The Obsolescent Mother

Is the artificial womb inevitable?
III

Early in 1970, the National Academy of Sciences published the results of a study undertaken by a panel of distinguished scientists, at the request of the federal government, on "The Consequences of Technology." The scientists were asked to estimate when various technological developments could be expected to take place. One of these developments was described as the "capability of fertilizing a human ovum in vitro and implanting it in a surrogate mother." (Surrogate motherhood will mean either a kind of space-age wet-nursing, or prenatal adoption, the principle in both cases being that an embryo from the egg of one woman may be implanted in the uterus of another woman at the right moment of her menstrual cycle.) At the time this panel of experts was asked for its estimate, the Edwards group bad already succeeded in getting the first stages of ii vitro fertilization, and was on the verge of getting cleavage to sixteen cells and perhaps beyond. Yet the average estimate of the panel for the date of achievement of this technology was 1995.

It was not the first time that those who are relied on for advice and prediction have failed to see bow, imminent the future is. The reasons for this failure not clear, but perhaps the general bewildering multiplicity of events and reports has something to do with it. Also, a panel entrusted with technological forecasting may be under strains of advocacy and opposition that are eased by pushing the future safely into the next century or to the very end of this century. However, in a democracy it is not only the experts who prepare the way for the future. Two familiar phenomena of democratic societies are the respected opinion-maker and the public opinion poll. Anyone who is interested in the social setting of embryological research should consult the evidence from respected opinion and public opinion; while the amount of it is not substantial yet, it does invite some working conclusions to be drawn. The New York Times, under the headline, "Test Tube Babies Ahead?" published an editorial about the Edwards experiments praising the hope they hold out for childless couples. Then the Times said:

Ultimately the prospect looms of human babies engendered by fertilization and development completely outside any woman's body-test tube babies, in the most literal sense. . . Abuses are easy to envisage, but it is encouraging that so far at least there is no evidence of such abuses in the use of artificial insemination to help women conceive. The real question even now is whether-and how-people can develop the sense of social responsibility that will be required if, by the year 2000 or earlier, women are able to have children without any of the morning sickness, special diets and other discomforts and dangers pregnancy now entails.

The Times mentions artificial insemination. At least 20,000 babies are conceived by mechanical means in the United States each year, and there may be a million Americans now alive who were so conceived. This indicates a widespread acceptance of the technique, though a recent Harris poll on "New Methods of Reproduction" had only 5 percent of the sample knowing what artificial insemination is. However, once it was explained to them, 49 percent of men and 62 percent of women approved insemination with the husband's sperm in cases of infertility; 24 percent of men and 28 percent of women approved insemination with anonymous donor sperm. The poll-takers also explained other 'techniques still not in existence, and got opinions on these. Thirty-two percent of men, 39 percent of women would approve of' embryo implants of the sort planned by Edwards-37 percent of men, 48 percent of women said they "would feel love" for a baby of their own conceived in this way. The poll-takers then asked about "test-tube babies," babies who at, no time 'would be inside the mother's body. Thirty percent of men, 35 percent of women were of the opinion that "this would be justified if wife might die or be crippled from childbirth." However, if "a woman just wanted to skip pregnancy and have a baby too," more than 90 percent of men and women would disapprove. Forty-seven percent of men, 53 percent of women said they "would feel love" toward such a "test-tube baby" of their own (for some reason, the percentage here, for both men and women, was higher than in the case of the embryo implant). Fifty-five percent of men, 61 percent of women said they believed a "test-tube baby would feel love for [its] family." A striking aspect of the results of this poll is that women invariably display a greater readiness to consider "new methods of reproduction" than men. This readiness is enhanced when the responses are broken down by age group: for example, of the women under thirty, fully 57 percent approved embryo implants. And yet, there was confusion too. Many of the men and women who approved of the new methods, including "test-tube babies," said they saw in them a way to bolster the ideal of monogamous marriage by ensuring that no couple need be childless; yet it was admitted that the new methods might have exactly the opposite effect-that is, of undermining further the ideal of the family.

