This document contains the testimony of Dr. Jean Wright before Congress regarding fetal pain. Some key points:
1) Dr. Wright discusses how medical practices have changed over the past 25 years based on new evidence showing premature infants feel pain. Procedures are now done with pain management to improve outcomes.
2) Observation of premature infants in NICUs provides clear evidence they experience pain from procedures like heel sticks. Hospitals now take many steps to minimize pain and stress.
3) While medical practices incorporating pain management advanced for premature infants, the same evidence was not applied to abortions until discussions around partial birth abortion in the mid-1990s.
4) As a doctor and mother, Dr.
Jonas faced adversity in learning to see things differently than others. He persevered through practice with the Giver. Gabriel struggled with sleeping but was able to get past it with memories shared by Jonas. The Giver faced difficulty with new children being released but accepted Jonas's explanation. The lesson is to face problems no matter the situation.
This chapter from the book "Why Can't We Love Them Both" discusses evidence that fetuses can feel pain by 8 weeks gestation. It notes that the necessary neurological structures are present by this age. It provides examples of fetuses reacting physically to stimuli through movements and changes in heart rate. Further evidence is discussed from studies measuring hormone responses and brain activity. The possibility of fetal pain during abortions is also addressed.
I WIN! Ranken Jordan 2010 Annual ReportRanken Jordan
The 2010 Annual Report details our activities for our fiscal year between July 2009 and June 2010 along with stories from patients Cecilia and Evie and social worker Ashley Rodemann.
This article discusses the presence of consciousness in children born with hydranencephaly, a rare condition where the cerebral hemispheres are absent or severely compromised. While it is widely believed that these children lack consciousness, the article reviews evidence that some hydranencephalic children exhibit behaviors indicating basic levels of consciousness, such as recognizing faces, responding preferentially to familiar people/stimuli, and learning associations. However, whether they experience reflective consciousness remains controversial. The article concludes the evidence for some level of consciousness in these children is more convincing than arguments against it.
This document discusses anesthesia considerations for fetal surgery. Fetal surgery presents unique challenges as two patients, the mother and fetus, must be anesthetized. Physiologically, pregnancy increases the mother's sensitivity to anesthetic agents and affects her respiratory, cardiovascular and gastrointestinal systems. The fetus depends on intact uteroplacental blood flow. Many anesthetic agents readily cross the placenta. Providing anesthesia requires integrating obstetric and pediatric practices while minimizing risk to both patients with little margin for error. Optimal anesthetic techniques for fetal surgery continue to be studied.
This document discusses fetal surgery for neural tube defects such as spina bifida. It summarizes the historical perspective and animal studies that provided evidence that fetal surgery may improve outcomes compared to postnatal surgery. A large randomized controlled trial (the MOMS trial) is currently underway at three US medical centers to determine whether prenatal repair is beneficial compared to postnatal repair. Until the results of this trial are known, the benefits of fetal surgery for neural tube defects remain unproven.
TESTIMONY OF SUNNY ANAND, DIRECTOR, PAIN NEUROBIOLOGY
LABORATORY, ARKANSAS CHILDREN’S HOSPITAL RESEARCH
INSTITUTE, AND PROFESSOR OF PEDIATRICS, ANESTHESIOLOGY,
PHARMACOLOGY, AND NEUROBIOLOGY,
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE.
Jonas faced adversity in learning to see things differently than others. He persevered through practice with the Giver. Gabriel struggled with sleeping but was able to get past it with memories shared by Jonas. The Giver faced difficulty with new children being released but accepted Jonas's explanation. The lesson is to face problems no matter the situation.
This chapter from the book "Why Can't We Love Them Both" discusses evidence that fetuses can feel pain by 8 weeks gestation. It notes that the necessary neurological structures are present by this age. It provides examples of fetuses reacting physically to stimuli through movements and changes in heart rate. Further evidence is discussed from studies measuring hormone responses and brain activity. The possibility of fetal pain during abortions is also addressed.
I WIN! Ranken Jordan 2010 Annual ReportRanken Jordan
The 2010 Annual Report details our activities for our fiscal year between July 2009 and June 2010 along with stories from patients Cecilia and Evie and social worker Ashley Rodemann.
This article discusses the presence of consciousness in children born with hydranencephaly, a rare condition where the cerebral hemispheres are absent or severely compromised. While it is widely believed that these children lack consciousness, the article reviews evidence that some hydranencephalic children exhibit behaviors indicating basic levels of consciousness, such as recognizing faces, responding preferentially to familiar people/stimuli, and learning associations. However, whether they experience reflective consciousness remains controversial. The article concludes the evidence for some level of consciousness in these children is more convincing than arguments against it.
This document discusses anesthesia considerations for fetal surgery. Fetal surgery presents unique challenges as two patients, the mother and fetus, must be anesthetized. Physiologically, pregnancy increases the mother's sensitivity to anesthetic agents and affects her respiratory, cardiovascular and gastrointestinal systems. The fetus depends on intact uteroplacental blood flow. Many anesthetic agents readily cross the placenta. Providing anesthesia requires integrating obstetric and pediatric practices while minimizing risk to both patients with little margin for error. Optimal anesthetic techniques for fetal surgery continue to be studied.
This document discusses fetal surgery for neural tube defects such as spina bifida. It summarizes the historical perspective and animal studies that provided evidence that fetal surgery may improve outcomes compared to postnatal surgery. A large randomized controlled trial (the MOMS trial) is currently underway at three US medical centers to determine whether prenatal repair is beneficial compared to postnatal repair. Until the results of this trial are known, the benefits of fetal surgery for neural tube defects remain unproven.
TESTIMONY OF SUNNY ANAND, DIRECTOR, PAIN NEUROBIOLOGY
LABORATORY, ARKANSAS CHILDREN’S HOSPITAL RESEARCH
INSTITUTE, AND PROFESSOR OF PEDIATRICS, ANESTHESIOLOGY,
PHARMACOLOGY, AND NEUROBIOLOGY,
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE.
