Contents
In order to understand how it happened that fetal surgery was seriously considered, one has to go back in time. Olivia Gordon, author of the book “First Breath”, described how the widespread ultrasound examination in pregnancy was born and what happened when doctors first detected irreversible defects in the fetus using this method.
- In the past, a fetus was most often referred to as a “little stranger”. If a child was born disabled, theories ranged from the presumption that the deformity was caused by the mother’s restless thoughts to the fact that the birth was a warning from heaven.
- Pregnant ultrasound examinations are an invention only from the 70s.
- One of the first to diagnose disabilities in unborn children was prof. Stuart Campbell
We publish an excerpt from the book “First Breath” by Olivia Gordon, courtesy of SQN Publishing House.
The fetus through the ages
Until recently, the fetus was an unattainable secret, a secret locked in a female body. The oldest known in utero fetus illustrations, dating from the thirteenth century, show tiny, fully formed people exercising in a jar. For hundreds of years it was believed that these tiny, well-formed people – homunculi, which in Latin means “little people” – were hiding in sperm or an egg and just growing. For centuries, the only reliable source of knowledge about the unborn were autopsies of aborted or aborted fetuses or animal experiments.
At the beginning of the XNUMXth century, a child waiting to be born was most often referred to as a “little stranger”. In turn, in the case of one born disabled, theories were various: from the presumption that the deformation was caused by the mother’s restless thoughts, to the fact that the birth was a warning from heaven.
The Tractatus de Monstris, or Treaty on Monsters, entry from 1570 by the French Bishop Arnaud Sorbin, was full of illustrations of children born with extreme (and unlikely) deformities, including an extra pair of eyes and ears or four feet. The bishop saw in these “monsters” an announcement from heaven, the result of human sins.
In the XNUMXth century, wax and clay models of babies with deformities were created for the new school of obstetrics in Bologna, Italy; they were used as examples of “monstrous birth”. The founder of this school, the obstetrician Giovanni Galli, argued about the power of the mother’s imagination and its ability to deform the fetus.
This attitude towards disability has changed relatively recently. Back in 1941, at the GOSH hospital, a pediatrician, writing about Sorbin and his monsters, commented: “it is possible that those who perceived these strange monsters as creatures in some way related to the Antichrist are right”.
The beginnings of ultrasound examinations in pregnancy
When I met Stuart Campbell at the Royal Medical Society in 2017, he was 81, tall, intelligent, and continued to work hard as director of a private reproductive medicine clinic. He turned out to be a practical man with a tart sense of humor, as well as a fan of golf, theater and (as we enjoyed tea) pain aux raisins.
Today Campbell is considered one of the pioneers of perinatology, but in the early 60s he was a young man with a vision. Donald, he recalled, “worked in a darkened office on the ground floor in the depths of Queen Mother’s Hospital. Nobody went there; I was the only intern who did this ». While he was not delivering – which was part of his job after all – Campbell would go downstairs and watch Ian Donald perform ultrasound scans on the pregnant women. One day he summoned up his courage and asked:
– Can I learn to do this test?
And Campbell was telling me: At that time, we were sending people into space, to the moon. And no one knew anything about the fetus hiding only a few centimeters under the mother’s skin. It even fascinated me.
On Sunday mornings, during his free time, Campbell did his own research and found how the head should be measured, which allowed the baby’s growth to be monitored throughout the pregnancy.
“The mothers were certainly delighted to see their children mature,” I said.
“Yes, but they also wanted to be really helpful,” Campbell replied. – The women of Glasgow are wonderful. Nobody had any particular hopes for what they were doing.
Campbell recalled Donald showing medical professionals pregnancy ultrasound images.
– They were laughing. It was scary. And I thought, “How can they be so stupid? This is visionary. And they mock each other ».
Back then, access to a living fetus seemed absurd and impossible. X-rays did not catch on in the long run, and in the 60s, few people thought that ultrasound would be different. Together with the amniotic fluid testing of human chromosomes, which began in the 50s, the possibility of in utero genetic testing was another important chapter in the history of perinatology.
In the early 70s, amniocentesis was rarely and most often performed without ultrasound – although it would have been technically possible at the time. This test was usually done only before surgery to identify the amniotic fluid. During the procedure itself, when the needle was inserted, the device (which seems amazing from today’s perspective) was turned off. The miscarriage rate was high, but that was what the procedure was like back then. The amniotic punctures were performed literally blindly. Doctors did not fully understand what an ultrasound can do – which is not surprising given the limitations of the first devices.
But in the 70s, a revolution took place. After medical people explained to engineers what they needed, the latter invented better devices, and by the middle of a decade, “real-time” fetal testing has become commonplace in hospitals. Small, handy probes were used, thanks to which it was possible to observe the fetus moving in the womb. Campbell’s eyes twinkled as he told me of the fetal world he was discovering.
– Has had hiccups since week 10. Around week 20, she already opens her eyes. In the 12th week, she moves her legs. Previously, no one had a clue about it.
The first ever diagnosis of the disease in a fetus
But Campbell was soon going to get serious; something that will forever change the lives of children born with a handicap and the way handicaps are viewed. 1On March 3, 1972, he was carrying out an ultrasound examination of the expectant mother when he noticed that something very bad was happening to the baby. The mother suffered from infertility for three years and did not have a period. At the hospital, she underwent fertility restoration therapy, and in November 1971, after drug therapy, she eventually ovulated.
