Note from the Editors:
Sir William Liley was one of the fathers of fetal therapy and paradoxically
one of the greatest early influences acting to retard the development of fetal
surgery. If the group in Auckland, New Zealand, had not been so outstandingly
successful in the development of percutaneous fetal transfusions, then fetal
surgery would have had to have developed to a point where major fetal surgery
could have been routine by this time. His untimely death in 1983 robbed the
field of fetal therapy of a mentor of incredible experience, breadth of vision
and wisdom.
This paper was based on an invited paper delivered to the Eighth Annual
Congress of the Australian and New Zealand College of Psychiatry in October,
1971. A wide variety of facts about fetal physiology are reviewed, exploding the
myth of the foetus as a passenger carried to term, and pointing out that the
foetus is an active, developing individual responding to his environment in ways
designed to improve his comfort. Liley's humor and tremendous breadth of
knowledge are both amply illustrated in this article. He is sorely missed.
I did not choose the title of this presentation. Had I done so, I would have
been more careful in my selection of words. The foetus is part of my province of
medical practice, and personality is part of yours. But whereas I am sure you
that you could all define, describe and even recognize a foetus, I am not so
confident that I can define personality. One dictionary offers 'what constitutes
an individual as a distinct person,' but does not define what the 'what' is.
Another dictionary asserts 'the state of existing as a thinking intelligent
being'. This definition might lead to the inference that personality increases
pro rata with intelligence, or that some people may not have a personality at
all if we followed Bertrand Russell's dictum that 'most people would rather die
than think and many, in fact, do!'
My copy of the late Ken Stallworthy's Manual of Psychiatry is more
help with the definition that 'personality is the individual as a whole with
everything about him which makes him different from other people,' because we
can certainly distinguish foetuses from each other and from other people. With
the next sentence - 'personality is determined by what is born in the individual
in the first place and by everything which subsequently happens to him in the
second' - we are really in business. Not only can I tell you what is apparent of
what is born in the foetus, but I can also describe the environment in which he
lives, the stimuli to which he is exposed, and the responses which he displays.
Therefore it might have been more apt to title this presentation 'A day in the
life of the foetus,' and together we can revisit a stage of life which we all
experienced but which, superficially at least, none of us remembers.
Such a journey is justified for several reasons. For many centuries interest
in foetal life was restricted to anatomical studies by embryologists or to
mechanical problems in delivery as they presented to the accoucheur. The
legacies of this era are well known - particularly the attitude that, apart from
some aimless kicking which began in the fifth month, the foetus was a placid,
dependent, fragile vegetable who developed quietly in preparation for a life
which started at birth. In the present century, many disciplines have extended
their interest to include the foetus, but in fields from surgery to psychiatry
the tendency has been to start with adult life and work backwards - knowing what
the adult state was, one worked back to what seemed a reasonable starting point
to reach that goal. Therefore, in fields from physiology and biochemistry to
education and psychology, there has grown up the habit of regarding the foetus
and the neonate as a poorly functioning adult rather than as a splendidly
functioning baby.
Until recently, the human foetus in situ was inaccessible to study and this
seclusion has had two further unfortunate results. First, much reliance has been
placed on animal experiment in spite of the fact that there is more variation
throughout the mammalian order in reproductive physiology than in the physiology
of any other body function. Second, for want of experimental verification or
repudiation, theories have flourished without serious challenge. As a
consequence, at one extreme, J.J. Rousseau and his pupils could regard the
foetus as a witless tadpole with a mind like a cleanly washed slate - the tabula
rasa - and at the other extreme some interpreters of dreams considered the
foetus a skilled voyeur, spying on his parents having intercourse - a sort of
'what the butler saw' through the cervix.