The document discusses fetal pain and the neural pathways involved in the experience of pain. It summarizes that while there is general agreement that the neural pathways necessary for pain are present by 24 weeks gestation, debates remain about the possibility of fetal pain before or after this point. Some argue fetal pain is possible earlier due to sub-cortical structures, while others argue it is not possible at any stage due to lack of development and sedation in the womb. The document also notes increasing interest in fetal pain from legislation and more invasive fetal surgeries and medical procedures.
This document discusses 3 common myths about fetal pain and the use of fetal analgesia during procedures:
1) That fetuses do not feel pain or remember pain. However, research shows fetuses may feel pain as early as 20 weeks and have stress responses to invasive procedures.
2) That fetal analgesia is not possible or safe and there is no data to support it. Some studies have shown fetal analgesia is possible and safe in short term use and reduces stress responses.
3) That maternal analgesia is sufficient to cover fetal pain needs. However, not all maternal analgesia crosses the placenta and individual variation exists, so direct fetal analgesia should be considered.
The document argues
This slideshow provides a comprehensive look at what a doula is and why they are needed. It is the first unit in the certification course from New Beginnings Doula Training.
This document discusses home birth and its advantages over hospital birth. It describes the process of an unassisted home birth where no medical personnel are present. It outlines the prenatal care and monitoring some women do on their own at home. Risks of home birth like lack of access to medical expertise or equipment if needed are addressed. Pain relief options, preparing for labor, obtaining supplies, who can be present, and what happens after birth are also covered. Some studies found better outcomes for mother and baby with home versus hospital births.
The document summarizes the author's internship experience at Kidnetics, a pediatric physical, occupational, and speech therapy clinic. The author's responsibilities included observing and assisting with patient treatments, cleaning equipment and treatment spaces, and completing a case study on a patient with a rare genetic disorder. The author gained exposure to a variety of pediatric diagnoses and treatments approaches, including for conditions like torticollis and cerebral palsy. They also learned about assessing infant development through their work in the clinic's Developmental Pediatrics department. The author found the experience reinforced their interest in specializing in pediatric physical therapy.
This document examines the possibility of fetal pain based on anatomical and psychological evidence. It finds that:
1) The basic anatomy for pain processing, including free nerve endings and connections from the spinal cord to the thalamus, develop by 7 weeks gestation. However, the nervous system is still immature at this stage without laminar brain structures or cortical development.
2) More advanced connections from the thalamus to the cortex begin to form between 12-16 weeks, but these connections initially target the transient subplate zone and not the cortical plate.
3) For pain to be experienced, unique in utero neuroinhibitors that maintain unconsciousness must be overcome, and the psychological elements of experience
What a Midwifery Model of Care could look like ... a Strengthened PartnershipCommon Knowledge Trust
New Zealand put in place a Midwifery Model of Care in 1990. Everything birth and midwifery advocates wanted has been the maternity system in New Zealand. What was hoped for: more natural births (or physiological births), more choice, informed consent, respect for pregnant women, continuity of care, a partnership model with primary care midwives, primary care midwives who continue care when secondary care is necessary ... great system. What could possible not work out? Simple ... the partnership model is weak and ineffective. The result ... a rise from 12.9% to 30% of caesareans since, more complaints against midwives and the unexpected ... women 'choosing' elective cesarean births and epidurals for pain relief.
We can have a strong partnership in maternity care only if we grow a skilled birthing population. It's a wonderful idea to believe a woman should choose what she wants at her birth. It's a great idea to know what a woman wants from her birth provider. However, there is absolutely NO societal expectation that families bring a good set of skills to their birth. Why is this important?
Birth choices are not always available. Choices often change. Choices have to be for 'saying no' to medical care and 'saying yes' to more medical care than necessary. Choices are varied and many so which ones are really important to a woman?
It's great if women are informed and respected. Sometimes a woman is being respected but doesn't appreciate it. Some women are informed, make decisions that they regret months later. Very, very few women have the birth they 'want' or 'plan' but instead have the birth they have.
We use terms like 'having a baby' or 'giving birth'. Instead we need to say 'you are going to 'do' your birth'. Doing your birth occurs over time. Skills are what you use to fill your time of doing your birth. Skills are what you do to cope with both the internal and external sensations or situation.
Andrea talks about how she strengthened her partnership with her general population clients. Clients know they will create a Birth Plan about what they 'want' and what they 'expect' of her as a birth provider. Clients are expected to learn birth and coaching skills and use them.
Dr. Schwartz discovered the physical cause of stuttering accidentally while using an ultrasound device to study throat movements in patients with cleft palate. He observed that the vocal cords would forcibly constrict just before every stutter. Further examination revealed that stuttering is caused by a locking of the vocal cords. Various stuttering behaviors, such as hesitations, repetitions, and prolongations, are learned reactions to overcome the locked vocal cords. Dr. Schwartz realized stuttering is a learned reflex triggered by a particular nerve impulse pattern when vocal cord tension reaches a locking threshold, believed to be an inborn reflex.
Dr. Schwartz discovered the physical cause of stuttering accidentally while using an ultrasound device to study throat movements in patients with cleft palate. He observed that the vocal cords would forcibly constrict just before every stutter. Further examination revealed that stuttering is caused by a locking of the vocal cords. Various stuttering behaviors, such as hesitations, repetitions, and prolongations, are learned reactions to overcome the locked vocal cords. Dr. Schwartz realized stuttering is a learned reflex triggered by a particular nerve impulse pattern when vocal cord tension reaches a locking threshold, believed to be an inborn reflex.
