Dystopian nightmare or utopian scientific wonder? The concept of artificial wombs (AW) once seemed to belong merely to science fiction novels, ideas underpinning societal commentaries rather than musings of actual potential medical advances.
Well, Aldous Huxley, Brave New World (or perhaps The Matrix?), say hello to modern-day Philadelphia, 2017. Just over six years ago, a research team led by Alan Flake, a fetal surgeon based at the Children's Hospital of Philadelphia (CHOP), achieved what will perhaps be considered the breakthrough moment for the development of artificial wombs for humans.
The so-called ‘biobag’ prototype was designed to help support premature babies, with the first version showing promising results in animal testing. Doctors are hopeful that future iterations will become viable for human use. Whilst developments are still in their nascent stages, the potential implications for the future of pregnancies are significant.
Extreme Prematurity and Neonatal Mortality
In the developed world, where neonatal medical support is readily available, the greatest risk to the baby is extreme prematurity. It is currently the primary cause of neonatal mortality, accounting for over a third of infant deaths.
Babies who survive premature birth are also more likely to experience health issues. For example, 50% of infants born with cerebral palsy can be attributed to premature births.
Source: Children's Hospital of Philadelphia YT channel.
Advances in neonatal care have resulted in increased survival rates in the last few decades, pushing viability to 22/23 weeks of gestation. However, survival rates at 23 weeks hovers at just over 15%. For babies born before 28 weeks, organ immaturity and a range of other health conditions are common, with many suffering from chronic lung disease (often as a result of ventilators).
The search for viable extracorporeal support for the fetus - in other words, existing outside of the mother’s womb - is understandably a focus for the medical community. Nevertheless, despite over 50 years of research, scientists have not been able to find a solution.
Is the Biobag the Answer?
The development of the biobag was hailed as a major medical breakthrough, both in the scientific community but also in leading news outlets. The magazine Science hailed the team for “overcoming engineering, biology, and technology obstacles.” The Guardian called the biobag “an advance that could transform the lives of the most fragile newborns.”
The system is simple, at least in theory. Here’s how it works:
the biobag, which is made entirely of plastic, mimics the womb’s amniotic fluid through a combination of salts and warm water. The fetus consumes this fluid, which is continually renewed through an external system.
An oxygenator, plugged into the baby’s umbilical cord, serves the dual purpose of delivering essential nutrients as well as removing carbon dioxide. The baby’s heart does the remainder of the work, pumping the blood, just as in a natural womb.
In the initial tests, the lambs were born at the human equivalent of 23 weeks of gestation. Once placed in the biobag, development occurred naturally and seemingly without issues. According to Dr Alan Flake, the lead investigator, the lambs “appear to have normal development in all respects.”
Whilst these results are certainly promising, we are still a long way off a viable product for human use. The risk of infection will still be very high, despite any attempts to create a fully sterile environment. In addition, the replacement for the womb’s amniotic fluid has not yet been fully developed.
Flake is also keen to temper expectations, with a full awareness of how media hype may negatively affect hopeful parents. He is quick to discourage people thinking of even the fully-developed product being considered a sort of ‘magic bullet’, citing the complexities involved in extreme prematurity.
In any case, it is clear that this treatment option will not be available at a hospital in the near future, with doctors citing the 20-year period it took for steroid injections used for fetal lung development to be made universally available, a treatment also initially developed in lambs.
Ethical Concerns of Artificial Wombs
Sensationalist headlines initially welcome the biobag with a heavy dose of scepticism, citing dystopian futures considered by works such as The Island, I am Mother, or Brave New World. The fears of artificial wombs replacing human mothers in a distant future were suddenly made very real, whilst more considered views arguing the potential impingement on women’s rights and equality.
Flake has been quick to assuage any worries of science fiction, with his team not looking to increase gestational viability, but rather to help babies being born in hospitals. In other words, premature infants at around 22 or 23 weeks and beyond. Their aim is for the developed device being ‘ethically unremarkable’, existing within current accepted frameworks of medical treatment.
Others have outed concerns that the development of an artificial womb may lead to a fetus’ right to life superseding a woman’s control of her own body, adding further complexity to current debate around abortion. Of course, this argument perhaps assumes that the technology will in future drop the viability threshold.
However, most critics are lauding the potential implications of this medical advancement. The release of a viable artificial womb for human use can lead to improved rates of infant mortality, in addition to lowering the risk of the development of health issues in surviving babies.
Further, the technology may also reduce risk to the health outcomes for pregnant women, which remain significant. Couples struggling with infertility, as well as same-sex couples, would perhaps be able to circumvent the surrogacy route, which is often complex and mired with difficulties.
We must also consider that IVF was once also considered science fiction, subsequently moving to become an ethical debate in wider society, finally finding its current place as an accepted part of assisted reproduction.
These debates on the specifics of artificial womb technology will remain very hypothetical for the foreseeable future. We are still potentially decades away from the release of a usable product, not to mention the regulatory hurdles that will need to be tackled.
Nevertheless, the eventual development of an artificial womb seems inevitable, and it will challenge our understanding of childbirth, the fetus, and women’s rights. As we edge ever closer to science turning the biobag, or an equivalent product, into a reality, we must prepare to navigate the complex ethical and societal implications it will bring.