The document discusses the history and current state of research on fetal pain. It describes how in the 1970s, the prevailing view was that fetuses and newborns could not feel pain. However, research beginning in the 1980s found that fetuses have fully developed pain receptor pathways by 8 weeks gestation. It provides extensive evidence that fetuses can feel pain, including the presence of pain-sensing structures, neurotransmitters, hormonal and physiological responses to painful stimuli, and efforts to reduce fetal pain through anesthesia. The document rebuts common arguments against fetal pain such as lack of cortex, myelination, communication or memory.

1. My focus today is on the basics of fetal pain, the elements of the
science and the implications of ongoing research. While I will
touch on religious and social justice aspects of the issue, my
perspective is almost brutally scientific. To understand that, you
need to know a little bit about where I came from.
Though pro-abortion in High school, I remember well the college
human embryology class when I was looking at slides of fetal
development. While I kept saying to myself 36 weeks, 38 weeks,
40 weeks gestation, my professors were saying 6 weeks, 8
weeks, 10 weeks. It was that difference, between what I saw with
my own eyes, rather than the propaganda I had been fed, that left
me convicted to the pro-life cause aand led me to become one of
the first researchers on Fetal Pain.
To understand the status of fetal pain science today, you have to
understand where we were, circa 1978. A concerted effort was
made to convince the public that there was no such thing as an
unborn child. The miracle of birth was, apparently, just that...
somehow, on the way down the birth canal, a mere collection of
cells congealed into a baby. Like Jello 1-2-3. I mean, if we could
drink Carnation Instant Breakfast, why couldn't we have Carnation
Instant Baby?
The general belief was that newborns didn't feel and experience
pain, at least not in the sense that you and I did. Circumcisions
were done without analgesia - and any concerns regarding
discomfort were dismissed as having no lasting effect. Newborn
surgery was done with a definitive form of anesthesia - adhesive
tape. The newborn was simply taped to the operating table and
surgery went on without regard for struggles or screams.
Newborn surgery had a high mortality, but, since the newborn
liver was unable to tolerate drugs, surgery was considered safer
without ANY anesthesia. The idea of an unfeeling newborn was

2. so fixed in mainstream medical thought that any contrary proposal
was openly mocked and ridiculed.
My research colleagues, Dr. Vincent Collins and Mr. Thomas
Marzen, asked a simple question, If the unborn child looks human
and moves like a human, at what point can the unborn child
respond to pain like a human? Communicating that pain might be
difficult, but that had not blocked efforts to limit suspected pain for
experimentation on monkeys, dogs and even lab rats. Yet I can
vividly recall being on an elevator with 2 of my peers, leading
obstetrician-gynecologists at my medical school, who, well aware
of my research, openly laughed while claiming, "Oh, we'll have to
give aspirins for circumcisions! Oh, we'll have to find an
anesthetist before we operate!"
Today, of course, to do a circumcision without analgesics would
be considered barbaric. To do newborn - and even intrauterine
surgery without anesthesia would be gross malpractice.
Opioid analgesics are routinely used to supplement general
anesthesia for fetal surgery to minimize procedural pain. Local
anesthetics are used to prevent pain from minor procedures in
pre-term neonates, especially in the Intensive Care Unit. (Sal)
The benefits of using anesthesia for neonatal and intrauterine
surgery have been nothing short of astounding, reducing mortality
by more than one-third.
The science of fetal pain is simple, as all science must be.
Pain can be defined as an unpleasant sensory and emotional
experience associated with actual or potential tissue damage, or
described in terms of such damage. Both science and experience
show us that the fetus and the preterm neonate are capable of
feeling the unpleasant sensory experience of actual tissue
damage. (Grissom)