Vtesse & the Patient Community - Working Together to Bring New Solutions for NPCvtessewebmaster
In this webinar, we will:
Answer questions and understand parent needs to make participation in a pivotal trial as easy as possible
Share information on the path to drug approval and pivotal trial
Learn about Vtesse
Establish communication channel with Vtesse
Agree on a mutual sense of urgency to demonstrate safety and efficacy of VTS-270 to ensure wider availability
Clinician perspective on the drug development process
Why drug development process is necessary for NPC community
Parent perspective of having a child treated with VTS-270
Successfully Navigating the Parent Landmines in the NICU Inspire
The document provides tips for nurses on successfully navigating common challenges, or "landmines", faced by parents in the neonatal intensive care unit (NICU). It discusses several key landmines including welcoming parents for the first time, helping parents bond with their infant, and promoting breastfeeding. The document offers insights from surveys of over 200 parents who had infants in the NICU. It provides tips for nurses on empowering parents, supporting parent-infant bonding, and addressing issues such as breastfeeding and pumping. Overall, the document aims to help nurses minimize stress for parents in the NICU by anticipating challenges and standardizing a supportive approach.
A doctor describes how caring for a 4-year-old girl with cancer who was in severe pain changed his life and approach to treating pediatric pain. The document outlines that children experience many types of pain from medical procedures, injuries, and illnesses, yet they often do not receive adequate pain treatment. It calls for implementing guidelines and initiatives to improve pain assessment, prevention, and management for all children worldwide.
The document discusses whether a fetus can feel pain and at what gestational age. It examines the anatomical, physiological, and behavioral evidence. While the fetus's experience of pain cannot be directly measured, the neural pathways for pain are developed by 20 weeks gestation. The fetus shows stress responses to invasive procedures from 16 weeks onward. Therefore, it is possible the fetus can feel pain from 20 weeks of gestation. More research is needed to fully understand fetal pain and how to provide appropriate analgesia during invasive prenatal procedures.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
Grief in the NICU: Identifying, Understanding and Helping Grieving ParentsKirsti Dyer MD, MS
The document summarizes a presentation by Dr. Kirsti A. Dyer about grief in the neonatal intensive care unit (NICU) and helping grieving parents. The presentation covers understanding loss and grief, types of losses experienced by parents of NICU babies, common grief responses, and strategies for supporting grieving parents. It provides insights from Dr. Dyer's experience as a physician and parent of a baby in the NICU.
The document discusses using self-hypnosis and relaxation techniques to have a calm, pain-free natural birth. It describes the author's experience using these techniques for the births of her two sons. For her first birth, she used hypnosis and was able to give birth naturally with only gas and air in 12 hours despite having a slipped disc. For her second birth, she had further refined her techniques into the Blissful Birth program and was able to give birth naturally in just 4 hours with no pain relief at all. The document encourages readers to learn more about and try the Blissful Birth program.
Diana was raped by one of her thesis subjects. She and her husband were trying to conceive their second child. At the emergency room after the rape, Diana was offered Plan B due to the possibility of pregnancy from the rape. Plan B could prevent implantation of a fertilized egg. Diana had to decide whether to take Plan B or not, considering the moral and religious implications as well as the impact on her and her husband's ability to have another child. In the end, Diana decided not to take Plan B. She gave birth to a healthy baby girl who turned out to be fathered by her husband based on a paternity test.
This bill seeks to ensure that women seeking abortions after 20 weeks of fertilization are informed about evidence that unborn children at this stage of development can experience pain during certain abortion procedures. The bill cites several findings regarding the capacity for unborn children to feel pain after 20 weeks of development, as well as existing laws and regulations that aim to protect animals and fetuses from unnecessary pain and discomfort. If passed, it would add a new title to the Public Health Service Act requiring abortion providers to inform women of the pain the unborn child could experience during the procedure.
The document discusses evidence related to whether a fetus can experience pain. It summarizes the development of anatomical structures and pathways involved in pain perception in a fetus from 8 weeks gestation onwards. It also discusses physiological evidence from preterm infants that suggests nociceptive pathways are functional from 24-26 weeks gestation. The document considers arguments that a fetus may experience pain in a primitive way without requiring consciousness, self-consciousness, or previous experience. It notes evidence that early painful experiences can have long-term effects on stress responses and sensitivity to pain.
The document discusses fetal pain and the neural pathways involved in the experience of pain. It summarizes that while there is general agreement that the neural pathways necessary for pain are present by 24 weeks gestation, debates remain about the possibility of fetal pain before or after this point. Some argue fetal pain is possible earlier due to sub-cortical structures, while others argue it is not possible at any stage due to lack of development and sedation in the womb. The document also notes increasing interest in fetal pain from legislation and more invasive fetal surgeries and medical procedures.
This document discusses 3 common myths about fetal pain and the use of fetal analgesia during procedures:
1) That fetuses do not feel pain or remember pain. However, research shows fetuses may feel pain as early as 20 weeks and have stress responses to invasive procedures.
2) That fetal analgesia is not possible or safe and there is no data to support it. Some studies have shown fetal analgesia is possible and safe in short term use and reduces stress responses.
3) That maternal analgesia is sufficient to cover fetal pain needs. However, not all maternal analgesia crosses the placenta and individual variation exists, so direct fetal analgesia should be considered.
The document argues
This slideshow provides a comprehensive look at what a doula is and why they are needed. It is the first unit in the certification course from New Beginnings Doula Training.
This document discusses home birth and its advantages over hospital birth. It describes the process of an unassisted home birth where no medical personnel are present. It outlines the prenatal care and monitoring some women do on their own at home. Risks of home birth like lack of access to medical expertise or equipment if needed are addressed. Pain relief options, preparing for labor, obtaining supplies, who can be present, and what happens after birth are also covered. Some studies found better outcomes for mother and baby with home versus hospital births.
The document summarizes the author's internship experience at Kidnetics, a pediatric physical, occupational, and speech therapy clinic. The author's responsibilities included observing and assisting with patient treatments, cleaning equipment and treatment spaces, and completing a case study on a patient with a rare genetic disorder. The author gained exposure to a variety of pediatric diagnoses and treatments approaches, including for conditions like torticollis and cerebral palsy. They also learned about assessing infant development through their work in the clinic's Developmental Pediatrics department. The author found the experience reinforced their interest in specializing in pediatric physical therapy.
This document examines the possibility of fetal pain based on anatomical and psychological evidence. It finds that:
1) The basic anatomy for pain processing, including free nerve endings and connections from the spinal cord to the thalamus, develop by 7 weeks gestation. However, the nervous system is still immature at this stage without laminar brain structures or cortical development.
