In 1981, Dr Michael Harrison from the University of San Francisco, California was faced with a difficult decision. A 20-week baby had been diagnosed with severe kidney disease caused by an obstruction of the urinary tract, a condition that was certainly fatal. With no other possibilities for medical intervention, the child’s mother agreed to venture into unknown territory and take a chance with the only procedure that offered any hope of survival for the baby – open foetal surgery.
Having never been attempted before, this involved a caesarean-like operation to partially expose the baby, remove the obstruction, and then return him to the uterus to continue developing for the rest of the pregnancy. The use of muscle relaxants to safely cut open the uterus without inducing pre-term labour, and a chemical solution to replace lost amniotic fluid, allowed for a successful surgery and subsequent continuation of the pregnancy, with the baby continuing to grow.
Unfortunately, kidney and lung damage, which had already occurred prior to diagnosis and surgical repair, was so severe that the baby did not survive after birth, but the attempt at pursuing treatment signalled the first step into the incredible world of foetal surgery. Doctors had shown that it was possible to operate on an unborn child. Within the same year, Dr Harrison went on to successfully treat baby Michael Skinner, who suffered from a similar condition. He became the world’s first survivor of foetal surgery.
Foetal surgery is not without its risks, especially as there are two patients – both the baby and the mother – and so careful consideration on a case-by-case basis is essential. Keeping this in mind, the option to surgically treat an unborn child is a growing reality, offering hope to babies diagnosed with life-threatening conditions or facing the prospect of severe disability if treatment is delayed until they are born. The development of foetoscopic surgery, in which probes and cameras are used to perform the procedure rather than making an open incision, has improved the safety and results of these remarkable procedures.
Today, foetal surgery treats a variety of conditions including congenital diaphragmatic hernia (in which abdominal organs are pushed into the chest cavity, preventing lung development), heart abnormalities, and the removal of tumours. The most famous example is spina bifida, a condition in which the baby’s spinal cord protrudes unprotected from its back, and frequently results in permanent leg and bladder paralysis as well as brain abnormalities. Traditionally spina bifida has been repaired in newborns. A study comparing the outcomes of children who underwent foetal surgery, as opposed to treatment after birth, found that foetal surgery had a significantly lower risk of death and decreased need for later neurological treatment. These children also showed higher rates of independent walking and a greater ability to care for themselves. Excitingly, foetal surgery for spina bifida was performed in Australia for the first time last year at the Mater Mothers’ Hospital in Brisbane.
As our medical technology exponentially improves, so too will the success rates and applicability of foetal surgical techniques. Increasingly, new foetal treatment centres are opening around the world, and the growing frequency of success stories in the media is an uplifting testimony to the fact that many illnesses which may once have been considered a death sentence for the unborn child finally have a therapeutic option. See here for a recent example!
The science is undeniable – an unborn child is a human being. You can call it a foetus, a pre-born human, a Homo sapien or a baby, but they all have the same implication. Why then are we working so hard to perform groundbreaking surgery on some babies but for others we don’t give them a chance at life? Equality begins in the womb, and we want equality for all.