The Times editorial and the Harris poll seem to show that there is important "public" enthusiasm for the goals, both official and possible, of the embryological research now under way, even if this enthusiasm is qualified by some doubts and fears. Indeed, it may be debatable how long the vociferous reaction in the case of a deformed baby from embryo-implant would persist, stifling grants and research. And if exquisite care is taken choosing the first embryo for implant, and the baby is born apparently sound, the excitement and, enthusiasm will probably overwhelm doubts, and criticism. The whole idea of "new methods" will be given a boost, and methods which had seemed fit only for science fiction will undergo a strange metamorphosis: "test-tube babies," for example.

Leaving aside for the moment the question whether such a method is desirable-is it feasible? The answer would have to do with technology, with whether ways could be devised to transfer the embryo fertilized in vitro to an artificial placenta which would duplicate for eight and a half months the environment of the natural placenta. The complexity of this invention of nature has already been 'hinted at. It has taken scientists five years just to get to understand the physiological process involved in the diffusion of oxygen and carbon dioxide across the placental membrane of the pig. How other substances-amino acids, vitamins, sugars, proteins-are passed is still a mystery. In addition, it is known that just a bit too much of a substance, or too little, too late or too early, can cause peculiar things to happen to embryos, whether they are mammalian and placental, or lower down on the phylogenetic scale. For example, if lithium chloride or magnesium chloride is added to fish eggs, the fish that are hatched will be Cyclopean. So it would be, at the least, a delicate, painstaking, and drawn-out task of plotting the career of a human embryo and fetus in the placenta from minute to minute, and then fabricating the machinery to duplicate the

placenta and a computer to monitor and direct it and oversee the piping-in of nutrients and carrying-off of wastes. The technological problems here are formidable, as fetologists working on the margins already know; but are they more formidable than those involved in, say, Apollo 11? Probably not, and using Apollo as a hackneyed but serviceable example, it might be said that for the United States, there is no technological project that is not assured of success provided the decision is made to invest whatever talent and money are necessary; provided also that there is a strong enough sense of national priority so that any misfortune (such as the death by flr of three astronauts on the pad at Cape Kennedy) does not endanger the life of the project itself. It would be too much to expect an artificial womb to "work" the first time, and people would have to be ready to accept the death of a fetus, even though, in contrast with Gus Grissom, the fetus never volunteered.

What reason would there be to make the development of an artificial womb a national priority? Once they are compiled, the specific and predictable benefits of an efficient artificial womb make an impressive list:

1. Fetal medicine would be much improved. By being able to monitor growth and development continuously, fetologists would be able to catch, and perhaps treat, sickness that occurs in the natural womb but does not show up until after birth.

2. Likewise, fetologists would be able to immunize a child for the diseases it would be likely to contract in the world, but while it is still in the sterile safety of the womb.

3. Tissue samples could be taken from the fetus, cultured, and frozen for storage, which would resist the rejection phenomenon should the human born ever require organ transplants.

4. An efficient artificial womb, far from increasing the incidence of birth defects, would reduce them by keeping the fetus in an absolutely safe and regular environment; safe, for example, from infection by German measles or drugs taken by the mother. There are now thousands of babies born in the United States each year with defects, ranging from relatively minor ones like harelip, to deformed limbs and congenital diseases of the nervous system. Whatever the magnitude of the defect, it is disastrous: doctors say that the immediate and overwhelming response of the parents is not love or pity, but anger; they are angry at the doctor, and angry at their deformed child for choosing them as its parents. This behavior is evident on the part of both parents alike: there is no special redemptive mother-love. Some parents will reject the child, or, after a guilty reaction, some will gird themselves for the job of lifelong sacrifice, of being "noble."

5. The same new conditions that would allow fetologists to prevent birth defects would allow geneticists eventually to be able to program a fetus' development for some superior trait on which society could agree: larger brain capacity, for example. This would seem to be the direction that is being taken anyway now, with genetic counseling. The artificial womb would lift such work out of the realm of the haphazard.

6. An artificial womb would make "sexing" (choosing the sex of the embryo) a simple matter.

7. That part of the population which would use the artificial womb would not have to worry about illegitimacy or doubtful paternity. For the first time it will be possible to prove beyond a shadow of a doubt that a man is the father of his children.

8. Women who are prone to miscarry, or who because of body structure or constitution run a danger of injury in childbirth, would be spared the unhappiness, disappointment, and danger. Other women would be spared the discomfort.