2) More advanced connections from the thalamus to the cortex begin to form between 12-16 weeks, but these connections initially target the transient subplate zone and not the cortical plate.
3) For pain to be experienced, unique in utero neuroinhibitors that maintain unconsciousness must be overcome, and the psychological elements of experience
What a Midwifery Model of Care could look like ... a Strengthened PartnershipCommon Knowledge Trust
New Zealand put in place a Midwifery Model of Care in 1990. Everything birth and midwifery advocates wanted has been the maternity system in New Zealand. What was hoped for: more natural births (or physiological births), more choice, informed consent, respect for pregnant women, continuity of care, a partnership model with primary care midwives, primary care midwives who continue care when secondary care is necessary ... great system. What could possible not work out? Simple ... the partnership model is weak and ineffective. The result ... a rise from 12.9% to 30% of caesareans since, more complaints against midwives and the unexpected ... women 'choosing' elective cesarean births and epidurals for pain relief.
We can have a strong partnership in maternity care only if we grow a skilled birthing population. It's a wonderful idea to believe a woman should choose what she wants at her birth. It's a great idea to know what a woman wants from her birth provider. However, there is absolutely NO societal expectation that families bring a good set of skills to their birth. Why is this important?
Birth choices are not always available. Choices often change. Choices have to be for 'saying no' to medical care and 'saying yes' to more medical care than necessary. Choices are varied and many so which ones are really important to a woman?
It's great if women are informed and respected. Sometimes a woman is being respected but doesn't appreciate it. Some women are informed, make decisions that they regret months later. Very, very few women have the birth they 'want' or 'plan' but instead have the birth they have.
We use terms like 'having a baby' or 'giving birth'. Instead we need to say 'you are going to 'do' your birth'. Doing your birth occurs over time. Skills are what you use to fill your time of doing your birth. Skills are what you do to cope with both the internal and external sensations or situation.
Andrea talks about how she strengthened her partnership with her general population clients. Clients know they will create a Birth Plan about what they 'want' and what they 'expect' of her as a birth provider. Clients are expected to learn birth and coaching skills and use them.
Dr. Schwartz discovered the physical cause of stuttering accidentally while using an ultrasound device to study throat movements in patients with cleft palate. He observed that the vocal cords would forcibly constrict just before every stutter. Further examination revealed that stuttering is caused by a locking of the vocal cords. Various stuttering behaviors, such as hesitations, repetitions, and prolongations, are learned reactions to overcome the locked vocal cords. Dr. Schwartz realized stuttering is a learned reflex triggered by a particular nerve impulse pattern when vocal cord tension reaches a locking threshold, believed to be an inborn reflex.
Dr. Schwartz discovered the physical cause of stuttering accidentally while using an ultrasound device to study throat movements in patients with cleft palate. He observed that the vocal cords would forcibly constrict just before every stutter. Further examination revealed that stuttering is caused by a locking of the vocal cords. Various stuttering behaviors, such as hesitations, repetitions, and prolongations, are learned reactions to overcome the locked vocal cords. Dr. Schwartz realized stuttering is a learned reflex triggered by a particular nerve impulse pattern when vocal cord tension reaches a locking threshold, believed to be an inborn reflex.
Vtesse & the Patient Community - Working Together to Bring New Solutions for NPCvtessewebmaster
In this webinar, we will:
Answer questions and understand parent needs to make participation in a pivotal trial as easy as possible
Share information on the path to drug approval and pivotal trial
Learn about Vtesse
Establish communication channel with Vtesse
Agree on a mutual sense of urgency to demonstrate safety and efficacy of VTS-270 to ensure wider availability
Clinician perspective on the drug development process
Why drug development process is necessary for NPC community
Parent perspective of having a child treated with VTS-270
Successfully Navigating the Parent Landmines in the NICU Inspire
The document provides tips for nurses on successfully navigating common challenges, or "landmines", faced by parents in the neonatal intensive care unit (NICU). It discusses several key landmines including welcoming parents for the first time, helping parents bond with their infant, and promoting breastfeeding. The document offers insights from surveys of over 200 parents who had infants in the NICU. It provides tips for nurses on empowering parents, supporting parent-infant bonding, and addressing issues such as breastfeeding and pumping. Overall, the document aims to help nurses minimize stress for parents in the NICU by anticipating challenges and standardizing a supportive approach.
A doctor describes how caring for a 4-year-old girl with cancer who was in severe pain changed his life and approach to treating pediatric pain. The document outlines that children experience many types of pain from medical procedures, injuries, and illnesses, yet they often do not receive adequate pain treatment. It calls for implementing guidelines and initiatives to improve pain assessment, prevention, and management for all children worldwide.
The document discusses whether a fetus can feel pain and at what gestational age. It examines the anatomical, physiological, and behavioral evidence. While the fetus's experience of pain cannot be directly measured, the neural pathways for pain are developed by 20 weeks gestation. The fetus shows stress responses to invasive procedures from 16 weeks onward. Therefore, it is possible the fetus can feel pain from 20 weeks of gestation. More research is needed to fully understand fetal pain and how to provide appropriate analgesia during invasive prenatal procedures.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
Grief in the NICU: Identifying, Understanding and Helping Grieving ParentsKirsti Dyer MD, MS
The document summarizes a presentation by Dr. Kirsti A. Dyer about grief in the neonatal intensive care unit (NICU) and helping grieving parents. The presentation covers understanding loss and grief, types of losses experienced by parents of NICU babies, common grief responses, and strategies for supporting grieving parents. It provides insights from Dr. Dyer's experience as a physician and parent of a baby in the NICU.
The document discusses using self-hypnosis and relaxation techniques to have a calm, pain-free natural birth. It describes the author's experience using these techniques for the births of her two sons. For her first birth, she used hypnosis and was able to give birth naturally with only gas and air in 12 hours despite having a slipped disc. For her second birth, she had further refined her techniques into the Blissful Birth program and was able to give birth naturally in just 4 hours with no pain relief at all. The document encourages readers to learn more about and try the Blissful Birth program.
