Giving Baby a Chance, Before Birth
Surgery in the Womb?
'Miracle Cure' Not Without Its Risks continued...
Their son, Nathan, has not progressed as well as they had
hoped. At 7 weeks of age he needed a shunt, and at 2 years old he is not yet
walking. His cognitive abilities, however, are on target. Janice Lamb, one of
the first women to have the surgery at Vanderbilt, was 28 weeks' pregnant when
doctors operated on Nathan. Now doctors are operating as early as 21 weeks.
For parents whose children are not the medical miracles for
which they had hoped, it can be painful to see other kids who are progressing
so much faster, Lamb says. But small accomplishments, such as Nathan's learning
to clap, to roll over, and to crawl, make her feel that the operation was worth
Even ardent supporters of the procedure acknowledge it is not a
miracle cure. It is risky to both mother and fetus, and carries a host of
ethical and moral questions. Until now, such high-stakes operations were
undertaken only to correct defects that otherwise would kill infants. With
spina bifida, surgeons are attempting to enhance life by treating a defect that
is disabling but not necessarily deadly.
For women who receive the surgery, there is a risk of excessive
bleeding, infection, and sometimes fatal side effects from drugs to control
premature labor. They must have future children by cesarean section. And
virtually all infants who have fetal surgery are born premature, increasing
their chances of complications.
Best Use of Resources?
In researching her book, The Making of the Unborn
Patient, sociologist Monica Casper concluded that in the early years of
fetal surgery, women were not adequately informed about the risks, though she
believes that has changed. Doctors at Vanderbilt, in particular, she says,
"have made themselves very open to outside ethical and legal analysis. They
are not behaving in a secretive way."
But Casper argues that the procedure "is not the best use
of resources. If we want to save babies, there are all kinds of other ways to
be doing it. We can be providing better prenatal care and nutrition to all
women in the United States rather than spending money on this experimental
Normally, when babies are born with spina bifida, doctors
perform surgery within 48 hours to cover an open lesion on the newborn's back.
By performing it before birth, doctors cannot correct nerve damage that has
already occurred but, instead, hope to prevent additional damage or
What's more, surgeons have found that fixing the spinal defect
appears to correct hindbrain herniation, which causes death associated with
breathing problems in 15% of children with spina bifida. It also reduces the
need for a shunt by between 33% and 50%, according to Vanderbilt's
"If we have the chance to lessen the extent of injury, why
wouldn't we do that?" asks Joseph Bruner, MD, director of fetal diagnosis
and therapy at Vanderbilt, on a fetal surgery web site started by parent Todd
Gardener to get the word out about the procedure.
The operation, which costs upward of $35,000 and is covered by
at least one large insurer -- Aetna U.S. Healthcare -- requires a team of
medical specialists, who open the mother's uterus, repair the opening on the
fetus' back with a patch made from human skin, and then close the uterus.