3. Dr. Collins, Mr. Marzen and I followed a rational method that had
been used as a basis for the existence of pain in all manner of
animals and in non-communicative individuals of every age. Such
objective evidence is regularly used even when patients and
animals are UNDER anesthesia to determine the adequacy of
treatment. Method was outlined in a 1983 paper by Kitchell and
Erickson titled Animal Pain: Perception and Alleviation.
The three components of this method are structure, function,
and the demonstration of an aversive response to a noxious
stimulus.
Structure
For structure, you must show the presence of pain receptors,
called nociceptors, in the skin. Next, Nerves to carry nociceptor
signals to the spinal cord and upward in the central nervous
system and, finally, a brain structure to receive, process and
respond to the signals.
The scientific literature has documented the presence of fully-
functioning sensory receptors in the skin around the mouth of the
fetus at 6 weeks gestational age. (salvacion)
Nociceptors are readily identifiable in the skin by the 7th week of
gestation and under a microscope look like small bushes or the
frayed end of a rope. They appear everywhere in the tissues of
the skin, muscle, bones, and organs. These cells respond to
different forms of energy such as pressure, heat, or cold - and
convert this information into electrical activity. (Salvacion)
Specialized nerve endings involved in pain transmission are found
throughout all organs by 20 weeks gestation. These nerves

4. connect to other nerves in the dorsal horn of the spinal cord.
(Think Dorsal Fin of a Shark).
No less an authority than Leslie B. Arie, the father of Human
Embryology, documented the existence of these spinal nerves,
already appearing as spinal cord structures - specialized
pathways called TRACTS, on embryos in the first six weeks of
life.
At the top of the spinal cord, these nerves enter a group of berry
and nut-sized clusters of brain cells collectively known as the
basal ganglia. One of the more central of these clusters is called
the thalamus.
The thalamus acts as a central processing center for sensory
information from the rest of the body. The thalamus is THE
critical brain structure necessary for pain sensation and response.
The thalamus is present at least as early as the 5th week of
development. As I will explain, these are all the structures
necessary for pain sensation and response. While the cerebral
cortex starts to form at about 8-10 weeks gestational age, the
cortex is not, and has never been, a critical pain perception
structure.
Function
But structure alone is not enough. Functional activity in these
structures must also be present. A wide variety of demonstrable
events can illustrate that tissue function among pain structures is
present. You may take your pick.
Electrical activity

5. At only 40 days after fertilization electrical waves as measured by
the EEG can be recorded from the baby's brain, indicating brain
functioning. This coincides with electrical activity up and down
the spinal cord.
Identifiable EEG activity is seen from 19-20 weeks gestational
age and sustained EEGs can be recorded from fetuses of 23
weeks gestational age. (Sal)
Chemical pain substances, neurotransmitters
The neurotransmitters in the spinal cord that mediate pain
transmission appear early in development and are abundant.
(Salvacion) They include Substance P, L-glutamate, CGRP,
(Wright - cong test.) calcitonin gene-related peptide, VIP,
vasoactive intestinal polypeptide, somatostatin and bombesin.
In an article on Neurotransmitters and neuromodulators during early human
development :
Neurotransmitters such as monoamines appear in the embryo at
less than 8 weeks, before the nerves are differentiated. Maybe some of them remain
as evolutionary residues. NMDA (Glutamate) receptors dominate in the foetus, while kainate
and AMPA receptors appear later. Neurotransmitters and modulators are not only important for
the neural trafficking in the embryo, but also for the development of the neuronal circuits.
(Actually creating the wiring). Prenatal or neonatal stress may disturb the wiring and cause long-
term behavioural effects.” (Best known example is abnormal pain processing following
circumcision without analgesia)
This, notably, is evidence of fetal and neonatal
programming.
Glutamate
The NMDA (Glutamate) receptor mediates a host of spinal responses to severe painful
stimulation. Consequences of glutamate receptor activation include production of c-fos and
spinal production of prostanoids and nitric oxide.