Diana was raped by one of her thesis subjects. She and her husband were trying to conceive their second child. At the emergency room after the rape, Diana was offered Plan B due to the possibility of pregnancy from the rape. Plan B could prevent implantation of a fertilized egg. Diana had to decide whether to take Plan B or not, considering the moral and religious implications as well as the impact on her and her husband's ability to have another child. In the end, Diana decided not to take Plan B. She gave birth to a healthy baby girl who turned out to be fathered by her husband based on a paternity test.
This bill seeks to ensure that women seeking abortions after 20 weeks of fertilization are informed about evidence that unborn children at this stage of development can experience pain during certain abortion procedures. The bill cites several findings regarding the capacity for unborn children to feel pain after 20 weeks of development, as well as existing laws and regulations that aim to protect animals and fetuses from unnecessary pain and discomfort. If passed, it would add a new title to the Public Health Service Act requiring abortion providers to inform women of the pain the unborn child could experience during the procedure.
The document discusses evidence related to whether a fetus can experience pain. It summarizes the development of anatomical structures and pathways involved in pain perception in a fetus from 8 weeks gestation onwards. It also discusses physiological evidence from preterm infants that suggests nociceptive pathways are functional from 24-26 weeks gestation. The document considers arguments that a fetus may experience pain in a primitive way without requiring consciousness, self-consciousness, or previous experience. It notes evidence that early painful experiences can have long-term effects on stress responses and sensitivity to pain.
An unborn child has the capacity to feel pain by 20 weeks gestation according to scientific evidence. By this point in development, the neural pathways, nerve tracts, thalamus, and cortex necessary to feel pain are all present. Studies show the unborn child responds to touch as early as 6 weeks and releases stress hormones when injected with a needle at 18 weeks, similar to the stress response in adults feeling pain. While abortion methods do not provide anesthesia to the unborn child, commercial livestock must be rendered insensible to pain before slaughter according to federal law.
This document discusses two approaches to understanding associative learning: the propositional approach and the dual-system approach. The propositional approach argues that associative learning results from controlled reasoning processes, while the dual-system approach argues it results from both controlled reasoning and the automatic formation of links between mental representations. The authors review evidence from past research and conclude that there is little support for the automatic link-formation mechanism proposed by the dual-system approach. Instead, they argue learning is better understood as resulting from propositional reasoning processes.
This document discusses the concept of fetal pain and whether a fetus is capable of perceiving pain. It explores definitions of pain, the anatomical and neurophysiological development of the fetal nervous system, and behavioral responses to stimuli. While connections from the spinal cord to the thalamus develop by 20 weeks, and thalamocortical connections are present from around 26 weeks, the document notes debate around whether these are necessary for pain perception. It concludes that while the very young fetus is likely incapable of feeling pain, the capacity for pain perception likely develops before full term birth.
The document reviews the development of the fetal pain system and debates whether a fetus can feel pain. It finds that:
1) While reflex reactions to noxious stimuli can occur very early in development, cortical processing required for the emotional experience of pain likely only emerges after 26 weeks of gestation with the development of thalamo-cortical connections.
2) Before the cortex is involved, noxious stimuli can still trigger stress responses that affect development.
3) Rather than speculate on fetal pain, the clinically relevant aim is to avoid noxious stimuli to prevent their potential adverse effects on development.
This document summarizes a research article about the mental capacities of newborn infants. It argues that while newborns appear helpless, research shows they have an integrated consciousness and can engage in synchronized interactions with caregivers. This suggests newborns have intersubjective minds, emotions, and motives for social engagement. The study of infant cognition required moving beyond theories of the mind as developing through experience and language alone, to recognize innate capacities for shared intentionality and cultural learning from birth.
1) The article proposes that the primary function of consciousness is to integrate competing demands from specialized systems in the nervous system that influence skeletal muscle plans.
2) These "supramodular systems" operate in parallel to control actions like breathing, pain response, elimination, but can only collectively influence action through consciousness.
3) During a "supramodular conflict", when different systems demand opposing skeletal muscle actions, consciousness is necessary to integrate the systems and determine the appropriate response.
This commentary agrees with Shanahan's view that language acquisition has an emotional basis. It provides a supplementary neuroscience perspective, arguing that:
1) Primary-process emotional systems in subcortical brain regions like the central amygdala generate affective intensity, not just secondary cognitive processes.
2) Social-emotional systems like separation distress, nurturance, play, and lust motivated the development of inter-subjective communication between mothers and infants, which may have promoted linguistic prosody.
3) Early affective communication through melodic "motherese" engages infants more than cognitive thought, and music is tightly linked to language in brain and development. Language may have evolved from our emotional nature through
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against developing mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The study recorded EEG signals simultaneously from the scalp and thalamus of 7 patients undergoing deep brain stimulation for essential tremor. The patients performed a go/no-go task where they had to either execute or withhold a cued finger movement based on subsequent go or no-go cues. Event-related potentials differentiated between go and no-go conditions earlier at thalamic recording sites compared to scalp sites, suggesting the thalamus is involved in early classification of go and no-go instructions. Correlations between thalamic and frontal scalp responses were stronger for no-go activities, indicating the thalamus provides information to frontal areas involved in inhibiting prepared actions. The findings support a role for the thalamus
This document summarizes recent research on the development of nociceptive (pain-sensing) circuits in infants. It discusses how:
1) Nociceptive neurons are specified early in development through molecular pathways involving tyrosine kinase receptors and neurotrophic factors.
2) Functional synapses and neural circuits in the dorsal horn develop over the first postnatal weeks through changes in excitatory and inhibitory synaptic transmission.
3) Sensory activity, both non-nociceptive and excessive nociceptive inputs, can influence the development of pain processing circuits in early life.
This randomized, double-blind study compared remifentanil and diazepam for fetal immobilization and maternal sedation during fetoscopic surgery. The study found that remifentanil produced better fetal immobilization with mild maternal respiratory depression, allowing for shorter surgeries, while diazepam resulted in greater maternal sedation but less fetal immobilization and longer surgeries. Remifentanil may thus be superior to diazepam for fetal immobilization during fetoscopic procedures.