In those days, this was confirmed with a vaginal swab rather than an ultrasound scan. The pregnancy seemed to be going well until that spring day, during which Campbell did a routine check-up to see if ovulation stimulation had resulted in a twin pregnancy and to take measurements of the baby. The anatomy of the fetus was so obviously so abnormal that he could not have overlooked it – part of the skull was missing. The child with anencephaly died immediately after it was born.
“It was amazing,” Campbell said to me, “because it’s not yet 20 weeks and the baby was very small and the images were black and white and grainy. Even so, I could see that the shape of the head was not what it should have been. I did another test and the result was identical. For two consecutive weeks the doctor repeated the procedure “basically to convince the patient that this discovery was true”.
The mother decided to terminate the pregnancy and gave birth to a fetus with painful contractions. The next day, she left the hospital, looking forward to getting pregnant again. The pathologist confirmed the diagnosis. For the first time in history, an unborn child has been officially diagnosed with the disease solely on ultrasound. Aside from a few anecdotal reports, it seems the idea has simply never occurred to anyone before.
Campbell later wrote: “To be honest, prenatal diagnosis of birth defects was not a big deal in my mind, so when I discovered an anencephaly it became an unexpected dilemma.” His mentor, Ian Donald, a passionate Christian, was a “staunch” opponent of abortion, and given how some parents would react to the news of their child’s serious or even fatal illness, Donald would never find a birth defect in the fetus. But now it was opening up to a new world in which disabilities could be diagnosed in unborn babies.
See also: Lethal defects of the fetus. What does it mean? [WE EXPLAIN]
Who was this mother who lost her child, and how did she feel? From Campbell’s report, we learn that she is a twenty-five-year-old employee of a Pakistani factory. She was advised to return for another examination when she was 14 weeks next pregnant. Today, Campbell no longer remembers those details, or whether she was able to get pregnant again. At that time, however, he wrote sympathetically in the Lancet: “The birth of a child with anencephaly in the third [sic!] Trimester of pregnancy … is an emotional traumatic experience for the parents … early enough for termination of pregnancy ”.
The first time invasive amniocentesis was performed in conjunction with a real-time ultrasound scan, reducing the risk of miscarriage. Doctors now had a glimpse into the womb and could finally see the mysterious child. This, combined with diagnostic breakthroughs in modern genetics and laboratory biochemical research, will change everything.
[…]
Late termination of pregnancy for medical reasons is a highly emotional issue. In the United Kingdom, where premature babies have been rescued since the early 90s, the UK Abortion Act 1992 moved the age of pregnancy without medical indication from 28 weeks to 24 weeks.
An abortion after 24 weeks for medical reasons is allowed in the case of a child at risk of “severe impairment” due to “physical or mental abnormalities” and in cases where the mother’s physical or mental health is at risk.
This means that an abortion for medical reasons can be performed, at the discretion of the physician, until termination. The procedure is the same as for previous abortions. Labor is induced or, under general anesthesia, the fetus is removed with forceps, but in the case of a pregnancy older than 22 weeks at the beginning or during the procedure, the heart rate of the fetus is stopped after the injection is given so that it is not born alive.
There is no legal definition of what constitutes a “severe handicap” *, so children with Down’s syndrome, which some argue is not at all a severe handicap, receive an abortion after 24 weeks – twenty-six in 2016.
A baby with Noonan syndrome can also be removed in the UK up to the 40th week of pregnancy. Society’s perception of when life begins has changed, which in turn undermines the very idea of abortion. Ultrasound pioneer Stuart Campbell told me of “that ungrateful situation where there is an intensive care neonatologist at one end of the corridor trying to keep a baby alive at 24 weeks gestation, and at the other end of a 24-week termination. week. It is illogical and stupid ».
Campbell advocates freedom of choice, but is campaigning to lower the UK time limit for non-medically indicated termination from 24 to 18 weeks, and the ideal date is 12 weeks. The more “real” the fetus becomes thanks to perinatology, the more it attracts the attention of society. Campbell’s work of observing the babies in the womb changed his perceptions.
“I didn’t have such firm beliefs until I started looking at fetuses between 20 and 24 weeks of age, the fetuses and the complexity of their behavior,” he told me. It is a desperately difficult situation to give an unborn baby who is already kicking with his feet an injection clearly labeled by the British Pregnancy Advisory Service as ‘killing the fetus’.
Late termination of pregnancy is an excruciatingly painful choice that deserves the highest sympathy. On the other hand, making a decision to terminate a pregnancy, during which, thanks to the new possibilities of perinatology, a serious problem is diagnosed, is a situation experienced by many parents, but it is rarely discussed in public.
One thing is certain: it is difficult to make a decision without knowing the “truth” about a given condition – and although in some cases a child will not have a chance to live long after birth or his quality of life will be very low, the truth about many genetic syndromes is overwhelmingly variable .
This may interest you:
- We explain why the term “eugenic abortion” should not be used
- “If I had known how sick my child would be, I would not have decided to be born”
- Gynecologist: Forcing a mother to be an incubator for a corpse is unworthy
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.Now you can use e-consultation also free of charge under the National Health Fund.