6. G-ABA
GABA is widespread in the brain and spinal cord. Together with its partner glycine, it has major
inhibitory effects.
Hormonal responses
A study of intrauterine blood sampling and blood transfusions in fetuses
between 20 and 34 weeks of gestation showed that hormonal responses
to the needle sticks were consistent with the fetal perception of pain and
were correlated with the duration of the painful stimulus. (Wright)
These hormones are present in umbilical cord blood in response to stress
in the 16th week and possibly sooner.
The final component necessary for establishing the presence of fetal
pain is an Aversive response to a noxious stimulus.
Full body aversive responses to painful stimuli can be easily
witnessed on ultrasound at 13-1/2 weeks gestation. That was the
obvious conclusion reached by Dr. Collins, Mr. Marzen and I
when we published "Abortion and fetal Pain: The Medical
Evidence" in 1984. Our greatest limitation for any conclusions
prior to that time in fetal development was the limited clarity of
existing ultrasound. But we had research reports from
experiments done on fetuses aborted in the first trimester that
supported our findings.
Other evidence of aversive responses:
From 16 weeks gestation, the typical change in brain circulation is seen
in the fetal brain in response to a painful stimulus.
Wladimiroff JW et. al. Obstet Gynecol 1987;69:705-9 (Ran)
Further physiologic response to painful stimuli include increased levels of
circulating hormones like cortisol and catecholamines (epinephrine) in

7. response to painful stimuli. These levels will actually increase in
relationship to the level of painful stimulation.
Pain and surgical stress are also demonstrated by a coordinated
outpouring of hormones from the pancreas, pituitary and adrenal
glands. Cardiovascular responses such as increases in blood
pressure and heart rate, abnormal heart rhythms, or poor cardiac
output may signal pain.
As we noted, Fetuses have been observed to exhibit hormonal
stress responses to painful stimuli as early as 16 weeks
gestational age. Studies have demonstrated the significant
increase in stress hormones following needle placement in the
fetal abdomen for in utero blood transfusions. In contrast, no
consistent hormonal response occurred in the fetuses transfused
through the umbilical cord, a structure which does not contain
pain receptors. These responses were reduced when pain
medication was administered directly to the fetus, demonstrating
that pain processing and the ability to ameliorate pain
pharmacologically is present in the fetus. So much for that
famous pro-choice song – It’s my body and I’ll kill if I want to.
(Sal)
Studies of electrical activity including EEGs and SEPs show that the fetus responds to
painful stimuli in the same way that infants do by 24 weeks gestation. In fact the
responses are exaggerated because the inhibitory pathways involved in moderating
pain signal transmission do not develop in the fetus until 34-36 weeks gestation.
(Grissom)
The administration of anesthesia to preterm infants with surgical
procedures not only reduced abnormal EEG patterns, it was also
correlated with better outcomes (grissom)
Various Excuses
Can't speak, can't feel pain.

8. Tell someone you are going to torture a lab rat or stick a knife in a
dog. Is there anyone who honestly believes that if they don't say
"Ouch" they can't feel pain? People have gone to jail for less. So
when PETA comes to your door looking for a donation, be sure to
ask them to contribute to your local crisis pregnancy center. After
all, humans are animals, too.
The inability to communicate verbally does not negate the
possibility that an individual is experiencing pain. Pain can be
expressed non verbally by movement in responses to a stimulus
or physiological changes, such as changes in heart rate or blood
pressure. (Salvaccion)
Adults who are unconscious and brain damaged can be
assessed for pain responses. Decorticate and decerebrate
rigidity are 2 full body responses often seen with painful stimuli.
Blood pressure, pulse, EEG and hormonal responses - along with
circulatory changes - are all used as stand-ins for pain when
communication is not available.
Reflex
You will be told "pay no attention to those movements, it's only a
reflex." If you place an object in the fetal palm at 8 weeks, the
hand may close around it. That is a reflex. If you poke the hand
with a sharp needle, the hand and arm may withdraw. That may
be a reflex. If, however, the neck arches and the mouth opens
and you see other components of a full body aversive response,
that is no longer a reflex. Modern ultrasound shows this

