The Waiting Womb

The Waiting Wall

While child mortality is relatively low in this day and age, babies born too early still face significant health risks. According to the World Health Organization, premature birth results in nearly one million deaths per year worldwide, and for babies born extremely premature, after an approximate twenty-three week gestational period, the mortality rate is almost 70%. The combination of insufficient time to develop in utero and treatments required to keep them alive, leave many of the surviving babies facing health issues such as brain hemorrhaging, respiratory problems, digestive issues and learning disabilities. For example, the treatments given to allow the baby to breathe, while necessary, can also harm lung development.

The root of all of these issues, of course, is that these babies cannot remain in the uterine environment for as long as is necessary for proper development. Since keeping them in their mother’s womb isn’t an option, scientists have opted for the next best thing—an external, artificial womb in which premature babies can safely mature.

Creating an external uterine environment has been a theoretical idea for over fifty years, but complications such as infection and heart failure have prevented experimental success after a few days use. An article published in Nature Communications, however, recently reported that scientists have managed to use their “Biobag” to sustain and mature extremely premature lambs for up to four weeks. Though at first glance it doesn’t look like much more than a plastic bag, the system uses complex mechanics to closely mirror the natural uterine environment, including the placenta and amniotic fluid, and the closed environment prevents the introduction of infection. It also uses the fetal heart rather than a pump for circulation, preventing the heart and other organ failure that had doomed previous models. Using this technology, babies born after only twenty-three weeks of pregnancy could safely mature for an extra month, which could astronomically reduce mortality rates.

While this experiment yielded extremely promising results, it is too early for the technology to be used on human infants. The lambs did not experience any negative effects as a result extra-uterine maturation, but placing humans in the Biobag rather than premature lambs may have a different result and pose a safety risk. The experiment also tested only eight premature lambs; therefore, much more testing will be necessary before the Biobag is shown to be a viable treatment option. Additionally, this system only works when coupled with birth by caesarean section, so it would not be an effective form of treatment for all premature babies.

The invention of an extra-uterine system unsurprisingly leads to controversy in multiple areas. In theory, an external womb could be used to develop a baby from a much younger age, minimizing, if not completely obviating, the need for pregnancy. Additionally, the changing of what could be considered a “viable” age for a baby could impact the abortion debate. For example, twenty-one-week-old fetuses are now considered “pre-viable,” but if they could mature in the Biobag safely, abortion restrictions would likely need to shift. While this use would undeniably spark ethical controversy, researchers behind this invention state that it could not be used to sustain infants less than approximately twenty-three weeks of age and does not intend to. This lessens the ethical impact, since it will not change the age of fetus viability, but only the mortality rate of already “viable” preemies. However, the Biobag can still have interesting halachic implications. Rabbi Yair Hoffman explains that it would raise the issue of whether a boy who finished development in this extra-uterus would require a pidyon haben, and whether that ceremony should be done a month after birth or leaving the “second uterus.” Though Rav Elyashiv differentiated between a womb and an incubator, the Biobag more greatly resembles the structure of a womb, and, therefore, may be considered as such.

While it brings up new ethical questions and requires further study, an artificial uterine environment would revolutionize treatment for premature infants, and holds the promise of saving thousands of lives or more in the future.