More from South Dakota Pain Capable Unborn Child Protection Act (20)
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Community pharmacy- Social and preventive pharmacy UNIT 5
Wright Testimony
1. 19
Mr. CHABOT. Dr. Wright, you are recognized for 5 minutes.
TESTIMONY OF JEAN WRIGHT, PROFESSOR AND CHAIR OF
PEDIATRICS, MERCER SCHOOL OF MEDICINE
Dr. WRIGHT. Thank you, Mr. Chair, Members of the Committee.
As you heard my introduction, I spent my career in the care and
anesthesia of critically ill children, and I have testified now twice
on this subject here on the Hill as well as testified in many States.
The opinions I present today are my own, and I don’t represent any
group during this time.
It is interesting. My own personal sojourn as a clinician parallels
a lot of the changes that we are talking about with respect to fetal
pain. When I began over 25 years ago in my practice, I would take
a premature baby to the operating room, paralyze that infant, not
give it any pain medication, and we would do a heart operation or
abdominal operation simply because we felt the child was too sick
for anesthesia. Never in our clinical dialogue did we ever think the
child doesn’t feel pain. We just felt we couldn’t give an anesthetic
in a safe manner.
By the end of the ’80’s, data had come out from Dr. Anand, from
Dr. Nancy Green, from Paul Hickey, from Glover, from many oth-
ers that showed us, yes, we could administer anesthetics safely,
and not only could we do it safely, it would change the outcome of
that child.
You know, it then became apparent to us, no wonder many of
these preterm babies when they came back to the neonatal inten-
sive care unit looked so devastated. In fact, many of them didn’t
survive, which at that time sort of reinforced our presumption that
they were too sick for anesthesia. But with time, with better
science, we began to provide anesthesia for those preterm babies,
and, in fact, we saw that their outcomes improved.
However, as the ’80’s progressed, new information continued to
come forward, and our day-to-day practice of pediatric anesthesia
had to change. At this point in time, it became unconscionable for
any of us to take a child to the operating room or do something
painful without providing it an anesthetic. For us, the question was
not, does the child feel pain, or if the child feels pain, the question
was, how are we going to block the pain?
So I would say, I think this dialogue today is actually 25 years
lagging behind our clinical practice.
Well, that was 20 years ago. If you came back with me to Savan-
nah tonight and came to our neonatal intensive care unit, we
would stand between the bed of a 23-week infant, a 26-week infant,
and you would not need a congressional hearing to figure out
whether that infant feels pain. We roll back the sheets or the blan-
ket, and you would look to the facial expression, their response to
the heel stick, you would understand that.
Now we know that when Roe v. Wade was decided, 28 weeks was
the time of viability. Today we look at 23, 24 weeks. So every single
day we have a perfect window into the womb to look at how that
child processes pain, and because of the work of Sunny and other
researchers, we continue to change our bedside practice.
Our previously held assumptions about these tiny babies had to
be set aside, and we began to understand the fight-or-flight hor-
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2. 20
mone response, their heart rate response, their sympathetic re-
sponse. We went so far as to invest in special beds and lighting and
even sound detection to minimize anything that would be seen as
stressful, even something as simple as a heel stick.
In the 1990’s, many of our NIC units did not have any uniform
approach to approaching pain in the NIC unit. Today they do. In-
tensive care units have a standardized approach. We monitor all
the things that I just mentioned. We respect the pain. We respect
the stress. We do everything we can to avoid it, and we treat it
when present. Today, pain relief is an important step to generating
a healthy outcome.
Well, with that knowledge explosion in the field of pain develop-
ment in the fetus, as I mentioned, the world of anesthesia changed,
and, you know, I guess I would use a phrase, the sound barrier,
particularly in the area of partial-birth abortion, or the discussion
around partial-birth abortion broke the sound barrier around this
whole topic of fetal pain. It was in the mid-’90’s when I was here
and we were discussing that legislation and we began to talk about
pain in the third trimester, but now we know that it is not just the
third trimester, but it is as early as 20 weeks, and there is data
that shows 16 weeks and even earlier, many of these infants feel
pain and have negative outcomes from it.
You know, as a mother I look at this whole topic, and I think
about it every time I take my daughter to the doctor. Her first
question to me is, ‘‘Mommy, is this going to hurt?’’ And as a mother
I feel like it is my duty to find out that information and to do ev-
erything I can to keep her from a painful or stressful situation.
Well, that is what we are asking today. We are asking for legisla-
tion that allows that question to be asked by mothers, and for them
to be given clear, scientific information that outlines that pain de-
velopment. You know, we believe that to do less than that would
not be giving good informed consent as a clinician.
I will stop right there.
Mr. CHABOT. Thank you very much, Doctor.
[The prepared statement of Dr. Wright follows:]
PREPARED STATEMENT OF JEAN A. WRIGHT
BACKGROUND
I am a physician who has specialized in the care and anesthesia of critically ill
infants, newborns, children and adolescents my entire career. I now head a chil-
dren’s and women’s hospital within a larger medical center in Savannah. I have tes-
tified before two Congressional subcommittees on this or a similarly related topic,
and have testified on the same subject in several state legislative bodies. The opin-
ions I render today are my own, and do not represent any group.
I am trained in the specialties of Pediatrics and Anesthesia, and am Board Cer-
tified by both. In addition, I am board certified in Pediatric Critical Care Medicine,
and similarly hold the Anesthesia special qualifications in Critical Care Medicine.
I continue to practice medicine in addition to my administrative responsibilities.
HISTORICAL PERSPECTIVE
My own personal sojourn in medicine historically reflects the changes in this field
of medicine, and the incorporation of new information into clinical practice. My ex-
perience and practice in this discipline over the past 25 years mirrors that of count-
less others who cared for the critically ill child. I entered the field of pediatric anes-
thesia and intensive care in the early 1980’s. Twenty-five years ago, it would have
been common practice to take a critically ill premature infant to the operating room
for major abdominal surgery and provide little or no pain management. Our knowl-
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3. 21
edge of pain and its importance in the overall outcome of the child was unknown,
and not part of our clinical decision-making.
