Eight baby lambs born extremely premature have successfully developed for four weeks in “Biobags” of temperature-controlled sterile fluid — a revolutionary innovation in the world of neonatal intensive care that produced superior results to all current incubator technology.
But along with the medical potential of these “artificial wombs,” some observers question the moral implications of such scientific advances, noting they could negatively impact the institution of motherhood.
A study published in Nature Communication describes how the team of researchers at the Center for Fetal Research at the Children’s Hospital of Philadelphia (CHoP) developed an “extra-uterine” system that used the fetal lamb’s own heartbeat to generate blood flow and an oxygenating circuit attached to the lamb’s umbilical cord vessels to connect to an external gas exchange unit similar to an artificial placenta.
The lamb fetuses were also enclosed in a liquid environment where they could swallow and breathe fluid to mimic the animal’s natural life in the womb as closely as possible.
“Animals opened their eyes, became more active, had apparently normal breathing and swallowing movements, grew wool and clearly occupied a greater proportion of space within the bags,” says the paper.
The longest runs were terminated at 28 days due to animal protocol limitations rather than instability, making the lamb experiments the most successful of their kind to date and suggesting that they could be supported longer, if necessary.
Pictures in the study and footage of the lambs show that they developed from pink, clearly premature fetuses to chubby, woolly lambs who seem unperturbed by their technological surroundings.
“It never fails to strike me what a miracle it is to see this fetus that is clearly not ready to be born enclosed in this fluid space, breathing, swallowing, swimming, dreaming, with complete detachment from the placenta and from mom. It is an awe-inspiring site,” Emily Partridge, the lead researcher on the study, said in a hospital video about the research.
Risks of Premature Birth
The “extra-uterine” research on lambs is motivated by the desire to improve survival rates among human babies. About 1% of American babies are born significantly premature, and these babies only have about a 50% chance of surviving.
“Of those infants that do survive the early neonatal period, they are normally around 90% morbidity, so the majority of those infants born at 24 weeks have some sort of illness; and most of the time that is due to lung immaturity,” explained Marcus Davey, one of the CHoP researchers.
More than one-third of all infant deaths and one-half of cerebral-palsy cases in the United States today are attributed to premature birth.
“Amongst those that survive, the challenges really are some of the things we all take for granted: walking, talking, seeing, hearing and developing along the normal path,” said Kevin Dysart, a neonatologist at the CHoP.
According to the study, as the limit of viability has extended back further, the total number of patients with severe complications from being born earlier is actually increasing, and the problem is not going away.
Working From Scratch
Researchers have made several attempts to develop an “artificial placenta” over the past 50 years, but with very limited success. Advances in neonatal intensive care have pushed the limits of viability to 22 to 23 weeks of gestation, but that has come with high rates of chronic lung disease among preemie survivors, particularly those born before 28-weeks gestation.
Initially, the researchers working at CHoP had no grant, so they rummaged around for equipment from hardware and plumbing shops, beer stores and eBay, to put together a primitive “fish-bowl system,” which gradually evolved into the “Biobag,” resembling a large Ziploc storage bag, which is currently in use.
The “Biobag” is filled with a simple electrolyte system, and, since natural amniotic fluid is much more complex, containing many growth factors, the search for an optimal artificial amniotic fluid is underway.
“If it’s as successful as we think it can be, ultimately the majority of pregnancies that are predicted at risk for extreme prematurity, would be delivered early onto our system rather than delivered premature onto a ventilator,” said Dr. Alan Flake, the center’s director.
“With that, we would have normal physiologic development and would avoid essentially all of the major risks of prematurity,” Flake said. “We’re in the process of interacting with the FDA, so it’s not inconceivable that we could be talking about a clinical trial one to two years from now.”
Utopian or Dystopian?
The prospect of human babies being gestated in plastic bags within a few years generated a storm of commentary about the societal implications.
Artificial wombs that can gestate babies — or clones of babies — are the only missing technology in the fictional Brave New World dystopia described by author Aldous Huxley.
“An artificial womb could present a better alternative to commercial surrogacy, which many denounce as exploitative,” Aarathi Prasad wrote in The Guardian. “It might also mean that the divide between mother and father can be dispensed with: a womb outside a woman’s body would serve women, trans women and male same-sex couples equally without prejudice.”
“If an artificial womb is created, it will mean that women will be freed from the dangers of pregnancy and create a more equal distribution of ‘labor,’ with women able to work throughout gestation,” she added. “It will also give men an essential tool to have a child entirely without a woman, should they choose. It will ask us to question concepts of gender and parenthood.”
Others questioned whether this development might frustrate champions of abortion on demand by requiring that “viable” fetuses be saved in artificial wombs rather than aborted.
“Up to now, we’ve been either born or not born. This would be halfway born, or something like that. Think about that in terms of our abortion politics,” Dena Davis, a bioethicist, told NPR.
“States could theoretically require women getting abortions to put their fetuses into artificial wombs,” Scott Gelfand, another bioethicist, remarked in the same article.
The CHoP researchers themselves said their technology is exclusively about saving premature babies and improving their outcomes. “It is a hugely important point that we do not intend to challenge the currently accepted standard for a viable infant. The challenging age that we are trying to offset is that 23-to-24-week baby who is faced with such a challenge to adapting outside of the uterus on dry land,” Partridge said.
Advancing technologies aimed at preserving and protecting vulnerable human life, including that of premature babies, is something the Church has always endorsed.
Unlike artificial conception, which the Church considers “gravely immoral” because it infringes on the “child’s right to be born of a father and mother known to him,” there is nothing inherently wrong with any of the components of the new neonatal technology.
However, like most new reproductive technologies that are racing in development, future ethical quandaries and misuses are likely to arise.
“I’m worried about using artificial wombs for ‘leftover’ embryos, unless there are adoptive parents ready and willing to bring the baby home,” Christopher Kaczor, a professor of philosophy at Loyola Marymount University, told the Register. He has written about how advances for growing embryos will one day open up a Pandora’s box of gestating possibility. “Also, anytime a new technology like this is used on human beings before maturity, they are being experimented on without their consent, which is ethically problematic.”
Those ethical quagmires are likely to fill newspaper pages in the future, but the first generation “artificial womb” is essentially a revolutionized incubator, which may save lives and dramatically improve the health of babies, which Catholics can use in good conscience and celebrate.
Celeste McGovern writes from Scotland.