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Facts Are Important: Gestational Development and Capacity for Pain

Facts are important, especially when it comes to policies and discussions that impact patients. Here are the scientific facts concerning gestational development and capacity for pain.

The science conclusively establishes that a human fetus does not have the capacity to experience pain until after at least 24–25 weeks. Every major medical organization that has examined this issue and peer-reviewed studies on the matter have consistently reached the conclusion that abortion before this point does not result in the perception of pain in a fetus.i, ii, iii, iv, v

Rigorous scientific studies have found that the connections necessary to transmit signals from peripheral sensory nerves to the brain, as well as the brain structures necessary to process those signals, do not develop until at or after 24 weeks of gestation.vi Because it lacks these connections and structures, a fetus or embryo does not have the physiological capacity to perceive pain until at least this gestational age.

Pain is a complex phenomenon. The perception of pain requires more than just the mechanical transmission and reception of signals. Multidisciplinary experts on the subject define pain as is "[a]n unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."vii The experience of pain "requires conscious recognition of a noxious stimulus."viii This capacity does not develop until the third trimester at the earliest. The evidence shows that the neural circuitry necessary to distinguish touch from painful touch does not, in fact, develop until late in the third trimester. The occurrence of intrauterine fetal movement is not an indication that a fetus can feel pain.ix

Whether anesthesia, analgesia, or paralytic agents are administered to the fetus during fetal surgery is a distinct question from the capacity to experience pain. During fetal surgery, anesthesia and analgesia may be appropriate because it serves other purposes unrelated to pain, particularly decreasing movement of the fetus and avoiding long-term consequences of stress responses to surgery.x

Sound health policy is best based on scientific fact and evidence-based medicine. Gestational age bans alleging concerns about "fetal pain" reflect a misunderstanding and misrepresentation of the science of gestational development and viability.xi

The best health care is provided free of governmental interference in the patient-clinician relationship. Personal decision-making by patients and their health-care professionals should not be replaced by political ideology.

Abortion is an essential part of comprehensive medical care, and a patient's decision to end a pregnancy following appropriate consultation with their trusted medical professional should be treated with respect.

The American College of Obstetricians and Gynecologists supports robust, fact-based dialogue on issues of importance to the American people. We urge you to call on us to provide expert factual explanation of issues related to the provision of obstetric and gynecologic health care.

Additional ACOG Resources

ACOG Amicus Brief in Dobbs v. Jackson Women’s Health Organization, filed with the American Medical Association, American Academy of Family Physicians, and 22 additional medical organizations

Society for Maternal-Fetal Medicine Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures (ACOG-Endorsed)

References

  1. Royal College of Obstetricians and Gynaecologists, Fetal Awareness: Review of Research and Recommendations for Practice (Mar. 2010) (concluding fetal pain is not possible before 24 weeks gestation, based on expert panel review of over 50 papers in medical and scientific literature);
  2. Apkarian et al., Human Brain Mechanisms of Pain Perception and Regulation in Health and Disease, 9 Eur. J. Pain 463 (2005)
  3. Lee SJ, Ralston HJ, Drey EA, Patridge JC, Rosen MA. Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. JAMA 2005;294(8):947-954
  4. Brief for the American College of Obstetricians and Gynecologists, American Medical Association, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Association of Public Health Physicians, Et Al. as Amicus Curiae, Dobbs v. Jackson Women’s Health Organization No. 19-1392 (2021).
  5. Brief for the American College of Obstetricians and Gynecologists as Amicus Curiae, Isaackson v. Horne, No. 12-16670
  6. Royal College of Obstetricians and Gynecologists, Fetal Awareness: Review of Research and Recommendations for Practice (March 2010).
  7. Society for Maternal-Fetal Medicine et al., SMFM Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures, Am. J. Obstetrics & Gynecology 4-5 (2021).
  8. Royal College of Obstetricians and Gynecologists, Fetal Awareness: Review of Research and Recommendations for Practice (March 2010).
  9. Lee SJ, Ralston HJ, Drey EA, Patridge JC, Rosen MA. Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. JAMA 2005;294(8):947-954
  10. Society for Maternal-Fetal Medicine et al., SMFM Consult Series #59: The use of analgesia and anesthesia for maternal-fetal procedures, Am. J. Obstetrics & Gynecology 4-5 (2021).
  11. Brief for the American College of Obstetricians and Gynecologists, American Medical Association, American Academy of Family Physicians, American Academy of Nursing, American Academy of Pediatrics, American Association of Public Health Physicians, Et Al. as Amicus Curiae, Dobbs v. Jackson Women’s Health Organization No. 19-1392 (2021).