9. definitively at 13 weeks and it is only limited by a lack of clarity at
8 weeks. Not a reflex. The tail does not wag the dog.
We could not see such full body aversive responses on the
primitive ultrasounds of the early 1980's. Modern 3-D and 4-D
ultrasound is so good, you can even see the face grimace in pain.
Try it sometime; show an intrauterine ultrasound to a pro-choice
zealot. The painful facial grimaces they make are just amazing.
No myelin - no pain.
Myelin is made up of a cell, separate from the actual nerve cell,
which coats and surrounds the length of the nerve cell. Myelin is
not necessary for a nerve cell to work, its presence only means
that the nerve cell signal is able to travel faster. This can be
important when you are six feet tall. It becomes a little less
important when you are only one inch tall. Myelin has been
shown to only be relevant to how quickly you respond to pain, it
has nothing to do with whether or not pain is perceived.
(Talk about MS - lack of myelin. May be numbed, may be slow.)
No Cortex
All the brain segments have obviously started to form by 5 weeks.
The midbrain, brainstem and cortex are all present in the fetus by
20 weeks gestation. This means that all the elements for the
perception of pain are present by 20 weeks gestation. (Grissom)
But no cortex is needed to experience and respond to pain. The
critical structure is the thalamus.
How do we know? People who have suffered the removal of
large portions of their cerebral hemispheres can still feel and
respond to pain. If I cut off the top of your head, I could stick pins

10. into your cortex all day and you would not feel pain. I could use
caustic chemicals or electric shocks and you would report nothing
more than an odd buzzing sensation. If I did any of these things
to the thalamus, extreme pain responses would occur. We also
know, in medicine, about Thalamic Pain Syndrome where the
body becomes hypersensitive to pain as a result of damage to the
thalamus. In TPS, Pain or discomfort may be felt after being
mildly touched or even in the absence of a stimulus. The pain
can be excruciating and often requires centrally acting narcotics,
anti-depressants and seizure medications to control.
Connections between the thalamus and cortex begin to appear as
early as 20 weeks gestational age. (Salvacion) and the cortex is
very important for localizing exactly WHERE pain is, but an
insistence on a functioning cortex is absurd. It's a lot like saying a
tornado didn't do any damage because we can't show you on a
map where it hit. The pain, like the tornado, still hurts.
Minimal or incomplete response
While some nay sayers go to great lengths to argue that all the
extensive nuances of adult pain sensation and response may not
be present, this does nothing to minimize the presence of fetal
pain. Newborns not only feel pain; they react to pain with 3 – 5
times the response of adults. They require higher doses of
anesthesia during surgery, and repeated exposure to pain lowers
the threshold to pain even more. (Wright) Newborns, like fetuses,
lack the development of inhibitory systems for pain reduction, so
that the painful consequences of relatively minor stimulation are
exaggerated.
Another argument, No memory
The argument is, if you haven't experienced pain, you don't know
what it is. But research now shows that INTRA-UTERINE painful
stresses may produce changes in memory patterns for pain

11. PRIOR to birth. Additional studies are beginning to elucidate the
actual GENETIC code of pain sensation and response.
In an article titled “Stressed-out, or in (utero)?”
Abstract
The molecular and cellular mechanisms by which plasticity is induced in the mature CNS (and, specifically, in the hippocampus) by
environmental input are progressively being elucidated. However, the mechanisms – and even the existence – of functional and structural effects
of environmental input (and, particularly, stress) early in life are incompletely understood. Here, we discuss recent evidence that
stressful stimuli have a significant impact on neonatal (rat) and
prenatal (human) hippocampal function and integrity.
Stressful signals provoke expression and release of neuromodulators, including the peptide corticotropin-releasing hormone (CRH), leading to
activation of CRH receptors on principal hippocampal neurons. Although physiological activation of these receptors promotes synaptic efficacy,
early-life stress could
pathological levels of CRH at hippocampal synapses contribute to neuronal death. Thus,
constitute a ‘double-edged sword’: mild stress might
promote hippocampal-dependent cognitive function,
whereas severe stress might impair neuronal function and
survival, both immediately and in the long-term. Importantly, these
CRH-mediated processes could be targets of preventive and interventional strategies.
Finally for those who believe Fetal Pain is more religious dogma
than actual science, I offer this:
If you believe in evolution - and all that implies for the
embryological development of the human species - you cannot
help but endorse the concept that pain sensation and response,
including fetal pain, would develop in evolutionary time at the
earliest possible moment as an essential mechanism of survival.
For those who seek to shove evolution down the throats of Bible-
Believing Christians, now is not the time to abandon your
scientific principles. Welcome, Mr. Darwin, to the Pro-life
movement!
Something needs to be said about my colleagues, because they
cannot be here today. We published in 1984, in an effort to aid
President Ronald Reagan, who had come under fire for his
comments on fetal pain. He based his original comments on our