For many of the procedures, we felt the premature and newborn infants were sim-
ply ‘‘too sick and too small’’ for anesthesia and pain relief. We did not feel that their
immature bodies could withstand an anesthetic along with their procedure. Little
did we know that in our avoidance of anesthesia, we were in fact creating a more
stressful and more harmful environment for these vulnerable patients. We often re-
lied on neuromuscular blocking drugs to hold the infant motionless during the pro-
cedure. Their motionless body did not tell the internal story of what they were feel-
ing and perceiving in regards to pain. Today, in hindsight, we now understand that
the infant was often returned to the neonatal intensive care unit in a more debili-
tated state than when they left it pre-operatively. We recognized then, and better
understand now that it took them days to stabilize, recover, and begin to gain
weight, and return to their pre-operative state. And we saw many infants that never
seemed to recover from the procedure.
CHANGING THE PRACTICE OF PEDIATRIC ANESTHESIA
However, in the 1980’s, new information began to surface, and in response to this
new body of scientific knowledge, our clinical practices of pediatric anesthesia and
intensive care had to change.
The practice of pediatric anesthesia for the premature and newborn infant began
to incorporate the use of narcotics and other analgesics on a regular basis. Soon it
became unacceptable to consider taking an infant to the operating room for major
heart or abdominal surgery without recognizing the stress response this would gen-
erate in the infant, and developing an anesthetic plan that would safely block or
blunt those responses. By the end of the 1980’s, the work of Dr. Anand, Dr. Hickey,
Dr. Ainsley-Green and others surfaced in a myriad of our most respected American
and British Journals. Their elegant work, along with the works of others, dem-
onstrated that this pain response in the infant was not an inconsequential byprod-
uct of a surgical procedure that could be ignored at the anesthesiologist’s whim or
personal choosing. For us practicing in the field, it was not a question of ‘‘if the pre-
mature or term infant felt pain’’ . . . it was ‘‘how do we block the pain to improve
the child’s outcome.’’ For us the question became ‘‘how,’’ not ‘‘if.’’
EXTENSION TO CARE IN THE NEONATAL INTENSIVE CARE UNITS
That was twenty years ago. Today, if you walk with me in our neonatal intensive
care unit, you will see the same concern exhibited for our tiniest of all infants. The
concern about how to block pain, how to eliminate stress, how to improve survival,
and how to minimize the complications that frequently accompany premature in-
fants is on the forefront of the care-givers mind. Viability for the premature infant
has long since passed the 28 week gestational age definition that existed when Roe
v. Wade was decided. For some infants, viability has been pushed back to 23–24
weeks. And so many of our neonatal units now have infants of 23 weeks and older
gestational ages.
Because of the work of many researchers in the fields of pediatric anesthesia,
their scientific inquiry led to a change in practice. Early in the 1990’s, many neo-
natal units considered the infants too weak or sick for pain-relieving medications.
Our previously held assumptions are replaced with first hand observations of these
tiny patients, with monitoring of the hormones released from the neuro-humoral
axis (our fight and flight hormones), and with a clearer understanding of the devel-
opment of pain pathways in the fetus. We invest in expensive beds to eliminate
noise and pain, and in a care plan that minimizes painful sticks and pokes. We now
regard even the pain of a simple heel stick for a routine blood sample.
In the early 1990’s many neonatal intensive care units did not have uniform ap-
proaches to minimizing painful events, or pre-treating infants prior to painful and
stressful procedures. Today they do. We are so mindful of even the stress of noise
and touch, that neonatal intensive care units monitor the sound level, and minimize
the number of times an infant is handled, poked or stress, . . . all in the name of
decreasing pain and stress, and improving clinical outcomes. We respect the pain
and the stress, we do everything we can to avoid it, and we treat it when present.
Today, pain relief is an important step to generating a healthy outcome. Today
with the survival of 23 and 24 week infants, we no longer speculate as to whether
they feel pain. We understand it, try to avoid it, and treat it when appropriate.
THE DISCONNECT BETWEEN PAIN IN THE NEONATE AND PAIN IN THE FETUS
With the knowledge explosion in the field of pain development in the fetus, the
world of pediatric anesthesia and neonatal intensive care changed. Why did this
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4. 22
same information not change the world for the unborn? To regard pain in the un-
born required that we consider pain during in utero surgical procedures, but also
pain to the unborn during an abortion. Furthermore to recognize the unborn’s abil-
ity to perceive pain would require that we disclose that information to the mother
prior to the procedure as part of the informed consent. Perhaps, with that informa-
tion at hand, the mother might change her position regarding an abortion for her
unborn. Therefore the scientific information regarding pain in the unborn was not
integrated with the dialogue around the procedures of abortion.
In the mid 1990’s the discussion around partial-birth abortion broke the sound
barrier around fetal pain. A discourse followed around whether the infant felt pain,
whether maternal anesthesia could or would treat the pain, and whether informed
consent for the procedure should disclose the possibility of pain to the unborn. Dis-
cussions on partial birth abortion brought into focus the developmental realities of
the infant in the 3rd trimester, and juxtaposed that stage of human development
with its ex-uterine counterpart, the preterm infant. Further scientific discoveries
over the past decade have only served to underscore the anatomy and physiology
of the pain pathways in the unborn and preterm infants. Now several states have
begun to wrestle with the legislative aspects of both protecting their most vulner-
able subjects from pain, and from informing their mothers of its presence and its
need for treatment.
THE ROLE OF INFORMED CONSENT
As a mother myself, every procedure I face with my own child is preceded by her
first question, ‘‘Mommy, will this hurt?’’ It is my natural maternal response is to
try to avoid all forms of pain and suffering for my child. As a parent I want to know
about the possibility of pain, and my child (if old enough) wants to know as well.