If, with regret, we must abandon such fascinating conjecture, I hope that we
can replace it with equally interesting fact, because recent advances in foetal
diagnosis and therapy have provided both the technology and opportunity to piece
together a new picture of the foetus. Far from being an inert passenger in a
pregnant mother, the foetus is very much in command of the pregnancy. It is the
foetus who guarantees the endocrine success of pregnancy and induces all manner
of changes in maternal physiology to make her a suitable host. It is the foetus
who, single-handed, solves the homograft problem - no mean feat when we reflect
that, biologically, it is quite possible for a woman to bear more than her own
body weight of babies, all immunological foreigners, during her reproductive
career. It is the foetus who determines the duration of pregnancy. It is the
foetus who decides which way he will lie in pregnancy and which way he will
present in labour. Even in labour the foetus is not entirely passive - neither
the toothpaste in the tube nor the cork in the champagne bottle, as required by
the old hydraulic theories of the mechanics of labour. Much of the behaviour of
the neonate and infant can now be observed in utero and, by corollary, a better
understanding of the foetus and his environment puts the behaviour and problems
of the neonate in better perspective.
In his warm and humid microclimate, the foetus is in neither stupor nor
hypoxic coma. From the few electroencephalographic studies, he appears to show
cyclical activity, the lighter periods of which correspond in the neonate to a
drowsy wakefulness from which he is readily aroused by a variety of stimuli.
Like all internal organs, the uterus is insensitive to touch, indeed, to all
stimuli except stretch. Hence foetal movements are not felt in the uterus but in
the maternal abdominal wall, which explains why quickening is not apparent until
16 to 22 weeks of gestation. The foetus has been moving his limbs and truck
since about eight weeks, but some 10 or more weeks elapse before these movements
are strong enough to be transmitted to the abdominal wall. In some 40 per cent
of pregnancies, an additional cushion, the placenta, is on the anterior uterine
wall, and this phenomenon plus variation in foetal position explains why
maternal account or external palpation may be a very erratic guide to foetal
vigour and welfare.
Foetal comfort determines foetal position, but comfort presents no problem in
the first half of pregnancy when the foetus inhabits a relatively large and
globular cavity. He is under no restriction and has no axis of stability.
Occasionally these conditions still prevail in late pregnancy - in the presence
of polyhydramnios, or with a uterine cavity truncated by a fundal or praevia
placenta - and then we see an unstable lie. Normally, however, in the second
half of pregnancy, the uterine cavity is no longer globular but becomes
progressively more ovoid with the lower pole narrower, and the foetus elongates
more rapidly than the uterus. Therefore the foetus tends to be corralled into a
longitudinal lie. However, amniotic fluid volume reaches a maximum at about 28
to 32 weeks, and until this time the foetus is far from cramped and under no
obligation to lie well flexed. As amniotic fluid volume diminishes and foetal
bulk increases from 32 weeks to term, comfort becomes more difficult to achieve.
If he chooses to flex his knees, the foetus will present by the vertex as his
head forms a smaller pole than his back, thighs, calves and feet, and this
disposition corresponds to the polarity of the uterine cavity. If however he
elects to extend his knees, he will fit in best as a breech since his tapering
trunk and thighs form a smaller pole than his head, calves, and feet.
Variations of uterine contour, unusual size or location of the placental, and
the presence of another foetus may all present further challenges to foetal
comfort and ingenuity and produce stable malpresentations. Foetal position,
whether he lies with his spine anterior, posterior, or lateral, is determined by
other influences. In late pregnancy, the most important of these are the
location of the placental, which converts the circular cross section of the
uterus to an oval, the tone of mother's uterine and abdominal wall, the shape of
the maternal lumbar lordosis, and the inclination of the pelvic brim. Maternal
movement and change of maternal position, Brazton-Hicks contractions, and
external palpation all disturb the foetus and may provoke him to seek a new
position of comfort. He will repeatedly and purposefully seek to avoid the
sustained pressure of a microphone or phonendoscope or of a knuckle on
prominences.
