“A life is begun which is neither that of the father nor the mother; it is rather the life of a new human being.
The human being is to be respected and treated as a person from the moment of conception.”
The Gospel of Life, 1995
“The embryo is a new human life which is genetically distinct
and which has energy and a direction of its own from the moment of conception.”
LMH, 2005
LIFE
True love between a man and woman leads to marriage. It is natural for a man and woman to be together. This is recorded in Genesis with God’s Creation of man and woman. God blessed man and woman and called them to “be fruitful and multiply.” Human life and love were an integral part of the Divine Plan of God our Creator.
So God created man in His own image; in the image of God He created him;
male and female He created them. Then God blessed them, and God said to them,
“Be fruitful and multiply; fill the earth and subdue it.”
Genesis 1:27-28
The natural law unites man and woman together in love and marriage for mutual comfort and the procreation of the human race. All religions have always protected the sanctity of marriage and the family. See Love for further discussion.
Marriage protects love and the growing family, the sanctuary of life. Within marriage, the parents can love and nurture their children. Is there any greater love than a mother has for her child? How beautiful is the newly pregnant mother as she treasures the infant growing within her. Children are the fruit and the bond of a marriage!
First we will review the Biblical sources and then the Medical aspects of Life in the Womb.
BIBLICAL SOURCES
God is the Author of Life:
Then the Lord God formed man from the dust of the ground,
and breathed into his nostrils the breath of life; and the man became a living being.
Genesis 2:7
“Did not He who made me in the womb make him?
And did not one fashion us in the womb?”
Job 31:15
Thus says the Lord who made you, who formed you in the womb and will help you:
Isaiah 44:2
Life begins at conception. Both the Old and New Testaments of the Bible indicate that God is aware of life in the womb.
God knows who we are even before conception (Jeremiah 1:5)!
You formed my inmost being;
You knit me in my mother’s womb.
I praise you, so wonderfully you made me;
Wonderful are your works!
My very self you knew;
My bones were not hidden from you,
When I was being made in secret,
Fashioned as in the depths of the earth.
Your eyes foresaw my actions;
In your book all are written down;
My days were shaped, before one came to be.
Psalms 139:13-16
“Yahweh called me when I was in the womb,
before my birth he had pronounced my name.”
Isaiah 49:1
“Before I formed you in the womb I knew you.”
Jeremiah 1:5
“In those days Mary arose and went with haste into the hill country, to a city of Judah,
and she entered the house of Zechariah and greeted Elizabeth.
And when Elizabeth heard the greeting of Mary, the babe leaped in her womb;
and Elizabeth was filled with the Holy Spirit and she exclaimed with a loud cry,
“Blessed are you among women, and blessed is the fruit of your womb!
And why is this granted me, that the mother of my Lord should come to me?
For behold, when the voice of your greeting came to my ears, the babe in my womb leaped for joy.”
Gospel of Luke 1:39-44
“But when God, who had set me apart even from my mother’s womb and called me through His grace,
was pleased to reveal His Son to me, so that I might preach Him among the Gentiles,”
Paul to the Galatians 1:15-16
“Blessed be the God and Father of our Lord Jesus Christ,
who has blessed us in Christ with every spiritual blessing in the heavenly places,
even as he chose us in him before the foundation of the world,
that we should be holy and blameless before him.”
Paul to the Ephesians 1:3-4
God the Father and the Lord Jesus Christ give a warning to those who take away life:
“I will demand an accounting for human life.
Whosoever shall shed man’s blood, his own blood shall be shed,
For man was made in the image of God.”
Genesis 9:5-6
“If you wish to enter into life, keep the commandments.”
He said to him, “Which ones?”
And Jesus said, “You shall not murder;
You shall not commit adultery; You shall not steal; You shall not bear false witness;
Honor your father and mother; also, You shall love your neighbor as yourself.”
Gospel of Matthew 19:17-19
MEDICAL ASPECTS
LIFE IN THE WOMB
Individual life begins with conception by the union of the sex cells or gametes of the mother and father. The 23 chromosomes of the paternal sperm (male pronucleus) fuses with the 23 chromosomes of the maternal oocyte (egg or female pronucleus) at fertilization to create a single cell embryo or zygote containing 46 chromosomes. Thus, while the zygote receives cells from the mother and the father, it is neither the mother nor the father. The fertilization process takes about 24 hours. The new human zygote has the inherent capacity or potential to become a fully rational and cognizant person. Each one represents a unique, irreplaceable, never-to-be-reduplicated human being!
