Future Tense

The Limits of the Artificial Womb

Futuristic reproductive technologies can’t fix these common pregnancy complications.

A nurse takes care of a premature baby at the maternity ward.
A nurse takes care of a premature baby at the maternity ward of the Argenteuil hospital, in a Paris suburb, in July 2013.

Photo by Fred Dufour/AFP/Getty Images

This article is part of Future Tense, a collaboration among Arizona State University, New America, and Slate. On Nov. 20, Future Tense will host “Will the Family Survive the Revolution in Reproductive Technology?” in Washington, D.C. For more information about the event and to RSVP, visit the New America website.

Uterine transplants. Lasering placentas. Cloning humans. Ovulation microscopes for at-home convenience. Every day, we’re talking about new ideas in reproductive technology (some already, surprisingly, in wide use). As an OB-GYN I’m a big fan for the most part—new technology solves old problems, allows for new and amazing families to be created (and accepted), and lets people take charge of their own health in unprecedented ways.

But when did we, as a society, fall so in love with technology that we started to forget the problems that it hasn’t solved? Here’s something we like to forget: Vast numbers of old-fashioned pregnancies are affected by health problems that we can do little or nothing to change. For example: Did you know that preterm birth affects up to 11 percent of pregnancies (and closer to 16 percent if you’re black)? We can do very little about that right now. We can slow labor for 48 hours; we give steroids to the mother to add a little maturity to the baby. Too little, I think when I hold a struggling, newly delivered, one-pound baby in my hands, before rushing her to the neonatologists for tubes and lines. I mean two things: The baby is too little, but also we’ve done too little.

Did you know that premature rupture of membranes occurs in about 3 percent of pregnancies? This is when the baby’s amniotic sac opens, often far from term. If the rupture occurs prior to 23 weeks or so, losing the pregnancy is the overwhelmingly likely outcome; later in pregnancy, we resign ourselves to an early baby, possibly infected, who has lived with months of in utero inflammation—and that’s if we’re lucky, and we manage to keep the pregnancy going. Has anyone fixed this simple mechanical problem? I can tell you when I see a woman, feverish and in pain, trying so hard not to cry when we tell her we need to induce her labor, even though she hoped and prayed for two more months of sitting in my hospital, what the answer is: no.

Did you know that pre-eclampsia is a weird disease that only occurs in humans, only in pregnancy? That makes it awfully hard to study. This disease affects millions of women worldwide, forces premature delivery of pregnancies before they make the moms sick, and kills a lot of women (and babies) all over the world. How close are we to solving that one? Here’s what I had to tell the family of a patient the other week, as she lay unresponsive in the ICU after undergoing several seizures immediately after delivery of her altogether-too-small baby boy: not very close at all.

These pregnancy problems seem like they should have a simple mechanical fix—seal up the cervix! Patch the membranes! Stop whatever it is that causes pre-eclampsia! And goodness, it’s not like science isn’t trying. Researchers have been working on all of these problems, with serious dedication, for a long time. With that work, we’ve made some advances in understanding how these things happen, or whom they happen to, or whom to worry about. But in a very real way, we’re no closer to fixing these problems than we were 30 years ago, despite microprocessors, cellphones, and yes, lasers. What we have achieved, in lieu of actual cures, are incremental improvements in neonatal and maternal care, yielding small gains in infant survival and maternal health over decades. Is that enough? Today, with that small baby in my hands, it doesn’t feel like enough. But, despite that, somehow these problems have left the realm of the public imagination.

Scientists continue to work. But out there, it seems that the general public likes to forget these illnesses. I don’t know why. Statistically speaking, you know someone who has had pre-eclampsia; you know two or three or four people who have had preterm babies, some a little early, some very early. You are probably aware that premature rupture of membranes can happen and that it can be a tragedy.

But as a society, I think we like to forget. We’ve managed to get comfortable with the idea that pregnancies are easy and always successful, when it’s pretty clear that neither thing has ever been true. We like to think that pregnancy is safe, and guaranteed, that two lines on a urine stick equal a healthy baby, that our current state of technology protects us from the bad stuff that’s out there. But for whatever reason, that’s allowed us to forget that our advances in technology haven’t done enough to change that.

So thanks for the lasers and the transplanted uteri and the robot babies. I appreciate them, I do. But can you take a second and look at the tragedy and loss that are caused by the more old-fashioned problems we have? Come back and let me know when you’ve got those squared away. Because we could really use the help over here.