Fetus Obviously Immature

Since maturity equals adulthood, the fetus is, by definition, immature, but immaturity acquires a nasty overtone suggesting inferiority. Thus the tendency has developed to consider the fetus, or neonate, as a poorly functioning adult rather than as a splendidly functioning baby.

Every age and stage of life has its excellencies and its weaknesses, and fetal life is no exception. We do not regard the fetal circulatory system, different as it is from the child's or adults', as one big heap of congenital defects, but rather a system superbly adapted to the circumstances under which a fetus lives.

We should not regard fetal and neonatal renal (kidney) function, assymetric as it is by adult standards (he handles a water load well, but not a solute load unless he has plenty of water), as inferior, but entirely appropriate to the osmometric conditions in which it has to work.

We should appreciate that the fetus has a much more prompt and reliable response to haemorrhage than adults, that a fracture which would incapacitate an adult for three to six months will heal in three weeks in a bandage in a baby, that the ability of a fetus to heal surgical scars or thermal burns would be the envy of a plastic surgeon. In these contexts at least, it would be more appropriate to consider the adult as a poorly functioning fetus.

Even when we accept that it is the fetus who is in command of the pregnancy, that it is mother, not baby, who is the passive partner in the relationship, people might still feel that the fetus is nevertheless but a new superconductor of some endocrine orchestra, a mindless programmed robot controlling his mother. Nothing could be further from the truth.

As the fetus develops structures - including sensory structures, he uses them. Development of structure and development of function go hand in hand. Indeed, if the function cannot be served without developing a differentiating the structure, equally, without the stimulus of function the structure does not develop properly.

Further, we are aware in extra uterine life that every individual represents an interaction of nature and nurture, of environement and genetic endowment. The same is true in the uterus. The fetus does not live in a metabolic Nirvana, or in a dark and silent world, in a state of sensory deprivation. The uterus may buffer, filter, and distort the outside world, but does not eliminate it. Stimuli do reach the baby and he responds to them.

We know that fetal movement is necessary for the proper development of bones and joints, that the fetus without room to move or without muscles or nerves to move with, is born with severe restriction of range of joint movements.

We know that fetal comfort determines fetal position, that changes in maternal position provoke baby to seek a new position of comfort, that contractions and external palpation provoke fetal movement and that the fetus will repeatedly evade the sustained pressure of a microphone or recording.

We know how babies change ends in the uterus while they still have room - they propel themselves with their feet, either frontwards or backwards, and how they change sides - with an elegant longitudinal spiral roll, rotating first their heads, then their shoulders, and finally their legs.

In early prognancy the fetus is free to move as he pleases, and he does precisely that. He can turn complete flips in one and a half or two seconds. In late pregnancy, with increasing fetal bulk and diminishing amniotic fluid volume, there is less choice, but fetal comfort determines which way a baby will lie in late pregnancy and present in labour.

Of course, in selecting a position of comfort in late pregnancy, the fetus may have chosen a position which which is difficult or impossible for vaginal delivery. In this regard he can be accused of lack of foresight, but this is a trait not unknown in adults.

Thus the fetus is responsive to touch and pressure, simple facts confirmed by any obstetrician who has ever stroked the palm of [unclear: a]