But for the child unable to speak, or unable to understand the upcoming flu shot
or laceration repair, the parent stands in the gap gathering clinically relevant infor-
mation, and exercising prevention and protection against harmful or painful situa-
tions. It is our question to ask, ‘‘Will my child feel pain?’’
Parents are entitled to this information for their children. They need it explained
in a clear and meaningful way that they as laypeople can understand. This standard
exists for children born; now we raise the standard and ask that it exist for those
unborn. ‘‘Will this surgery or procedure on my premature baby cause pain? What
will be done to alleviate the pain and suffering?’’ We should answer those questions
as clearly for procedures concerning the unborn as the born.
WHAT WILL WE TELL THEM?
Beginning as early as 6 weeks of development, tiny pain fibers pepper the face
and oral mucosa. The spread of these unique fibers proceeds in a head to toe fashion
until by the 20th week, they cover the entire body. Not only do these fibers exist,
they do so with greater density per sq inch than in the adult.
These fibers will connect with the spinal cord, and then connect with fibers that
ascend to the thalamus and cortex. By the 10–12th week, the cortex is developing,
and by the 15th week, the fibers from below have penetrated into the cortex.
Studies at 16 weeks and beyond show hormonal responses to painful stimuli that
exactly duplicate the responses that the infant and adult possess. The critical dif-
ference is that the unborn lacks the ability to modulate itself in response to this
pain. Therefore, the responses of hormones to painful procedures show a 3–5 x surge
in response. This ability to down-regulate the response in light of painful stimuli
will not exist until the unborn child is nearly full term in its gestational age. Fur-
ther studies demonstrated that the magnitude of pain response reflected the mag-
nitude of the stimulus and blocking the pain receptors with narcotics, blocked the
hormonal surge. By 19–20 weeks, EEG recordings are readily documented, and
somatosensory evoked potentials (SSEP) are seen by 24 weeks.
After 20 weeks of gestation, an unborn child has all the prerequisite anatomy,
physiology, hormones, neurotransmitters, and electrical current to ‘‘close the loop’’
and create the conditions needed to perceive pain. In a fashion similar to explaining
the electrical wiring to a new house, we would explain that the circuit is complete
from skin to brain and back. The hormones and EEGs and ultrasounds record the
pain response, and our therapies with narcotics demonstrate our ability to ade-
quately block them. Therefore, any procedure performed on an unborn child after
20 weeks should take this into consideration.
• ‘‘Can the unborn fetus feel pain at this stage of development,’’ we would be
asked.
• ‘‘Is there something that can be given to alleviate the pain?’’
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5. 23
• And we would answer, ‘‘Yes,’’ to both.
WHY ISN’T TREATING THE MOTHER ENOUGH FOR THE CHILD?
Most obstetrical anesthetic care plans use spinal, caudal, epidural or other forms
of nerve blocks to interrupt the cause of pain and the perception of pain. We refer
to this as regional anesthesia. The sensory nerves that innervate the abdominal wall
and the lower pelvic structures are anesthetized in the same manner that a tooth
is numbed by a nerve block with Novocain at the dentist. The mother’s specific
nerves, or nerves that innervate the perineum, are blocked by these regional anes-
thetic techniques. While this serves as excellent anesthesia for the mother, it pro-
vides no anesthetic relief to the unborn child.
Advances in intra-uterine surgery have required more detailed thinking about
pain management of the unborn during these operations. In essence, two anesthetics
are planned. One for the mother and one for the unborn child. If an intravenous
anesthetic is used, such as a narcotic, it must go through the mother’s circulation,
and then enter the fetus’ circulation, and the reach the fetal brain, in order to
achieve pain relief. Dosing via this route must be such to achieve a safe level of an-
esthetic in the unborn. Similarly, doses of narcotics may be given directly into the
amniotic sac, or into the vein of fetus. Experience with premature infants shows us
that the dose of narcotic is small, and can be given safely, and is inexpensive, and
is effective in blocking pain and improving outcomes.
CONCLUSION
The development of the perception of pain begins at the 6th week of life. By 20
weeks, and perhaps even earlier, all the essential components of anatomy, physi-
ology, and neurobiology exist to transmit painful sensations from the skin to the spi-
nal cord and to the brain.
Infants in the neonatal intensive care unit give us a clear picture into life in the
womb for the unborn fetus age 23–40 week gestation. Our understanding of the
presence of pain, and the need to clinically treat this pain in the premature infant
leads us to understand the presence of pain, and the need to treat pain in the un-
born fetus of the same gestational age.
Our conscience as clinicians requires us to apply the same standards of informed
consent that we would to any other patient in a same or similar situation. We no
longer can ignore the fact that maternal anesthesia treats the mother’s pain percep-
tion during these procedures, but leaves the unborn with no pain protection.
Our knowledge of this field has changed our clinical practice and now the legisla-
tive issues must change as well.
Mr. CHABOT. Dr. Caplan, you are recognized for 5 minutes.
TESTIMONY OF DR. ARTHUR CAPLAN, DIRECTOR, CENTER
FOR BIOETHICS, AND CHAIR, DEPARTMENT OF MEDICAL
ETHICS, UNIVERSITY OF PENNSYLVANIA
Mr. CAPLAN. Thank you, Mr. Chairman and Members of the Sub-
committee, for the opportunity to testify before you in this legisla-
tion. I know you have the written testimony there, so I am going
to narrow my remarks down to four subjects.
First, is there consensus on fetal pain? I am not an expert on
fetal pain like some on the panel here, but I have access to Chil-
dren’s Hospital of Philadelphia, which is an institution that has
many experts in fetal pain there. And so when this hearing came
to my attention, I went over and asked them what they thought
about fetal pain, when it begins, when is the age of onset, and it
is clear to me that there is not a consensus.
Secondly, I want to say a word about risk and benefit as pre-
sented in the script that is in the legislation concerning risk to
mothers of the administration of pain-relieving analgesics and an-
esthesia to the fetus.
Third, I am just going to say a word about is it a good idea to
get use a script to get informed consent, which is perhaps of less
interest to some on the Committee, but is of keen interest to me
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