12. research, which was taken from my desk drawer and provided to
the White House by a republican political operative. Based on the
outcry over Reagan's comments, you would have thought the
President had denied the Holocaust, when in fact he was drawing
attention to it.
We published three years before Dr. Anand, who is often -and
erroneously, given credit for the concept of fetal pain. Vincent
Collins, our lead author, was a Professor of Anesthesiology at
Northwestern University and the University of Illinois. He was the
first chairman of Anesthesiology at Cook County Hospital in
Chicago. He authored numerous research articles on
Anesthesiology, including a major textbook in the field. He died in
2004, at the age of 90. If you Google him, he is remembered for
2 things - Cook County Hospital - and fetal pain.
Thomas Marzen was a noted pro-life attorney who was actively
involved in all aspects of the movement. He was, without
question, the architect of the rigorous research protocol we used
to prove the existence of fetal pain. Tom, who was probably one
of the brightest and most compassionate men I have ever met,
suffered from polycystic kidney disease. He endured kidney
failure and a kidney transplant. He died in 2007 from
complications of cancer. Both he and Dr. Collins had the joy of
knowing they made a difference.
The recognition of fetal pain led to a re-assessment of treatment
for the unborn and the neonate. The introduction of anesthesia
and analgesia, along with an enhanced recognition of the
humanity and uniqueness of each human life, has saved
thousands of lives. Absent the entire issue of abortion, countless
numbers of newborns were saved because they had access to
anesthesia as part of their lifesaving surgery. Absent the pro-life
movement, the questions might never have been asked, the
answers never sought.

13. And so, on behalf of my colleagues - and on behalf of the pro-life
movement that stood with us, when the rest of the world laughed
at us and mocked us - I claim those lives! Know that these lives
were saved. Know that, despite the pain, you did good.
While unborn children in the womb may be pro-choice, they
almost universally choose life.
Some postscripts…
http://www.anaesthetist.com/icu/pain/Findex.htm#pain3.htm
Probably the most significant discovery ever in the field of
pain has been the gene c-fos. The cellular analogue of a viral
oncogene, this rather special gene and its cellular product, the
protein called Fos seem crucial to the profound central nervous
system changes that occur when an animal (or man) feels pain.
Central nervous system c-fos expression correlates extremely
well with painful stimulation. Generically, Fos is one of the
inducible transcription factors (ITFs) that controls mammalian
gene expression.
We now have a molecular marker for pain! Even more
important, we know that because c-fos is a proto-oncogene - that
is, it can promote vast intracellular changes including cellular
restructuring and proliferation - it is almost certainly involved in
the long-term neurological consequences of noxious stimulation.
An incidental note - FOS has been found in the fetal bones at
least as early as the 16th week of gestation.
CONCLUSION
It doesn't matter if you start with the FOS gene in the fertilized
egg at the moment of conception or work backward from where
we left off with the 8 week embryo and the lab animals who can't
communicate their agony.

14. The Future: Knowing the earliest moments when humans can feel
and respond to pain, you will understand the mechanisms at a
basic level; you will be able to develop new drugs and new
methods to relieve pain, prevent disease and modify the course of
illness.
Our opponents will not challenge us on fetal pain because they
know that their scientists are with us and they fear the dire
consequences if they ever prove us wrong. Kittens would be
tortured in the streets, you couldn’t fundraise off the slaughter of
helpless baby seals, Michael Vick would not only be exonerated
in the SuperBowl, his pets would be the halftime show.