L’aube du moi – Pr. Carlo Valerio Bellieni

Is the foetus a person? This is this question L’aube du moi, by Carlo Valerio Bellieni, professor in neonatology at the university of Sienne and member of European Society of Paediatric research wants to answer. When “we often deny that the foetus is a person because we associate the idea of person to that of self-awareness“, the author affirms right away that “the neonatologist – the foetus physician- has no doubt about what a foetus is; the evidence imposes to him“. In this book, which gathers different articles published in scientific journals, the author wants to “help to understand who the foetus really is” to be attentive to “precautions [we have] to take with it“.

 

“Without any doubt, we can say that the human foetus is a person: he feels, he reminds, he dreams, he experiences pain and pleasure, he has desires.” The observation of reactions to stimuli of the foetus or premature infant (foetus outside the uterus) reveals today that the uterine life is far from being inert and that the foetus has a lot of neural receptors which give him a sensitive, rich and structuring life. Olfactory and taste, tactile and vestibular, acoustic and visual sensitivity develops progressively during the pregnancy in order to shape the central nervous system and to prepare the future infant to the outside world.

 

7 or 8 weeks after the conception, the foetus presents an escape reaction if the circumoral region is stimulated. At 22 weeks, he gives a start with a high volume music perceived through the uterine wall (Relier 1996). If the stimuli are repeated, the observation reveals a habituation phenomenon (Hepper 1997), which also proves that the foetus has a memory. When the mother lives in a too noisy environment, it is not rare the foetus suffers auditory problems. Paediatrics from Marseille also found that the child was sensitive to food tastes of her/his mother. Finally the author notes that if the newborn baby falls asleep when he is rocked, it is because he finds again the reassuring vestibular sensations he felt in his mother (Loux 2002). It is from all these sensations that the foetus could dream.

 

There are still people who affirm that as she/he is not able to say “I” the foetus cannot feel the pain. Until 1987, surgical procedures on newborn baby were performed without anaesthesia: we thought the foetus and the infant had a level a conscience and memory too low to be able to feel the pain. In fact, the foetus feels the pain in a quite same way as the adult because she/he has anatomic pain pathways: receptors, neural pathways and cortex able to receive and integrate information (Hamon 1996). The very little child would be even more sensitive to pain than the adult: the density of receptors and substance (pain mediating substance) is more important than in adults and she/he is not prepared to experience it.

 

It is then indubitable that VTP is extremely painful for the foetus (Vial et al. 1996). In France, the administration of anaesthetic is suggested in the case of termination of pregnancy from 14 weeks. Yet nothing allows knowing if the child does not suffer before.

The foetus, a relational being 

 

The discovery of the pain in premature infants allows knowing that the foetus was a being of desire and relationship: faced with pain, the infant needs human presence. The method of analgesia for premature infants perfected by Pr Bellieni and called “sensorial saturation” proves it: it consists in providing the child, during the painful blood collection, with several sensorial stimuli which entertain and reassure him. Extremely efficient, this method only works if it is performed with the intention to entertain and comfort the child.

 

The haptonomy or science of touch contact invented in The Netherlands by Frans Veldman, shows also that the foetus can enter into contact with her/his parents through the uterine wall. “From the moment when the first movements are perceptible, […] the mother takes her/him, literally, in her arms, enveloping her/him affectively. The perceptive stimulation, felt by the child, invites him to reply in a reflexive and more and more participating way. And little by little a communicative interaction develops between the mother and the child.”

 

The experiences of intra-uterine life fundamentally influencing the development of the child, the evolution of the procreation techniques generates new difficulties for paediatrics. The development of medically assisted procreation (MAP) and the systematisation of prenatal diagnosis (PND) can be for him factors of risks. Bellini reports the study by Hansen et al. from 2002 in the New England journal of Medicine: “children conceived by ICSI or in vitro fertilization have at birth a risk of major defects twice higher than for children conceived naturally.” Schieve et al. describe in 2002 the link between IVF and the low weight of children at birth, even in case of non-multiple pregnancy. If the untrasonography does not seem to have impact on the development of the child, some articles show the link between amniocentesis and respiratory problems at birth. (Greenough, Lancet 1997). The foetus also feels his mother’s anxiety (Sjostrom et al. 2002) and the research of anomalies has on him a deep impact. Mrs Vial, director of child care department in a Paris hospital estimates that “any foetal exploration, in particular the karyotype, causes, above all in the mother, a real “interruption” of the relationship with the child, which will be only resumed after the result guarantying the normality. If observing the slightest anomaly, the suspicion on child quality induces in the parents a reaction of rejection totally disproportioned compared with the real gravity.”

 

 

The prenatal life has quite no care but the consumerist research of the perfect child and the right of the parents to know everything about the child generate an interference which would not be acceptable for an adult subject and which can be source of damages for the whole life of the child. In such a context, the physician has to protect the foetus from a possible “‘non-conformity‘ diagnosis compared with expectances” and the beginning of the acceptation passes through the look the parents see in the physician. Despite the anxiety of such a moment, they know well how to distinguish if the child is sawn as a “clinical case”, a “product”, or as a child, with a name, a story, a value which is greatest than his pathology.
Throughout the articles, Pr. Carlo Valerio Bellieni reminds it is recommended “to call child a child, even if he is not even outside his mother, because the name we give him includes the judgement we have“.

L’aube du moi, Carlo Valerio Bellieni, oct. 2009, Ed. de l’Emmanuel.