use of analgesia be considered where the fetus was over 24 weeks of gestational age. However, this more recent review has concluded that the evidence that the fetus can and does experience pain is less compelling and accordingly the benefit of administering analgesia is less evident, while the risks and practicalities of so doing remain. So on the basis of ‘first do no harm’, prior to the procedures described in this report, analgesia is no longer considered necessary, from the perspective of fetal pain or awareness."