The mechanism by which the foetus changes ends in the uterus is simple - he
propels himself around by his feet and legs. The mechanism by which he changes
sides is more subtle - he employs an elegant longitudinal spiral roll and at the
midpoint of his turn has a 180 degree twist in his spine. He first extends his
head and rotates it, next his shoulders rotate and finally his lumbar spine and
legs - in fact, he is using his long spinal reflexes. Insofar as this is the
obvious way to turn over, there would be nothing remarkable about it except that
according to textbooks of neonatal and infant locomotor function the baby does
not roll over using his long spinal reflexes until 14 to 20 weeks of
extrauterine life. However, we have unequivocal films of the foetus using this
mechanism at least as early as 26 weeks gestation, and it is apparent that the
reason we do not see this behaviour in the neonate is not that he lacks the
neural co-ordination but that a trick which is simple in a state of neutral
buoyancy becomes difficult under the new-found tyranny of gravity.
The very early embryo develops in flexion, but beyond this stage there is
little evidence to justify the traditional assumption that flexion is
fundamental in foetal musculoskeletal development. In midpregnancy with plenty
of room, neutral buoyancy and intervertebral discs virtually synovial joints, he
can assume postures difficult or impossible for the child or adult. In late
pregnancy, as the foetus elongates more than the uterus, he must fold to fit in.
Commonly the attitude is again one of flexion, but sometimes he elects to lie
with neck, trunk or limbs extended and sometimes grossly hyperextended, a
preference he will continue to express as his position of comfort after birth,
particularly in sleep, if nursed naked in a warm environment.
Foetal movement is necessary for the proper development of foetal bones and
joints. The foetus without muscles - amyotrophia congenita - has the slender
bone structure more familiar in the victim of paralytic poliomyelitis. From the
characteristic and uniform angulations in different limb segments, it is
apparent that the fractures in the foetus with fragilitas osseum, the 'battered
baby in utero,' are self-inflicted by the baby's own muscles. The foetus who is
severely constrained in utero like a pound of deep frozen sausages with extreme
oligohydramnios presents an assortment of compression deformities with severe
restriction of joint range of movement.
The realization that the foetus himself determines the way he will lie in
pregnancy and present in labour by making the best he can of the space and shape
available to him puts the practice of version in new perspective, and nowadays
fewer obstetricians assume that they know better than the foetus how he will be
most comfortable. Of course, in selecting a position of comfort in later
pregnancy, the foetus may have chosen a position which is difficult or
impossible for vaginal delivery. In this regard he may be accused of lack of
foresight, but this is a trait not unknown in adults.
The foetus is responsive to pressure and touch. Tickling the foetal scalp at
surgical induction of labour provokes movement, stroking the palm of a prolapsed
arm elicits a grasp reflex, and to plantar stimulation the footling breech
obliges with an upgoing toe. Being totally immersed, the foetus does not feel
wet nor cough or choke with his airway full of fluid. The peripheral sensation
of wetness and the irritation of fluid in the airways are dependent on surface
tension effects at gas/fluid interfaces, and normally wetness is a new
experience at birth. That this experience, however, may be startling if not
uncomfortable for the foetus is suggested by the one recorded case of air
amniography where the presence of a substantial volume of intraamniotic air led
to prolonged loud foetal crying.
Since the foetus lacks an external surface of his own, his temperature
inevitably cannot be les than his mother's. Among many other functions, the
placenta is his heat exchanger and its performance may be gauged by the fact
that foetal temperature is normally 0.5 - 1.5 degrees Celsius above maternal
core temperature. If mother runs a fever the foetus must also. The walls of the
foetal world are probably not thermally homogenous, as thermography shows that
the areas of the maternal abdominal wall over the placental site are several
degrees hotter than areas over the chorion laeve. Although the range of ambient
temperature to which the foetus is exposed is limited, his awareness of and
reactions to thermal stimulation are intact before birth. If cold saline is run
into the amniotic cavity, he shows appropriate motor and circulatory responses.
The foetus responds with violent movement to needle puncture and to the
intramuscular or intraperitoneal injection of cold or hypertonic solutions.