9. Women who decided to have children by the artificial womb might choose to undergo the operation in which the fallopian tubes are tied. This would not affect fertility, but it would be an instant, guaranteed, and permanent barrier to conception from sexual intercourse. No other "birth control" would have to be exercised, and the Pill, together with its harmful and unknown side effects, could be dispensed with. Of course, these women would never have to have abortions, either.

It would seem that from the development and use of an artificial womb, all of society would benefit, but women would stand to gain the most. The artificial womb would set about breaking to pieces the stubborn remnant of biological fact and cultural myth that makes all women pay. The invidious question whether women are different from men in some ultimate and irreducible metaphysical way, whether as a result they should be set and should set for themselves, different goals and different styles of life, would be removed from the context of biological difference, which has so far complicated its resolution with gratuitous 'factors, and would be set in a context of biological equity. Culturally, if the artificial womb "catches on," it will mean that the awefulness 'associated with pregnancy and childbirth will have nothing to feed on, and motherhood, if it continues to excite any awe at all, will not do so more than fatherhood. This will have its inevitable effect on the relation of women to men, women to their children, and the society or state to children. Once a woman has no more difficult or lengthy role in reproduction than a man (or not much more difficult or lengthy: she will still have to undergo laparoscopy once, when several dozen eggs will be collected and put into cold storage), she will find that society does not expect her to have a special relation to her offspring that takes up years of her life, and also she will not expect it of herself. Too, a society that can grow fetuses in a laboratory will be more disposed to have meaningful day- and night-care centers and communal nurseries on a large scale, for the state, being a third parent, will wish to provide for the maintenance and upbringing of its children. Natural pregnancy may become an anachronism. The two tiny laparoscopy scars, exposed by a bikini on the beach, will be as ordinary as our smallpox vaccination, but women will no longer have lost their figures in childbearing. The uterus will become appendix-like, though the ovaries will be as crucial as before. At the age of twenty, each girl will be able to choose to be superovulated and her eggs collected and frozen, as it is known that babies conceived by young women are less likely to suffer from mongolism and other birth defects. If there are advances in prenatal care, it may not be necessary to prohibit natural childbearing in the interest of public health and eugenics. In that case, the women who wish to put up with the old style and all that it implies will be free to do so. But it will be a throwback and increasingly rare as the manifest advantages of the artificial womb make it likely to win the competition.

Most, if not all, of its disadvantages might be more apparent to us than real to the next generations. We bear it in mind that a man-made mutation like this, finishing what the Pill started, unprecedented in evolution perhaps since sea creatures grew lungs and came out on land or apes developed the ability to touch thumb to forefinger, must have its effect on the body and mind of everyone in society, men not much less than women. Might not everyone, and particularly women, also suffer from the artificial womb? The myth of the beatific Madonna has, after all, among its various sources the fact that some women do experience unusual wellbeing when they have a baby. A more recent myth is that women on the Pill for a long time, who have much sex but never a baby, suffer the opposite of the bodily and psychic happiness of the Madonna. Does this mean the body has its own wisdom and that for, women to be given access to an artificial womb would be to go against the deepest instincts provided by nature?

Again, the question may be invidious. In the first place, as a matter of fact, for every beatific mother in our society there is at least another with "postpartum blues." To propose a "fundamental nature" for women (or men) to which it is immoral or unwise to offer an alternative may be to support a fallacy which is really old-fashioned. The well-being of the Madonna, her rosy complexion, may have as simple an explanation as that during pregnancy and lactation, her body's production of estrogen has shot up: maybe a woman having a baby by the artificial womb might take estrogen orally.

But won't women be "alienated," as we say, from their children, causing further distance to be put between all of us from the crucial beginning, which is not what we need? Again, perhaps an invidious question. In the 1840s, opponents of Dr. Simpson asked whether (actually they claimed that) anesthesia during labor would make children "strangers" to their mothers. Has this proven true? Maternal love does not seem to be connected with the pain of childbirth, or even with childbirth; we know that some women beat the children they have borne, while others love the children they have adopted.

