Artificial placentas and wombs

In 1992, the author JG Ballard was invited by Zone magazine to supply a glossary for the 20th century, and defined science fiction as ‘the body's dream of becoming a machine’ (Ballard, 1996). This might appear to have little relevance to midwifery, but the fast‑developing relationship between premature infants and machines may yield life‑saving advances, as well as ethical challenges.

Globally, 0.4% of infants are born before 28 weeks; yet despite this modest percentage, ‘extreme prematurity remains the leading cause of infant morbidity and mortality even in developed countries’ (De Bie et al, 2021). To reduce the mortality and morbidity of extremely premature infants, a fundamental shift in therapy was needed: to delay pulmonary gas exchange by treating these infants as fetuses not neonates (De Bie et al, 2021). Such an approach preserves normal organ maturation, especially lung development, and ‘constitutes the foundational rationale for artificial placenta and womb technology’ (De Bie et al, 2021).