Conception, implantation or birth? When does life begin?

I’m my friend’s best party trick. When conversation is lacking, someone will always mention what I do for a living, and just like that, conversation explodes. Questions flow, and some interesting — And kind of dirty — topics are put on the table. But sometimes, when the planets align, conversations take deeper paths, and I’m faced with the rare opportunity to offer a different perspective that’s usually hidden from people.

I live for those little moments that come so far and apart. They are always complex, always a cause of debate, always presented with such passion by everyone participating, that eventually, someone always starts yelling to make a statement. But my approach is never aggressive. I’m 2 different persons living in the same body. One wants to tell everyone what to do, the other believes information is the answer.

That’s “Midwife-Me”.

For some reason — And we all know what that reason is, ahem, ahem — women’s sexual health issues are always controversial. Everyone, at some point, has taken the time to develop an opinion for each of The Classics, — As I like to call them — and form an argument in the back of their minds, waiting for the right time to display them.

I’m no exception.

Do you want to cause a riot? Say “Abortion” and see what happens. Arguments will rise, and eventually, people will be possessed by the spirit of Søren Kierkegaar and everyone will become an existentialist. “Life begins when fecundation happens!”, some will say, “No, it begins after implantation!” others will refute, while the rest will simply state “No, it begins when you’re born!”

But, when does life really begin? Conception? Implantation? Birth? Somewhere in-between?

I strongly believe that every debate about abortion should either begin or end with this question. As a living creature, you already have enough information to talk about it with confidence, and my desire is to contribute to this deeply personal questioning by taking you on a little trip to the beginning of life.

Every living cell is not an independent living entity by itself. A sum of millions of cells creates tissue, and a sum of tissues create an organ, a sum of organs creates a system, and a sum of systems create a living, breathing human under the right conditions.

From conception emerges one cell, with the “potential” (But not certainty) to begin this process. Here, we are confronted with the first set of problems. Chromosomic abnormalities, diminished or complete lack of movement from cilia in the fallopian tubes, movement in the wrong direction and more, will put an end to this process.

If there’s a nucleus inside that cell, fast mitosis will occur, and one cell will become 2, then 4, then 8, then 16, then 32 cells, and so on and so on until the implantation in the endometrial layer of a uterus, that may or may not happen.

If it occurs, then in days, 3 layers of tissue will be established, and they will have the potential to create organs… or not. Several factors can affect this process too. An average fertile woman will complete conception and implantation several times in her life, but discard the products afterwards with her next period.

But lets say the process continues. And so, you will have an embryo (Trilaminar embryo) that is basically 3 layers of germ tissue in the shape of a disc. These layers will curve, a tube will be created, and the embryo will begin to grow the primitive foundations that will eventually create organs… or not. In here, we still have several factors that can affect the course of development.

Again, lets say it continues. During the span of 12 weeks, the embryo will develop a rudimental system of organs. But still, it will be completely dependent on its surroundings to exist, with no autonomy whatsoever. In here, fewer factors (But still a considerable amount) can limit its existence, but its longevity is in no way established.

Moving on. After 12 weeks, an embryo will become a fetus that needs to sharpen its organs and create fully functioning systems. This won’t happen fast. Most of its time in the womb will be spent in this tedious task, but once week number 20–24 hits, enough systems will be partially functional to allow it some minuscule portion of independency.

Any pregnancy that ends before week 20, or before the fetus weights 500 grams (1.1 pounds) is considered an abortion (That can be spontaneous, retained, septic or induced). Why? because the survival rate of a fetus any smaller than that is zero.

Any pregnancy that ends after this, is considered a birth, and the premature newborn, although precariously ready to be autonomous, has a very low, but present chance of survival once the cord is cut, marking his or her independence, but not assuring his/her optimal survival. Such an immature baby will require special care that can only be given by professionals in a NICU.

The baby won’t be able to breathe by itself, so special machines such as a CPAP to keep his/her lungs functioning, or ECMO to oxygenate his/her blood will be required. Feeding him/her will be imperative, since weight gain is crucial to increase any chances of survival. Because reflexes of suction and swallowing will be absent, and his/her digestive system won’t work, enteral feeding (Regular feeding), even with an oral gastric tube, will be impossible (Digestion simply doesn’t happen. If you give milk to an extremely preterm newborn, it’ll decompose in the digestive tract. The consecuence of this will be infection and necrosis of tissue, so surgery will be required to cut the damaged portions of the intestines. This is extremely common in prematures). Parenteral feeding will be required then (A specially formulated solution of nutrients that is given directly to his or her bloodstream). In order to do this, a central venous catheter would have to be installed. This is basically a thin tube, that goes into a peripheral vessel in an arm or a leg, up that extremely, and into the chest, until it reaches major vessels in the heart. Him/her won’t have a fully functioning immune system, so a sterile environment will be necessary to prevent infections. The skin will be frail, and will come off and get damaged under very light pressure, and vessels will be small and will break easily, so several hemorrhages, specially in the brain, will occur. The baby won’t be touched unless its absolutely necessary, because the slightest stimuli could push him/her into cardiopulmonary arrest. Sedation will be also necessary 24/7, because the pain will stress him/her, and reduce weight gain.

Long term damage is practically assured even under the best conditions. Cognitive functions will be impaired as well as hearing and sight, renal and hepatic functions will be compromised partially or fully, several interventions will be necessary, each one increasing the risk of infection, and tissues will suffer from oxygen deprivation and toxicity (Oxygen is toxic if administrated at any concentration higher than the 21% found in air), damaging other organs partially or totally. If immaturity doesn’t kill these extremely premature babies, any of the side effects I just enlisted, can.

The chances of survival increase as the fetus grows inside the uterus and fewer interventions will be required if the pregnancy is interrupted by natural conditions or induction. Finally, at 37 to 42 weeks, the fetus will be fully formed, and so, chances of survival will be optimal outside the womb.

But “optimal” is the key word here, because we don’t live in an ideal world and optimal has never been a guarantee. A number of obstetric conditions can result in the death of the fetus inside the womb or vaginal canal at any given point during pregnancy and childbirth. From congenital malformations to gestational diabetes to simple torsion of the cord to no evident reason at all. This is why, the delivery of a fetus without a heartbeat is called a stillbirth, and the end product of childbirth will only be called a newborn once the cord is cut and the first intake of air is achieved.

The entire process that some try to summarize with the phrase “the beginning of life” is a long and fragile phenomenon, as you can see. Each stage brings multiple factors that can interrupt its progression, and only one of those is premeditated (Induced abortion until week 20, or the induced interruption of pregnancy after that).

So, when does life really begin?

I guess that’s your call.