The future of babies is sous vide.

This past week, physicians at Children’s Hospital in Philadelphia announced that they’d had remarkable success with keeping lamb fetuses alive outside a womb—in a plastic bag filled with warm amniotic fluid, with the fetus’ heart circulating blood through a filter to keep it oxygenated.

Astonishing pictures of wee unborn laminated lambs quickly spun up the media science-fiction reference engine. Someday, that might be a human baby floating in a next-gen artificial uterus. Talking heads name-checked Gattaca and Brave New World. You could get a whiff of Blade Runner in there. The idea felt like a creepy-but-cool technological incursion into one of the last things that connects humans to the wild. We’re never so reminded of our own animal nature as when we eat, bleed, defecate, copulate, or gestate.

It looked pretty nuts, to be honest. The lead researcher, fetal surgeon Alan Flake, tried to keep everyone’s feet on the ground. “If you can just use this device as a bridge for the fetus then you can have a dramatic impact on the outcomes of extremely premature infants,” Flake said during a press conference. Even if his team can get the “BioBag” to work on humans, its job would be to keep those infants alive until they’re mature enough to transfer into an incubator. Nothing else.

Yes, as currently designed, the BioBag only works for fetuses at least 22 weeks along. If it works with humans, hospital neonatal units will use it, because premature infants often experience expensive medical problems later in life. Extending gestation in an artificial womb could obviate some of them.

But that probably isn’t where this is going to end. One example: If you think that being in a synthetic uterus is a post-birth intervention rather than something that continues normal gestation, putting a fetus into one could redefine “viability.” That might change the way people think about what constitutes the beginning of life.

That in turn might impact abortion law. Today, 18 states say abortions must be performed by a physician if the fetus is anywhere from 14 weeks to viability; 43 states prohibit abortions outright from between 20 weeks to viability. Presumably if a next-generation synthetic uterus changes what constitutes viability, a lawyer could argue that the limits on abortion should become more strict. (Still, over 90 percent of abortions occur at 13 weeks or less, so a future artificial womb would have to be a lot better than the current one.)

If it did work, though, maybe no one would ever get abortions. Not all abortions are elective, of course, but an artificial womb could conceivably allow viable unwanted pregnancies to come to term without the mother. This seems unlikely. Even if the technology is cheap enough to see widespread use, the US Centers for Disease Control and Prevention recorded 664,435 legal abortions in 2013 (down 5 percent from 2012). It seems unlikely that anyone would build that many technological uteruses. It seems even more unlikely that insurance would cover their use.

The policies and ethics get really squicky really quick. Would a woman want her unwanted pregnancy to come to term without her? If the technology existed to make it possible, the political climate might not even let her make that choice. To the list of sci-fi references, add The Handmaid’s Tale.

And could the planet handle that many more people? The CDC says the US has about 4 million births per year; 2.6 million people die. So adding all the fetuses that would have been aborted to the “births” column would effectively be a 40 percent increase in US population. And now I can add Soylent Green, too. (The overcrowding part, not the eating-people part. Or is it? [Oh, sorry, spoiler alert: Soylent green is people.])

Hard to believe, but if we move from abortion to creation, things get even weirder. A sufficiently advanced synthetic womb, one that could go from conception all the way to birth, could upend the biology and culture of parenthood.

Take the difficulties faced by working mothers, for example. Families who want to have a baby shouldn’t lose out on job opportunities for promotion or tenure, or risk a perception that having a child implies a lack of commitment to a gig. But women, especially, face all that. If you believe that discrimination against pregnant women is one reason women sometimes aren’t as successful in workplaces as men, maybe artificial exogenous pregnancy is a solution. Pregnant people could just outsource the gestation, just as some people now do with surrogates.

Sadly, this wouldn’t deal with all the challenges parents face after birth—breast feeding, postpartum recovery, parental leave, sometimes postpartum depression, the disproportionate impact of child care on mothers. No help there at all. It’s a synthetic womb, not a synthetic parent.

Of course, building a baby human without growing it inside another human would require a much better understanding of gestation. Pregnancy triggers gene expression changes in the placenta that in turn affect development of an embryo. That wouldn’t happen in an artificial womb.

But then, neither would an artificial womb experience the environmental and psychological stresses that apparently drive down academic performance and other developmental indicators. Exposure to the stress hormone cortisol early in gestation seems to have a negative effect on performance, but nobody really knows how that works. At least one study suggests that cortisol exposure late in gestation may have beneficial effects. Similar outcomes based on the mother’s diet, exposure to violence, and other conditions during pregnancy also hint, tantalizingly, at some kind of deep connection between maternal biology and the life course of a child.

In end-running all that, a synthetic uterus might change the way people think about biological connections to children. The child might be yours, but the intrauterine environment might not be. Or maybe the chemistry inside the chamber could be an optimized version of your own, grown from your own cells and tweaked with hormones or gene mods … but the path of an embryo could be grown from gametes made of genetic material from you and your partner (or from genetic material from several partners) and then frozen until you’re emotionally and financially ready to have a kid. Maybe it spends its first trimester in your uterus, if you’re a person who has a functioning one. You can go on to win a tennis Grand Slam or something. And maybe it spends the second and third trimester in a tank. Or maybe that fetus didn’t come from your genetic material at all, but in concert with scientists you’re tweaking the dials on the tank of the offspring that’ll become your child. What would “biological parent” mean after all that?

In Brave New World, Aldous Huxley seemed to consider the end of the biological family a sign of dystopia. But adoption has been a feature of all of human history, and IVF a fact of the last four decades. Yet families are still a thing. Even in a future of synthetic wombs, what emerges from them will be no more or less a miracle.



[WIRED]