Although we would accept, rather selfishly, that these stimuli are painful for
adults and children and, to judge from his behaviour, painful for the neonate,
we are not entitled, I understand, to assert that the foetus feels pain. In this
context I think Bertrand Russell's remark in his Human Knowledge, its Scope
and Limitations, rather apt - he relates 'A fisherman once told me that fish
have neither sense nor sensation but how he knew this he could not tell me.' It
would seem prudent to consider at least the possibility that birth is a painful
experience for a baby. Radiological observation shows foetal limbs flailing
during contractions, and if one attempts to reproduce in the neonate by manual
compression a mere fraction of the cranial deformation that may occur in the
course of a single contraction the baby protests very violently. And yet, all
that has been written by poets and lyricists about cries of newborn babies would
suggest that newborn babies cried for fun or joie de vivre - which they never do
afterwards - and in all the discussions that have ever taken place on pain
relief in childbirth only maternal pain has been considered. Karelitz in New
York has shown that, as judged by the strength of stimuli required to arouse
them, the first sleep of neonates is more profound than any subsequent sleep,
and this is perhaps hardly cause for surprise when we know that labour may
represent very prolonged stimulation and interference with normal foetal
activity cycles.
The foetus drinks amniotic fluid in a phasic pattern throughout pregnancy,
and measurement by isotropic techniques shows that his consumption has an
affective rate of interquartile range 15 to 40 ml per hour in the third
trimester. Now the foetus has a much larger number and a much wider distribution
of taste buds in his oral cavity than the child or adult, but no-one knows - or
can recall - whether the taste or flavour of amniotic fluid varies much or if,
for instance, meconium stained fluid tastes worse than normal fluid. However,
experimental modification of the taste of amniotic fluid produces dramatic
results. Foetal drinking rates crash after the injection of the contrast medium
Lipiodol - an iodinated poppy seed oil which tastes foul to an adult or child
and which causes a neonate to grimace and cry. Conversely, de Snoo (1937)
claimed that saccharin stimulated foetal swallowing, and our isotopic
measurements support this claim with usually an approximate doubling of rate.
However, some foetuses drink less after saccharin injection and perhaps, like
the author, they find saccharin in concentration bitter rather than sweet.
Foetal swallowing appears the major if not the only route of disposal of
amniotic fluid colloid and hence, especially in the second half of pregnancy,
has an increasingly important effect on amniotic fluid homeostasis and volume.
The foetus who cannot swallow, for example with oesophageal or duodenal atresia,
has a polyhydramnios. Since foetal swallowing powerfully influences if not
regulates amniotic fluid volume, what influences or regulates foetal swallowing?
Now the foetus gains nourishment from amniotic fluid, for he digests the
constituents of amniotic fluid. His calorie intake from this source may reach 40
calories per day and the foetus who cannot swallow is 'small for dates.'
Traditionally it has been assumed that hunger is a brand new sensation after
birth, that in utero an obliging mother and faithful placenta have supplied
baby's every need. However, the sight of babies with gross intrauterine
malnutrition makes it rather hard to believe that every foetus lives in a
metabolic Nirvana. Could foetal hunger be the stimulus to foetal swallowing?
Rather contrary to expectation on this hypothesis, in general, large,
well-nourished babies swallow at a high rate and small, grossly malnourished
babies at a very low rate. We could of course suggest that the malnourished
child has passed beyond the hunger pangs and into the state of apathy and
anorexia known from extrauterine starvation. However, the fact that the large,
well-nourished feotus has a bulimia and the small, malnourished foetus an
anorexia accords well with endocrine evidence that much of what has been called
traditionally placental insufficiency is in fact primarily foetal and of
hypothalamic origin.
Foetal hiccups are common and often can be induced by irrigating the amniotic
cavity with cold solutions. Foetal hiccups are easily recognized, and mother
should be reassured, for some have misgivings about these episodic series of
clonic movements, especially if there is an epileptic somewhere in the family
cupboard.