As physicians do not know when fertilization occurs, one measures the term of the baby from the first day of the last menstrual period, which is approximately two weeks prior to fertilization, and this is known as the Gestational Age.
There are traditionally three phases in the prenatal development of an individual: the Germinal and Embryonic phases of the Embryo, which lasts from fertilization through the eighth week after conception or tenth week of gestation. These phases are characterized by dramatic cell differentiation through the eighth week after conception, so that the beginnings of all essential organs of the human body are present. The Fetal Phase proceeds from the beginning of the ninth week after conception until birth, generally until the 38th week after conception or the 40th week of gestation.
The Germinal Phase of the embryo extends from the moment of fertilization of the ovum through the second week after Conception or fourth week of Gestation. Cells in the newly-formed baby in this Germinal Phase, before the time that implantation would normally occur in the mother’s uterus, are called embryonic stem cells. During this phase, the zygote undergoes continual cell division, implants in the uterus, and forms the embryonic disc, which will produce the primary germ layers that give rise to the organs of the human body.
The zygote begins dividing about every 12-20 hours, first into 2 cells called blastomeres. The blastomeres divide repeatedly without growth and thus decrease in size. By three days division into 16 cells has taken place, and the zygote assumes the shape of a mulberry, becoming known as a 16 cell morula. The morula then leaves the fallopian tube and enters the uterine cavity three to five days after fertilization. Cell division continues, and a cavity known as a blastocele forms in the center of the morula. With the appearance of the cavity in the center, the entire structure is now called a blastocyst.
The presence of the blastocyst indicates that two cell types are forming: the embryoblast (inner cell mass on the inside of the blastocele), and the trophoblast (the cells on the outside of the blastocele). The inner cell mass becomes the embryonic disc, and the trophoblast becomes the placenta. The blastocyst begins implantation into the endometrial lining of the uterus via its trophoblast from the 7th to 10th day after fertilization. Implantation is generally complete by the 14th day and the embryo is receiving nourishment from the mother.
The Embryonic Phase of the embryo extends from the beginning of the third week through the eighth week after conception. The Trilaminal Embryo develops during the third week with the formation and development of the three primary germ layers – the ectoderm, mesoderm, and endoderm. These germ layers will fashion the beginnings of all the organ systems of the human body. The ectoderm differentiates into two parts, the surface ectoderm which produces the skin, hair, and nails, the lens of the eye, the internal ear, and enamel of teeth, and the neuroectoderm which develops into the brain, spinal cord, and nervous system. The mesoderm forms the heart and circulatory system, the blood cells and bone marrow, the reproductive system, kidneys, musculature, bone and cartilage, connective tissue, and the serous membranes. The cardiovascular system is the first organ system to reach a functional state. An embryonic heartbeat begins on the twenty-first or twenty-second day after fertilization! The endoderm forms the thyroid and parathyroid glands, the epithelial lining of the lungs and digestive tract, the liver, pancreas and biliary system, and the urinary system including the bladder and vagina.
A human embryo is fully recognizable after the eighth week of conception!
The human embryo now measures just over one inch long and weighs about 4.5 grams.
The prenatal infant enters the Fetal Phase and is now called a Fetus, from the beginning of the ninth week after conception to birth, generally on the thirty-eighth week after conception or fortieth week of gestation. This Fetal Phase is characterized by rapid growth and continued tissue and organ differentiation. Recent studies in neuroscience point toward a nonreflective fetal pain experience from as early as twelve weeks gestation!
Viability is the time when the fetus can live outside of the womb, independently of the mother. Prematurity is defined when an infant is born before 37 weeks of gestational age. With modern neonatal units, extremely premature babies may survive at 23-25 weeks gestation (21-23 weeks of embryonic growth), although there is a high risk of permanent handicap. Premature infants with very low birth weight are those who weigh 1500 grams (3.307 pounds) or less; those with extremely low birth weight weigh 1000 grams (2.205 pounds) or less. The decision to resuscitate or offer comfort care for the extremely premature infant is a complex one: the goal to care should be one that will increase survival and decrease the prevalence of disability among survivors. The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: female sex, exposure to antenatal steroids, single birth, and higher birth weight in 100 gram increments (Note: one gram = 0.002205 pounds; one pound = 453.59 grams).
