‘It never fails to strike me what a miracle it is to see this foetus that is clearly not ready to be born enclosed in this fluid space, breathing, swallowing, swimming, dreaming, with complete detachment from the placenta and from mom. It is an awe-inspiring sight,’ says Partridge, smiling with her eyes shut just like the lamb in the video, and shaking her head as if she can’t believe what she’s managed to do.
It’s a team effort, but Partridge talks like the biobag is her baby. She is the most junior member of the team and the only woman; she came to CHOP from Toronto as a research fellow. In interviews with Canadian broadcaster CBC on the day the paper was published, she takes ownership of the whole concept. ‘I pitched this idea, really, with the belief that this offered an unprecedented opportunity to improve what we can do for these babies,’ she says. She describes looking after the lambs in the bags like a mother beside her newborn’s cot: ‘rolling out a sleeping bag and camping out beside these lambs for weeks and weeks at a time.’
In the CHOP video, Partridge talks us through the two key components of the biobag that act as substitutes for a mother’s body. The placenta is replaced by a circulatory system, ‘a device in which blood flows and carbon dioxide is removed and oxygen is added to that blood.’ This is an oxygenator plugged into veins in the lamb’s umbilical cord, which also delivers nutrients and any necessary medication the lamb might need. (It actually performs exactly the same function as the woman in the lab coat at JUST pipetting the medium in and out of the seed trays to allow the chicken cells to proliferate.) There are no mechanical pumps to drive the blood through it, because even gentle artificial pressure could overload the lamb’s tiny heart. The flow of blood is instead pumped entirely by the beating of the foetus’s heart, just as it would be in the womb.
‘The other component is recreating the womb itself, and that’s really the fluid environment, which we have recreated with a soft, bag-like structure,’ Partridge continues. ‘It’s meant in some ways to swaddle and keep the foetus supported physically the way that it would be in the uterus.’ The plastic bag acts like an amniotic sac filled with warm, sterile, lab-made amniotic fluid that the lamb breathes and swallows, just like a human foetus would. This fluid flows in and out of the biobag through tubes in two small, watertight apertures. The team went through 300 gallons of the stuff a day during their experiments.
The biobag is needed because of the fallibility of the uterus. Normal pregnancy is forty weeks; any baby born before thirty-seven weeks is considered premature. At twenty-three weeks – a little over five months – the mother has only just passed the halfway point of her pregnancy. One per cent of all babies born each year in the US are born as premature as this, Flake says. That twenty-three- to twenty-four-week figure is totemic: it’s the border of viability, the age after which modern medicine currently has a hope of keeping babies alive when they are born early, and the point at which doctors will attempt to resuscitate a newborn. The NHS currently uses twenty-four weeks as the border of viability, and a baby born dead at twenty-four weeks is classed as a stillbirth, whereas a dead baby born at twenty-three weeks and six days is still called a miscarriage. It is a brutal boundary.
In countries with good hospitals there is currently a 24 per cent chance of keeping a baby born at twenty-three weeks alive. But 87 per cent of those that make it will go on to experience major complications that dominate their lives, like chronic lung disease, bowel problems, brain damage, blindness, deafness and cerebral palsy. More extremely premature babies are surviving in wealthier countries: between 1995 and 2006 in England, there was a 44 per cent increase in babies born before twenty-four weeks living long enough to receive neonatal care. But we aren’t getting better at avoiding the problems associated with premature birth at this stage, and the number of children growing up with chronic conditions associated with prematurity has also increased dramatically. Preterm birth is the greatest cause of death and disability among children under five in the developed world.
Incubators deal with some of the functions a premature newborn needs help with, but they don’t allow for the process of gestation to continue. They provide warmth and humidity, but not nutrients – that’s why the babies inside them are covered in catheters and cannulas that deliver what they need to survive and grow, and also why they have to be sedated: to stop them trying to pull the tubes out of themselves. Ventilators keep premature newborns alive by breathing on behalf of their underdeveloped lungs, but also increase the chance of infection, stop the lungs from developing properly and can potentially damage whatever delicate lung tissue is already there. Instead of supporting the newborn as it tries to survive outside its mother’s body, the biobag treats the baby as a foetus who has not yet been born.
‘If it’s as successful as we think it can be,’ Flake says in the promotional video, ‘ultimately the majority of pregnancies that are predicted at risk for extreme prematurity would be delivered early onto our system, rather than being delivered premature onto a ventilator.’
I have to listen to this comment a few times. Is he saying that women at risk of going into very early labour would have a caesarean just in case, so their babies could be transferred into the artificial womb for the rest of their gestation?
But then he continues: ‘With that, we would have normal physiologic development, and avoid essentially all of the major risks of prematurity, and that would translate into a huge impact on paediatric health.’ The shots in the video are now of chubby babies sitting up and giggling, a gap-toothed six-year-old grinning, a young woman breaking into a slow-motion smile. If a biobag could mean a healthy future for so many babies instead of one of illness and disability, who could deny it to them?