The foetus is not only experienced in swallowing, but also in many cases in
suckling. In the neurological examination of the neonate, the 'seeking' or
'rooting' reflex is elicited by stroking the circumoral area. The baby opens his
mouth and turns to the stimulus. This reflex is clearly the mechanism by which
baby homes on the nipple and underlines the tremendous importance of feeding to
the neonate. Indeed his face and mouth are the only part of his body the neonate
can reliably locate in space and the mouth remains one of the chief tools of
exploration in infancy. Since the foetus is often lying with hands and feet in
close proximity to his face, he may readily elicit a seeking reflex himself.
Accordingly, it is not uncommon in obstetric radiology to detect the foetus
sucking thumbs, fingers or toes, and thumbsucking has been photographed in the
9-week abortus. Incidentally, the common observation in neonates of clenched
fists, which would appear to preclude thumbsucking, is not a feature of babyhood
really but of high thermal tone in muscle. Careful examination of hand position
in x-rays shows that usually the foetus with his low thermal tone in his warm
environment has his hands relaxed and his thumbs protruding.
Perhaps nowhere does the notion of foetal life as a time of quiescence, of
patient and blind development of structures in anticipation of a life and
function to begin at birth, die harder than in the concept of the pregnant
uterus as a dark and silent world. Indeed even as great a neurophysiologist as
Sir Charles Sherrington (1951) could speak of 'the miracle of the human eye
developing in darkness for seeing in light and the miracle of the human ear
developing in silent water for hearing in vibrant air.' As anyone familiar with
a phonendoscope knows, a pregnant abdomen is not silent, and the uterus and
amniotic cavity, especially with any degree of polyhydramnios, may be readily
transilluminated with a torch in a darkened room. Given a naked abdomen in
sunshine, light intensities would be much higher. With a fibre optic light
conduit and photomultiplier, not only can the intrauterine illumination produced
by an external tungsten or quartz iodide lamp be recorded, but the shadow cast
by the foetus is detectible.
Now, for activation of visual pathways, there is strictly no threshold, for
the visual rods respond individually to single photons. Sure enough, Smith
(1965) at University College Hospital found that flashing lights applied to the
maternal abdominal wall produced fluctuations in foetal heart rate. However,
with the high attenuation in tissue, the abnormal spectral composition and the
boring view, what the foetus lacks is adequate illumination and a worthwhile
image for practice in cone or macular vision. At birth he can see but does not
know what he is looking at. Confident recognition of familiar people and
reassurance from the sight alone of mother takes some 4 to 7 months of
extrauterine life to acquire. However, before this age the baby can be reassured
by a familiar voice alone in the dark, and we have to argue either that auditory
recognition of patterns matures more rapidly than visual recognition, or that
auditory experience began earlier. The latter seems more likely.
Sudden noise in a quiet room - the dropped gallipot or maternal voice -
startles the foetus lined up under an image intensifier, and from at least 25
weeks the foetus will jump in synchrony with the tympanist's contribution to an
orchestral performance. By applying intermittent pure tones by hydrophone or air
microphone to the maternal abdominal wall, foetal audiometric curves may be
constructed by recording the abrupt changes in foetal heart rate. There is
dispute among the professionals as to sound energy levels reaching the foetus (a
given sound energy produces higher sound pressure levels in fluid) and naturally
the state of foetal wakefulness and the maintenance of attention span are very
hit and miss. Nevertheless, averaging of foetal electroencephalographic records
with repeated stimuli shows sound evoked cortical potentials and demonstrates as
does experience with deaf mothers that the foetus is responsing directly. Both
habituation and conditioning - dare we say learning? - have been noted.
