Artificial wombs: Assisting or replacing?

Artificial wombs: Assisting or replacing?

Artificial wombs: Assisting or replacing?

A premature lamb develops in a special bag of amniotic fluid. (Credit: Nature/Children's Hospital of Philadelphia.)

Technology is advancing in the area of ‘ectogenesis’: The ability for a baby to develop outside of the womb. Although the technology could eventually be helpful for a baby born very premature and at real risk of death, there is a danger of forgetting pregnancy is a core aspect of motherhood that grounds each of us socially in the world into which we are born.

Commentary

Recently, the world was captivated by the story of lambs gestated in womb-like devices: Not incubators as we know them, but bags of amniotic fluid where the fluid was gently pumped around not by a mechanical pump but by the lamb’s heart itself.  

The maturing lungs in the meantime, as in pregnancy, were able to practice breathing amniotic fluid and not the air they would have struggled to support. We saw images of lambs lying under plastic, first a delicate pink, then reassuringly white as the wool duly grew.

Plans to use the ‘biobag’ device eventually on human beings raise the possibility of successful ‘partial’ ectogenesis: Artificial wombs supplementing pregnancy, in particular when a baby is born very premature and at real risk of death.  

They also raise the more remote possibility of ‘complete’ ectogenesis: Artificial wombs that would replace pregnancy entirely, from in vitro fertilization all the way to viability and ‘birth.’

Human pregnancy has a significance that goes well beyond mere provision of ‘life support.’  

Pregnancy is not intensive care or even babysitting but a core aspect of motherhood that grounds each of us socially in the world into which we are born. Replacing pregnancy, should this ever occur, would deprive both mother and child of a profound and unique form of human relationship.  

Even the curtailment of pregnancy for social reasons in favor of transfer to an artificial womb should be repugnant to anyone who values the specifically maternal form of parenthood. Pregnancy is not without its trials, but should not be seen as a mere means to an end, of a kind a mechanical, non-human device could readily stand in for.  

All that said, we can and should warmly welcome efforts not to replace but to supplement pregnancy, not for social reasons but simply to improve care for highly vulnerable babies who are born very premature.  

While the ‘biobag’ device is certainly innovative, it will really just offer a more womb-like variation on existing care for premature babies, if and when the device is tried on human beings.

Extreme prematurity causes serious dangers for the baby and fear and/or heartbreak for the parents. It also raises very real medical dilemmas concerning how to weigh the possible benefits of technological support for the baby against its risks and burdens.  

In the case of babies currently below viability, the ‘biobag’ researchers seem skeptical whether the risk-benefit ratio would justify use of the new device. They see its initial use as applying more to extremely premature, but still post-viability babies.  

The researchers flag up the issue of “parental perception of having their fetus in a ‘bag’,” but point out that “the comparator is the extreme premature infant on a ventilator and in an incubator” and say reasonably that “parents will be relatively reassured that their fetus is being maintained in a relatively protective and physiologic environment.”

Going further, they suggest that “the clinical device will be designed with many features that should allow the parent to be connected with the fetus including ultrasound, a darkfield camera allowing real-time visualization of the fetus within its darkened environment and the ability to play maternal heart and abdominal sounds to the fetus.” 

The picture of parents watching their baby ‘from afar’ and playing maternal heart and abdominal sounds to him or her is touching, if a little alarming. The way the word ‘fetus’ used is striking, since the babies in question will already have been born once; indeed, the researchers elsewhere refer to them as ‘infants.’ A distinction without a difference, indeed.

Whether or not the new technology is ever extended to babies currently seen as ‘pre-viable,’ this possibility illustrates the changeable nature of ‘viability,’ a concept sometimes used arbitrarily to decide, not who may be supported postnatally but who may be prenatally attacked. 

Abortion laws in many countries refer to viability in some way, although there is no logic in imputing lower status to those who most need nurture and protection from their mothers.

Viability could be pushed back considerably with ‘partial’ ectogenesis and even fall to conception in the event of ‘complete’ ectogenesis throughout 9 months gestation, dire as this last event would be. Abortion laws would then be entirely deprived of a dividing line that morally was always a non-starter.

Should the sci-fi scenario of ‘complete’ ectogenesis ever become a reality, such non-human gestation would not be a remotely effective substitute for the identity-grounding, bond-creating, uniquely maternal care that only a pregnant woman can provide.  

Important as it is to save new lives, this should be done in ways respecting the mother’s unique role.  Supporting women in the archetypal nurture that is pregnancy should be high on our list of concerns.  

And while ‘partial’ ectogenesis of premature babies is indeed welcome in principle, we should always remember that what most pregnant women need is not novel technology but respectful, realistic social support through pregnancy and beyond.

Dr. Helen Watt is Senior Research Fellow at the Anscombe Bioethics Centre in Oxford.  She is the author of The Ethics of Pregnancy, Abortion and Childbirth: Exploring Moral Choices in Childbearing (Routledge, 2016)

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