Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what the evidence base is to support the use of fetal analgesia during in-utero surgery for spina bifida from 19 weeks' gestation, but not its use before the termination of a pregnancy at the same gestation.

The Department does not set clinical practice. The Royal College of Obstetricians and Gynaecologists has considered the issue of fetal pain and awareness in its guidelines ‘The Care of Women Requesting Induced Abortion (Evidence-based Clinical Guideline No. 7)’ and ‘Fetal Awareness: Review of Research and Recommendations for Practice’, which are available at the following links:

https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf

https://www.rcog.org.uk/globalassets/documents/guidelines/rcogfetalawarenesswpr0610.pdf

The Royal College is currently reviewing these guidelines to consider the latest evidence on fetal pain and fetal awareness. It has advised that that the difference in approach in the use of fetal analgesia for in-utero surgery for spinda bifida is related to the fetal stress response, which is not related to fetal pain and the need for the fetus to be immobilised during spinal surgery. There is also evidence that the stress response could impact ongoing development of the fetus.