With tympanic membranes damped by fluid in both middle and external ears, the
foetus could be expected to have a relative high-tone deafness, but higher
frequencies suffer less loss than low frequencies in transmission through
tissues and fluid. Therefore, it is probably that with sound, unlike light,
intrauterine spectra are similar to extrauterine. Further, it is worth nothing
that, unlike most foetal organs which start off in miniature, the structures of
the inner ear are very nearly of adult size from initial development. This
magnitude of course is necessary because cochlear spectral response obeys simple
physical laws dependent on cochlear dimensions. If, for instance, the cochlea
grew in proportion to the rest of the body, babies and children would hear in a
different frequency range from adults and the communication gap between
generations would be even wider than it is already.
However, it is not only external sound which bombards the foetus. The
pregnant uterus or abdomen is itself a very noisy place. The loudest sounds to
reach the foetus or an intrauterine phonocatheter are maternal borborygmi
peaking to 85 decibels. Reaching and below 55db the content is richer in pattern
and meaning - the intermittent voice and the all pervading bruits, pulsing in
synchrony with the maternal heart beat, of blood in the great arteries supplying
the uterus and placental bed. Does this long exposure explain why a baby is
comforted by holding him to your chest or is lulled to sleep by the old wives'
alarm clock, or the modern magnetic tape of a heart beat? Does this experience
explain why the tick of a grandfather clock in a quiet study or library can be a
reassurance rather than a distraction, why people asked to set a metronome to a
rate which 'satisfies' them will usually choose a rate in the 50-90 beat per
minute range - and twins show a strong concordance in independent choice? Elias
Carnetti points out that all the drum rhythms in the world belong to one or
other of two basic patterns - either the rapid tattoo of animal hooves or the
measured beat of a human heart. The animal hoof pattern is easy to understand
from the ritual and sympathetic magic of hunting cultures. Yet, interestingly,
the heart beat rhythm is more widespread in the world - even in groups like the
plains Indians who hunted the great herds of bison. Is this rhythm deeply
imprinted on human consciousness from foetal life?
Not only do the human eye and ear, therefore, not develop in darkness and
silence, but there is also good reason to believe from experimental work and
comparative physiology that they would not develop properly in those conditions
anyways. As with other foetal organs, development of structure and development
of function go hand in hand. And if the function cannot be subserved without the
development of the structure, equally the stimulus of the function is necessary
for the proper maturation of the structure.
The mechanism by which a concept of sensory space develops has long been a
troublesome topic for psychologists. However, for the amateur dabbler, the
subject has received some much-needed simplification by the evidence that the
various sensory modalities all feed and share a common space, and that this
space in fact is the effective motor space. This synthesis certainly has logical
simplicity to anyone who compares, say, the tunnel vision of the jet pilot or
freeway driver with the short cone extending just a few yards ahead of the
walker on rough ground and encompassing the field of the next few paces.
Parallels in auditory function are easily drawn. When does such a concept of
space begin? Refined experiment on the neonate suggests that his sensory space
is a little ball, that although he may receive visual and auditory signals from
more distant sources he is not much interested in anything outside a sphere
which extends just beyond his toes - a restriction which very neatly corresponds
to his recently vacated home.
This then is our picture of the foetus. He does not live in a padded,
unchanging cocoon in a state of total sensory deprivation, but in a plastic,
reactive structure which buffers and filters, perhaps distorts, but does not
eliminate the outside world. Nor is the foetus himself inert and stuporose, but
active and responsive.
Since on the one hand the foetus is exposed to a variety of stimuli, and on
the other hand can sense and respond to them, presumably we have the
prerequisites for learning of some sort. Is there in fact any evidence or
suggestion that the foetus has learned anything in utero? Study is
understandably difficult, for not only are nature and nurture at least as
intricately entangled in intrauterine life as in extrauterine life, but for good
measure any but the briefest observation and tests after birth may be
compromised by the high rate of learning in the neonate. For instance, babies
who have had as few as 10 heel punctures for blood samples in the first 72 hours
after birth, for weeks or months afterwards will promptly cry if you
thoughtlessly grasp their foot.