DIAGNOSIS OF PREGNANCY
A skipped period, fatigue, nausea, and breast tenderness are the most common symptoms of early pregnancy. Physicians have three primary means of diagnosing pregnancy – the physical examination of the mother, the pregnancy test, and the ultrasound.
The trophoblast after implantation begins secreting the protein β-HCG, βeta human chorionic gonadotropin. All pregnancy tests – home urine and hospital serum pregnancy tests – detect this protein at varying degrees of sensitivity. A serum pregnancy test may detect pregnancy after implantation occurs, as early as 7-10 days after conception, and almost certainly within two weeks of conception, or 4 weeks of gestational age. In other words, a pregnancy test is generally positive by the time the mother misses her period. Once implantation occurs, β-HCG doubles every 1.4 to 2.0 days for the first trimester of pregnancy.
The ultrasound has become an invaluable tool in assessing life in the womb. The earliest definitive finding on ultrasound is the gestational sac, which may be detected from 4-6 weeks of gestation. The heartbeat may be detected on doppler ultrasound as early as six weeks of gestation! The baby’s heartbeat may be heard with a stethoscope by 16 to 19 weeks of gestation. The normal fetal heart rate ranges from 120 to 160 beats per minute.
A fully-formed baby can readily be seen on ultrasound by the first trimester of pregnancy!
The human being takes 38 weeks (266 days) to develop in the womb from conception to birth, and the Gestational Age is given as 40 weeks (280 days) or 10 lunar months (each lunar month being 28 days), or roughly 9 calendar months and 7 days. This time is divided into the three trimesters of pregnancy lasting 3 months each. The expected Due Date for delivery, or EDC (Estimated Date of Confinement), is calculated by adding 7 days to the first day of the last menstrual period and then adding 9 months. For example, if the pregnant patient’s first day of her last menstrual period is March 1, then her due date is December 8.
NORMAL LABOR AND DELIVERY
Parturition is the birth process of the baby. Labor begins with involuntary uterine contractions that first result in effacement and dilation of the cervix, and then, in conjunction with voluntary bearing-down of the mother, the progress of the baby down the birth canal. Crowning is the presentation of the baby’s head at the introitus or vaginal opening. Delivery occurs with the complete birth of the baby!
Five essential factors influence the process of labor: the baby or the passenger, the size of the birth canal or “passageway,” the “power” or strength, frequency, and duration of uterine contractions, the position of the placenta, and the psychologic state of the mother.
Vertex and Breech Presentations
The ideal situation is for the baby to be in a longitudinal or vertical lie and to present head first in the birth canal, or vertex presentation. Delivery may be difficult if the baby is in a vertical lie but a breech presentation. Breech presentations are called frank when the pelvic sacrum enters first, complete when the pelvis and both feet enter, and footling when one foot enters the birth canal. Delivery is impossible if the baby is in transverse lie, and this generally leads the obstetrician to surgically remove the baby by Caesarean Section.
There are three traditional stages to labor.
The first stage occurs from the beginning of uterine contractions to the complete dilatation of the cervix. The beginning of labor often coincides with “show,” the discharge of the mucus plug of the cervix, and the “water breaking,” the release of amniotic fluid with the rupture of the amniotic sac. Effacement of the cervix means the thinning of the cervix, and dilatation refers to the widening of the cervical diameter from 1 cm to 10 cm, to allow for the progress of the baby down the birth canal.
The second stage lasts from full dilatation of the cervix with transition down the birth canal to the actual delivery of the baby. Progress in the descent of the presenting part (usually the head) is determined by vaginal examination until crowning occurs. The location of the head in relation to the ischial spines is designated the station, and is a means of determining the progress of the baby down the birth canal. The level of the ischial spines is considered to be station 0, and the position of the head is described in centimeters minus (-1 to -5) above the spines or plus (+1 to +5) below the spines.