This is how CHOP approaches all of the potentially massive controversies their artificial womb brings up: by focusing on paediatric health, on gurgling babies, to the exclusion of everything else. There are no ewes in the film or the scientific paper, and no input from mothers. The researchers want their device to be seen as ethically unremarkable, to be about helping sick babies and nothing more. ‘Our goal is not to extend the current limits of viability, but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units,’ the paper says, carefully. Extending the current limits of viability would create an ethical minefield. The legal abortion limit in the UK was brought down from twenty-eight to twenty-four weeks in 1990 because advances in neonatal care meant that foetuses born between twenty-four and twenty-eight weeks were more likely to survive. If artificial wombs are helping ever-smaller babies survive, that can have enormous implications for women. But women are not mentioned in CHOP’s work.
The closing sentences of the scientific paper show how absent women are from their considerations: ‘Our system offers an intriguing experimental model for addressing fundamental questions regarding the role of the mother and placenta in fetal development. Long-term physiologic maintenance of a fetus amputated from the maternal–placental axis has now been achieved, making it possible to study the relative contribution of this organ to fetal maturation.’
As much as CHOP’s communications department want to emphasize that the biobag is a therapeutic tool for very sick, very tiny babies, the people who made it are keen for the scientific community to know that they have managed to ‘amputate’ foetuses from the mother and placenta, meaning that the ‘relative contribution’ of pregnant mothers and their organs to how babies grow can be studied. And perhaps, eventually, be deemed entirely replaceable by technology.
As I get to the final minutes of the promotional film, it’s beginning to look more like the JUST chicken video, a familiar story of good old American grit, tenacity, resourcefulness and entrepreneurship that might just save the world. Davey and Partridge describe how the prototypes for what became the biobag developed. ‘For the first few generations we used a lot of supplies from plumbing, piping, beer stores,’ Partridge grimaces. ‘We did not
have grants at the time, so it really required a bit of innovation to create the first prototype really from nothing.’
‘Thomas Edison said to be an inventor all you need is an imagination and a pile of junk. Essentially, that is the story of this system,’ says Davey. ‘Sometimes we ended up going to Home Depot, we ended up going to Lowes and to Michaels, we would bring these objects back to the lab and glue them and melt them all together.’
By the end of the CHOP video, Partridge is beaming with pride. ‘This certainly is a project that would have sounded more like science fiction than a reality, but over three years of really doggedly pursuing it, and refusing to accept setbacks and limitations, it has become a very real therapeutic tool.’
But this is not just a therapeutic tool: it’s an invention that will one day go on the market, a commodity, and CHOP wants to protect its intellectual property. After a Google deep dive I find an application to patent the biobag, filed in 2014, long before the scientific paper was submitted, and it’s probably the most revealing thing the team has ever put into the public domain. There’s no coyness about extending the limits of human viability in this document: it explicitly says that the possible ‘subjects’ who will use the invention include ‘pre-viable foetuses (e.g. 20–24 weeks)’.
There are some touching details in the patent application that didn’t make it into the scientific paper or the promotional video. Partridge, Flake and Davey gave their little lambs names, in their early experiments, at least. There was June, Charlotte, Lily, Little Alan, Eddie, Willow, Seinne, Bowie, Iggy and Manson. Most of them were killed at birth so CHOP could study their organs, but a few lucky ones were allowed to live, and were bottle-fed by the team. Iggy did particularly well and was ‘successfully delivered from the artificial placenta and transitioned to postnatal life […] The animal displayed appropriate growth and development over eight months before transport to a long-term adoptive facility.’ The final photo in the patent application is of a sprightly lamb inside a shed, looking over one shoulder to face the camera, as if striking a pose.
It is probably because of this patent that I have to rely on CHOP’s online promotional videos and research paper to describe the biobag and all the work that went into it. I am not allowed to go to Philadelphia to see the team’s work with my own eyes. I so nearly was: Alan Flake told me I was welcome to come; we fixed a date and time for my visit. I was about to book my flight when I thought I should really let CHOP’s press office know I was coming; you can’t just stroll into a children’s hospital without the right permission. I had a very friendly forty-minute conversation with the CHOP press officer, who seemed keen to have me too, but told me to hold off booking anything until they got the green light from CHOP’s legal department, which would take a couple of days. It sounded like a formality.
But days became weeks, and the flights were getting more expensive, and for some reason the friendly press officer now wouldn’t answer my calls or return my messages. Then, finally, a very brief email dropped into my inbox. ‘I’m very sorry to report that CHOP is going to pass on this opportunity,’ the press officer wrote. ‘I really enjoyed talking with you, and was hopeful we could make this work but could not. I apologize for the confusion and delay getting you a final answer. Thank you for your interest in this research.’
It took several more emails to get a hint of why I was suddenly unwelcome. Flake apologized and said it was out of his hands. They want to be able to put babies inside the biobag within a couple of years, and the prospect of my visit made the legal department twitchy. ‘There is a lot of caution to do anything that could jeopardize FDA approval,’ the press officer finally told me. CHOP didn’t want to threaten the medical and commercial future of their invention by talking to a journalist too soon. Their focus, at the moment, is getting their artificial womb to market.