That recognition by voice precedes recognition by sight and the world
preference in drum rhythms is suggestive of foetal learning, or at least
imprinting. What of circadian rhythms? It is known that there is not one
physiological clock but numbers of relatively independent clocks, some more
stubborn than others. Moreover, that such rhythms are modified, if not
determined, by activity cycles rather than of cosmic origin is strongly
suggested by the evidence that the diurnal rhythms of the inhabitants of fishing
villages, living by the tides, are lunar not solar in periodicity. In this
context, it is interesting to reconsider the claim, at least of young parents,
that the one thing that shows the foetus is utterly stupid is that many neonates
do not seem to appreciate that night is a time for sleep.
We know that maternal movement and change of position provoke foetal
movement, that if we want a foetus lying still and unsuspecting for some
diagnostic or therapeutic procedure it is necessary to have mother lying still
and comfortable for 15 to 20 minutes to allow the foetus to find a position of
comfort. Further, we must avoid last minute palpations and auscultations.
Compare these precautions with the performance and restlessness of many pregnant
women in bed - with the leg cramps and heartburn, the subcostal and pelvic
girdle discomfort, and for variation a trip or two to the bathroom. The neonate
could perhaps be forgiven if, as a foetus, he had gained the impression that
night was anything but a time for rest.
A similar cri de coeur concerns these young babies who cussedly elect
to have their briefest rest periods and shortest intervals between feeds in the
late afternoon and at dinner time just when it would be most helpful if they
would sleep. For the breast fed baby, a ready explanation arises from the fact
that there is a striking diurnal variation in the fat content of human milk -
from as high as 9 per cent in the early morning to as low as 1 percent in the
afternoon. Hence the breast fed baby may be shortchanged on calories on his
afternoon feeds. However, precisely the same pattern may be seen in the
bottle-fed baby, and we are left with the suspicion that the foetus may have
been conditioned to the fact that this time of day represents peak activity for
mother and peak uproar in many households.
A question very commonly asked is whether maternal emotion elation, fear,
anxiety, may be communicated to or influence the foetus. Certainly, with
monitored foetal hearts, there may be abrupt changes in rate with sudden
maternal emotions. Such responses could be mediated indirectly by changes in
maternal arterial pressure, or directly by substances, for instance
catecholamines, which cross the placenta. It has been argued that since the
foetus experiences only the consequences and not the cause of the emotion itself
the experience would mean nothing to him. More recently this view has been
challenged on the evidence that the pharmacological induction of the
physiological responses to fear and anxiety induces the sensation of fear and
anxiety also but this may be just a learned response.
It is apparent that many more questions may be asked but as yet few answers
given. What I have tried to do is to provide a background, so that by asking the
right questions in the right way we might some time get the right answers. We
may not all live to grow old but we were each once a feotus ourselves. As such
we had some engaging qualities which unfortunately we lost as we grew older. We
were physically and physiologically robust. We were supple and not obese. Our
most depraved vice was thumbsucking, and the worst consequence of drinking
liquor was hiccups not alcoholism.
When our cords were cut, we were not severed from our mothers but from our
own organs - our placentae - which were appropriate to our old environment but
unnecessary in our new one. We do not regard the foetal circulatory system,
different as it is from the child's or adult's, as one big heap of congenital
defects but as a system superbly adapted to his circumstances. We no longer
regard foetal and neonatal renal function, asymmetric as it is by adult
standards, as inferior, but rather entirely appropriate to the osmometric
conditions in which it has to work. It is too much to ask therefore that perhaps
we should accord also to foetal personality and behaviour, rudimentary as they
may appear by adult standards, the same consideration and respect?
References
de Snoo, K.: Das trinkende Kind im Uterus. Mschr. Geburt. Gynak. 105:
88 (1937).
Karelitz, S.: Personal communication.
Serrington, C.: Man on his Nature, 2nd Edition (Cambridge University Press,
Cambridge 1951).
Smyth, C. N.: Experimental methods for testing the integrity of the foetus
and neonate. J. Obstet. Vynaec. Brit. Comm. 72: 920 (1965).