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Artificial wombs could someday help save babies born prematurely

AILSA CHANG, HOST:

Scientists around the world are testing artificial wombs. The goal is to rescue babies who would die or end up severely disabled because they're born very prematurely. The research is generating excitement, but also concerns. NPR health correspondent Rob Stein recently became the first journalist to watch one team of scientists test their experimental artificial womb. Here is his exclusive report.

(SOUNDBITE OF MACHINE BEEPING)

ROB STEIN, BYLINE: About a half-dozen researchers are scurrying around a crowded operating room in downtown Toronto. A big pregnant pig lies unconscious on the operating table, covered except for part of her belly. That's where Christoph Haller, a pediatric surgeon at the Hospital for Sick Children, will make an incision to remove one of the sow's fetuses.

CHRISTOPH HALLER: The ultimate goal of today is to transition a fetus onto the artificial womb, so basically transitioning it into an artificial environment that allows the fetus to still maintain its regular physiology.

STEIN: So the fetus can mature enough outside the mother's womb to survive on its own. Today it's another pig fetus that the researchers have been using to test their experimental device. But the hope is that someday, maybe not too far off, artificial wombs will help humans born too soon survive and avoid devastating health problems.

HALLER: We're basically trying to find a new concept on how to preserve fetuses to allow them to mature more physiologically compared to the regular preterm.

STEIN: So the idea is for human babies that are born prematurely?

HALLER: Yeah, that would be the target, to treat extreme premature babies. So this would hopefully be a big deal, be likely a game changer.

STEIN: A metal tray next to the pig's belly holds a big, clear, plastic sack with tubes going in and out of it.

So is that what you're going to be putting the fetal pig into?

HALLER: Yeah.

STEIN: That's the artificial womb?

HALLER: Yeah, yeah. It's basically a compartment that's going to be filled with fluid later on. You'll see that as we proceed.

STEIN: As Haller puts the finishing touches on tubes that will be hooked up to the fetus' umbilical cord, his team arranges surgical equipment and examines the 10 fetuses in the sow's womb with an ultrasound.

HALLER: All right. I think we're gonna get started.

STEIN: Haller starts cutting with an electric scalpel. An assistant suctions the area to keep it dry. After deciding which fetus looks healthiest on the ultrasound, Haller makes another incision and starts to pull out a pink fetal piglet.

UNIDENTIFIED PERSON: Fetus 1, head out.

STEIN: So that's the fetus.

HALLER: That's the fetus, yeah.

STEIN: The fetus looks peaceful, like its sleeping.

HALLER: Cord is about to be cut.

UNIDENTIFIED PERSON: Cord clamped. Cord cut. Transitioning.

STEIN: Once the fetus is completely out, Haller and his team assess the piglet's health and cut the umbilical cord so they can gently slide the animal into the artificial womb. Haller then quickly stitches three tiny tubes into the umbilical cord to provide oxygen to its blood, remove carbon dioxide and supply nutrition and medicine. Finally, his colleagues fill the bag with clear, warm liquid meant to mimic amniotic fluid and seal it.

HALLER: It's going to be a bit of a rocky period now.

STEIN: The team carefully monitors the fetus' heart rate, blood pressure and other vital signs. Once the fetus look stable, they surround the artificial womb with warmers.

The fetus is inside the artificial womb now?

HALLER: Yeah.

STEIN: How'd it go?

HALLER: It's as close to a good transition as we can get, I think.

STEIN: Do you breathe a sigh of relief now?

HALLER: Yeah. I mean, I'm excited as if it was, you know, a proper human surgery, I would say. We want to get it right and we want to see the fetus doing well there.

STEIN: If very premature human babies can be safely sustained on a device like this for just two or three weeks, it could make all the difference between life and death, or life with severe disabilities and health problems or not. The Toronto group has had problems with blood clots and heart damage, and it's only been able to sustain a pig fetus for about a week so far. But researchers in Philadelphia have used an artificial womb like this to safely nurture fetal sheep for four weeks, making the Toronto group and others optimistic the approach will eventually work.

HALLER: I definitely think it's exciting - new field of medicine, almost.

STEIN: But the possibility of an artificial womb is also raising lots of moral, ethical and legal questions, especially in the current environment.

VARDIT RAVITSKY: I am absolutely pro that technology because I think it has great potential to save babies. But my concern is that pregnant people will be forced to allow fetuses to be taken out of their bodies and put into an artificial womb rather than being allowed to terminate their pregnancies, basically a new way of taking away abortion rights.

STEIN: Vardit Ravitsky is president and CEO of The Hastings Center, a bioethics think tank. She wonders, what if someday it becomes possible to use artificial wombs to gestate fetuses for an entire pregnancy, making a mother's womb unnecessary?

RAVITSKY: Science fiction writers have been playing with this notion for decades. It's not like we never thought about it. It's just different to think about it as a thought experiment than to think about it as something that's potentially around the corner. The scenario of a complete use of artificial wombs could become pretty scary pretty quickly.

STEIN: But Haller and his colleagues say no one's anywhere near anything like that and probably never will be.

HALLER: We've heard people fearing that this translates into women not having to go through a full pregnancy anymore and kind of more like a "Matrix" style of dystopian future. But it would be outrageous to assume that any artificial intervention in any way is better than nature.

STEIN: Haller and his colleagues say they're just trying to save babies.

HALLER: You know, every tool can be misused. It's like AI. It has its benefits, but if it's not regulated adequately, a lot of harm can arise from something like that as well.

(SOUNDBITE OF MACHINE BEEPING)

STEIN: Meanwhile, the fetal pig is settling into its new artificial womb.

The fetus looks pretty good and healthy and cozy in there.

HALLER: Yeah, I think it looks pretty comfy and settled. It looks pretty happy in there. Yeah, it's good.

STEIN: The Toronto group and others around the world plan to continue trying to perfect their artificial womb. And the Food and Drug Administration recently convened a workshop to decide what evidence would be needed to allow an artificial womb to be tested on humans.

Rob Stein, NPR News, Toronto. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Rob Stein is a correspondent and senior editor on NPR's science desk.