Delivery of the Infant
Once crowning (A) occurs, gentle delivery of the head (B) follows. Gentle downward traction brings descent and then delivery of the anterior shoulder (C). Subsequent gentle upward traction allows delivery of the posterior shoulder (D). The rest of the body easily follows once the shoulders are delivered, and the newborn is here!
The baby enters the world of relationship!
The third stage occurs from the delivery of the baby to the delivery of the placenta.
IMMEDIATE CARE OF THE NEWBORN
The newborn must receive immediate care upon delivery. The delivery team must first ensure a clear airway. A bulb syringe is used to suction the mouth to prevent aspiration. Then the nares (nose) is aspirated. Suctioning of the nares stimulates the neonate to take a breath.
The umbilical cord is clamped about 30 seconds after delivery when cord pulsations cease. The cord is examined for the normal presence of two arteries and one vein.
The newborn must be kept warm, generally by placing a blanket around the baby’s head and body, and then placing the baby on the mother’s abdomen.
The condition of the baby is assessed at one minute, 5 minutes, and if indicated 10 minutes, generally by using the APGAR Score. The APGAR Score assesses the baby’s heartbeat by auscultation with the stethoscope; respirations by observance of chest wall movements; muscle tone, based on movement of the extremities; reflex irritability, the response of the baby to suctioning; and color, whether blue or pale, body pink with cyanotic feet, or all pink. The one-minute score is variable, but a five-minute score of 7 or greater is generally indicative of a healthy baby; the ideal five-minute score is 10.
| NEWBORN APGAR SCORE | |||
| 0 | 1 | 2 | |
| Heart Rate | Absent | Less than 100 | Over 100 |
| Respirations | Absent | Slow | Good cry |
| Muscle Tone | Limp | Some Flexion | Active Motion |
| Reflex | No response | Grimace | Cry |
| Color | Pale or Blue | Feet Blue | All pink |
The giving of the baby to the mother and father brings overwhelming joy.
The birth of a baby is truly a miracle of love!
REFERENCES
1 Pope John Paul II. The Gospel of Life, the encyclical Evangelium Vitae, Times Books, Random House, New York, paragraph 60, March 25, 1995.
2 LM Haddad MD. Principles of Medical Ethics. 14th Annual Intensive Review in Emergency Medicine, Medical University of South Carolina, Charleston, September 2005.
3 Revised Standard Version of The Holy Bible. Ignatius Press, San Francisco, 2005.
4 Paul Ramsey. The Patient as Person – Explorations in Medical Ethics, Yale University Press, New Haven, Connecticut, 1970.
5 Pellegrino ED MD, Thomasma DC. Christian Virtues in Medical Practice. Georgetown University Press, Washington, D. C., 1996.
6 Henry Gray. Gray’s Anatomy of the Human Body. 27th Edition, Lea & Febiger, 1959. 40th Edition, Susan Standring (ed), Churchill Livingstone, Elsevier, Orlando, 2008.
7 Keith Moore PhD, TVN Persaud MD, Mark Torchia PhD. The Developing Human: Clinically Oriented Embryology, Tenth Edition, Elsevier Saunders, Philadelphia, 2016.
8 TW Sadler. Langman’s Medical Embryology, 13th Edition, Wolters Kluwer, Philadelphia, 2015.
9 Stuart WG Derbyshire, John C. Bockmann. “Reconsidering Fetal Pain.” J Medical Ethics 46:3-6, 2020.
10 Bridget Thill MD MS. “Fetal Pain in the First Trimester.” The Linacre Quarterly Vol 89 (1), 73-100, February 2022.
11 JM Lorenz MD. “The outcome of extreme prematurity.” Seminars in Perinatology 25(5):348-59, October, 2001.
12 Cnattingius S MD, Johansson S, Razaz N. “Apgar Score and Risk of Neonatal Death among Preterm Infants.” New England J Medicine 383 (1):49-57, July 2, 2020.
13 FG Cunningham MD, Editor in Chief: William’s Obstetrics, 24th Edition, McGraw-Hill, New York, 2014.
14 Kliegman RM, Stanton B, St. Geme J (MD Editors): Nelson’s Textbook of Pediatrics, 19th Edition, Saunders, Philadelphia, 2011.