However, by "creating life" won't we be raising ultimate questions that we are not prepared to answer, such as "What is a human being?" The effect may well be to raise such questions. As for "creating life," that is to misunderstand what the artificial womb will do. It will not "create" life, for the materials which contain all the factors for differentiation, growth, and genetic coding—the egg and sperm will not be created or fabricated: they will only be given another environment in which to work out their process. Sexual reproduction will be preserved; only intercourse and reproduction will be separated, once and for all.

The "ultimate" questions will be harder to ignore, perhaps. But this has been predicted. Jean Rostand, the French biologist and Nobel Prize winner, has considered what life will be like and what questions people will have to face up to when the artificial womb and other "inevitable" technologies become a reality:

People will live for two hundred years, or even more. There will be no more failure, no more fear, no more tragedy. Life will be safer, easier, longer. But will it still be worth living? . . How shall we contrive to exercise the formidable powers allotted to us . . . ? How . . . shall we avoid finding ourselves on the perilous slope and yielding to the abuses of a Promethean intoxication?

Well, Rostand says, "our task will be to improvise the solution, taking account of the collective mentality, of the social and moral situation [and remembering Bacon's warning], 'Knowledge, if it be taken without the true corrective [charity] hath in it some nature of venom or malignity.'"

Rostand assumes the artificial womb and other such innovations are "inevitable": that seems a peculiar idea. He also predicts that when the womb arrives it must have a universal effect. Here he is evidently right. If there is a single prototype artificial womb made and successfully tested, it is unlikely that it will turn out—as the Apollo missions might—an exorbitant stunt without consequence for "the man in the street." Because it will literally be down to earth, an artificial womb will have the potential to change the life of every person. But is the artificial womb "inevitable," as Rostand says? "Inevitable" seems to imply that something will come to pass without our doing anything or despite our intervention, which in the case of an artificial womb is nonsense. And yet there is a meaning of "inevitable" which, in this context, is not ridiculous. This is the meaning which in effect asks to what extent human beings exercise free will, and to what extent they are determined by forces forever beyond them. A very ancient question. Yet is it conceivable that if Dr. Simpson, in 1842, had not decided to give anesthesia to a woman in labor, anesthesia would not be routinely used in labor today? It is not conceivable. If he had not done it, some other doctor would, driven by the combination of curiosity, sympathy, and ambition which many men, not just a single indispensable man, are endowed with. The picture of the solitary scientist breaking ground may be excessively romantic. Without denying the medical scientist in particular his glory, his Nobel Prize, and the gratitude of the people whose suffering he has eased, it may be said that the scientist is far from being on his own, that he is, as we all are, an agent of something, determined by a force, a momentum which blurs distinctions between "it has become possible to do it," "it should be done," "it must be done," and is resolved in the inevitable: "it will be done."

Looked at in this light, it would not seem to make much difference (except, obviously, to the volunteer childless couples at Cambridge) whether Dr. Edwards decides to implant an embryo: the operation is going to take place pretty soon whatever he decides or does. Likewise the question whether what is about to be done in embryology, and what is about to be done in fetology, will ever come together in its logical consummation. If it becomes a national priority, it will be achieved sooner; if unlimited money and support are not forthcoming, it will be achieved later. But it is hard to imagine it not being achieved at all.

Certainly it would take more exertion, over the long run, to prevent it than to achieve it, and why prevent it? Who is to say that Monsignor Vallainc, the Vatican press officer who branded the Edwards experiments "immoral acts and absolutely illicit," is not the hapless spokesman of cruelty and stupidity, our contemporary version of the ministers who damned Simpson? In any case, it is not the thirteenth century anymore, and the centers of research happen not to be in Russia or in Roman Catholic theocracies. There is no forbidding most things and no arresting Dr. Edwards and charging him with murder. More than this: the research is conducted quietly, indoors; it does not require the vast hardware of an Apollo project, and there are no thunderous blasts and clouds of smoke. The expunging of perhaps our foremost Myth, with its ancient, numberless effects of inspiration and practice, habit and suffering, may be accomplished both inevitably and quietly—which leads to the ironic part, that whether anyone, or any movement, comes out for the artificial womb, or not, will make little difference in the end. The only difference it might make—and perhaps this is no small thing for the race—is that at least we will be able to say that our liberation did not catch us by surprise.

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