When the biobag does hit the market, it will be only the latest and most literal manifestation of how pregnancy is becoming externalized. In any pregnancy in the developed world a woman is routinely prodded and probed, scanned vaginally and abdominally, has her blood taken and tested so the form, growth and DNA of her baby can be analysed. If something is suspected to be wrong with the foetus she will be probed some more: large needles will be inserted through the skin and muscle of her abdomen and into her uterus to sample cells from her placenta or her amniotic fluid, which can be subjected to further DNA testing. Even if everything is going well, it’s taken for granted that a pregnant woman will be strapped to foetal heart monitors and blood pressure gauges and have the size of her cervix routinely measured while she’s in labour. In an age when being a good parent means being as attentive as possible even before birth, we want better access to the babies growing inside pregnant women, better ways of measuring them and putting them under surveillance, so we can do the best for them even before they enter the world. Women’s bodies are almost getting in the way.
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‘Ectogenesis’ – reproduction outside the human body – was coined by British scientist J. B. S. Haldane in a lecture he delivered to the Cambridge University Heretics Society in 1923. Haldane imagined an essay written by a Cambridge University student of the future describing the great biological inventions engineered since Haldane’s time. ‘We can take an ovary from a woman, and keep it growing in a suitable fluid for as long as twenty years, producing a fresh ovum each month, of which 90 per cent can be fertilized, and the embryos grown successfully for nine months, and then brought out into the air,’ his imaginary future essayist wrote. ‘France was the first country to adopt ectogenesis officially, and by 1968 was producing 60,000 children annually by this method.’
Haldane was interested in ectogenesis for its social engineering potential, at a time of slowing birth rates; in 1923, eugenics was not yet considered a despicable idea. ‘Had it not been for ectogenesis there can be little doubt that civilization would have collapsed within a measurable time owing to the greater fertility of the less desirable members of the population in almost all countries,’ he said. Haldane concluded that the complete separation of reproduction from sex would mean ‘mankind will be free in an altogether new sense’.
Churchill’s ‘Fifty Years Hence’ article from 1931 had as much to say about ectogenesis as lab-grown meat. ‘There seems little doubt that it will be possible to carry out in artificial surroundings the entire cycle which now leads to the birth of a child,’ he wrote of his imagined 1981.
Churchill was writing only a year before Aldous Huxley published Brave New World. Huxley took a lot from his friend Haldane’s ideas, but turned them on their head: his brave new world of 2540 was a dystopian nightmare, where reproductive technology was a form of social control. Human beings were mass-produced in bottles lined with pigs’ peritonea, which spent 267 days on a production line conveyor belt in the Central Hatchery. ‘One by one the eggs were transferred from their test tubes to the larger containers; deftly the peritoneal lining was slit, the morula dropped into place, the saline solution poured in,’ Huxley wrote. ‘The procession marched slowly on; on through an opening in the wall, slowly on into the Social Predestination Room.’ Here, embryos were turned into humans of different social classes: some were starved of oxygen to give them brain damage, so they were content with menial work; others were kept in freezing conditions to give them an aversion to cold, so they were happy to become miners in the tropics. Huxley’s view of ectogenesis has come to dominate: its place in our collective imaginations has been a dark trope of science fiction ever since.
In the real world, the possibility of having a baby without a womb began to represent a new frontier of freedom. In the 1970 feminist classic The Dialectic of Sex, Canadian radical feminist Shulamith Firestone argued that the biological division of labour in natural reproduction forms the basis of male domination over women. Her ‘first demand for any alternative system’ was ‘the freeing of women from the tyranny of their biology by any means available, and the diffusion of the childbearing and childrearing
role to the society as a whole, to men as well as women’.
The manifesto of the UK’s Gay Liberation Front, first published in 1971, said ectogenesis had potential to emancipate both men and women by erasing the natural distinctions between them. ‘We have now reached a stage at which the human body itself, and even the reproduction of the species, is being “unnaturally” interfered with (i.e. improved) by technology,’ it reads. ‘Today, further advances are on the point of making it possible for women to be completely liberated from their biology by means of the development of artificial wombs […] Technology has now advanced to a stage at which the gender-role system is no longer necessary.’
This might have been a rather optimistic reading of the state of reproductive technologies in the early 1970s, but it was not complete fantasy: scientists had been experimenting with growing both animal and human foetuses outside female bodies for decades by this time. CHOP might like to depict its research as an unprecedented paradigm shift, but it’s actually built on the back of a long and international body of scientific work. And while the CHOP team got a lot of attention when the biobag paper was published, there are scientists across the world, in Asia and Australia as well as other parts of North America, who have been working successfully with artificial wombs for years, and are racing the CHOP team to be first to try their devices out on human foetuses.
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‘This is not a new field at all,’ says Matt Kemp, a little wearily. He runs the perinatal laboratory at the Women and Infants Research Foundation (WIRF) in Western Australia, and his team’s artificial womb, Ex-Vivo Uterine Environment or ‘EVE’ therapy, reported its first great successes in a paper published a few months after the CHOP team’s research. The biobag completely stole EVE’s thunder, and although Matt makes little reference to the biobag, he does sound somewhat narked about it.
Sex Robots and Vegan Meat Page 19