In the winter of 2018, I started to hear rumors about miraculous clinical developments taking place in my hometown of Philadelphia involving growing sheep fetuses in plastic bags. “Bio-bags” was what they were called. Eager to learn more, I got in touch with the renowned pediatrician Dr. Thomas Shaffer. Shaffer wasn’t involved with the bio-bag experiments, but he knows a lot about fetuses. He is a pioneer of “liquid breathing” techniques designed to help prematurely born babies survive.
“As we’ve known for some time, fetuses are not little adults,” he told me over the phone, in early 2019. “Have you read Water Babies by Charles Kingsley? Have you watched James Cameron’s The Abyss? Fetuses’ survival comes down to what a deep diver needs to do: fill his lungs with water.” I nodded, hoping for Shaffer to say explicitly what I (a creature of the humanities) had not yet felt able to argue: that fetal humans are a distinct, aquatic species.
Intrauterine space is wet. The amniotic sac that holds the fetus contains up to about a quart of oxygen-rich fluid that is mostly composed of urine. Exposure to the air stops fetal lungs from completing their development. Before we turn into “land babies” (that is to say… babies), we breathe amniotic liquor. Though we have no gills, we move our tiny diaphragms and intercostal muscles in a dedicated rehearsal of future gaseous breathing, and we do not drown.
Some escapologists and deep-water divers try to slow their heart rates by “remembering” this time before fear — this state of non-antagonism towards water — to calm themselves. These trance-like attempts at becoming-amphibian are not, I feel, what the conservative Christian organization Focus on the Family had in mind when it gazed, via ultrasound, into the abdomen of Abby Johnson — the Planned Parenthood volunteer turned abortion opponent whose memoir Unplanned made her into a heroine of the anti-choice movement, and is now the basis for a movie with the same title — and declared the contents “human.”
Dr. Thomas Shaffer did not explicitly say whether or not he agrees with the anti-abortion political thrust of this kind of humanization of the fetus. Yet, as he himself explained to me, breakthroughs in the field of neonatology have frequently been predicated precisely on the recognition that fetuses are simultaneously part of land-based humans, and nothing like land-based humans. They are another species. The wetness of the womb — or, rather, the wetness of the entity some academics call “the motherfetus” — is both moat and membrane, bath and barrier, bridge and buffer: it is both what makes gestator and gestatee dissoluble, and what makes them indissoluble. Wetness is, in this sense, intrinsically Janus-faced and inhuman: “we” cannot live there. Liquid is villainously difficult to control, contain, and put to work within “wet tech.” It is lethal to the gestator when it floods her from the inside in, for instance, a hemorrhage. Water is just as much a killer as a nourisher, just as much a threat to life as a source of life.
Born in a Ziploc
I started contacting neonatal scientists in Philadelphia because I wanted to talk about what water does in the context of a pregnancy, and to what extent the process might be automated through something like a “bio-bag.” Eventually, I managed to find a researcher directly involved in the bio-bag experiments: a surgeon at the Children’s Hospital of Philadelphia named Dr. Emily Partridge. I also learned something extraordinary: while the bio-bags currently involve sheep fetuses, the researchers plan to begin trials with human fetuses next year.
Partridge is an unlikely candidate for the role of Dr. Frankenstein, as I already knew from watching her kindly and unthreatening TV appearances on YouTube. When I first emailed her, I received an enthusiastic reply. She floated a future coffee date but, being a cursedly impatient person, I couldn’t wait. I started hanging out around the reception areas of the hospital that I imagined would be nearest the bio-bag unit. My hope was to glimpse the half-gestated lambs-in-the-making — breathing, growing wool, and kicking their little legs in outsized Ziploc sachets.
Alas, I didn’t. And soon there was a change of tone in my email inbox, after I unwisely mentioned my interest in the “history of ectogenesis” — artificial gestation — to the hospital’s public relations officer. She was polite but firm: “We are going to pass on this opportunity.” No more emails with Partridge.
It could have been a coincidence that our communication chilled at a time of rapidly worsening abortion politics. This was just a few days after Trump tweeted, falsely, that “[Democrats] don’t mind executing babies AFTER birth.” It would sadly be astonishing if the hospital board didn’t want to keep its hands as free as possible from contamination by the struggle over abortion.
Dr. Thomas Shaffer, for his part, was explicitly worried about the Trumpian “news” that — as he put it — some doctors were now “killing viable babies.” He seemed to be trying to depoliticize his work by focusing as narrowly as possible on saving preemies. He recounted to me how “huge” it felt in the 1980s when it dawned on him that “preemies” (premature neonates) required a completely separate body of medical care. “The lungs were always the bottleneck, and we have broken that ceiling,” he explained, charmingly mixing his metaphors.
His team at Temple University is widely recognized as having revolutionized the standard approach to caring for fetuses’ still unformed pulmonary apparatuses: filling them with surfactant fluid rather than prolonging their premature exposure to gas. Preemie death-rates — and their age of viability, counted in weeks — plummeted as a result. “But that doesn’t mean we can go younger and younger,” said Shaffer, listing to me a number of other fetal organs it is as yet still impossible to envision not failing at fewer than twenty-two weeks’ gestation.
I noted carefully, here, that he said “can” rather than “will.” Indeed, I got the distinct sense that, whoever that “we” was, it would cater to “younger and younger” preemies. Could scientists keep going younger and younger, to the point where they are automating gestation entirely? Put another way: in the image of the bottleneck, what is the bottle? If we’ve broken the ceiling, where is the sky? Is the ultimate goal to remove the human gestator from gestation altogether — and if so, cui bono?
Building the Bag
Type Emily Partridge’s name into a search engine, and you will find her on CBC, stressing the “awe-inspiring” character of the bio-bag she has co-designed: the gravid see-through amnion that exposes the process of pregnancy to the gaze for the first time in human history. The news anchor is determined to play and replay the few seconds of footage Partridge’s lab has seen fit to release, of a visibly alive lamb-to-be plastic-wrapped in brine. Partridge cheerily evokes the “dogged three years” she spent developing prototypes, “camping out” on a sleeping mat next to the waterborne lamb fetuses “for weeks and weeks at a time.” She helpfully explains that the sheep is the standard scientific surrogate for the human where fetuses are concerned, due to its similar size and pace of physiological progression in utero.
While long-term data on Partridge’s fetal sheep does not yet exist, the cyborg brood are reported stable and “not distressed” after four weeks inside the bio-bag. For now, animal protocols dictate that specimens plucked from organic wombs and inserted into inorganic ones cannot be mechanically “gestated” for longer than that. In the last few years, the patent-holders — Partridge and her fellow researchers Alan Flake and Marcus Davey — have published a slew of reports and research papers with titles like “Development of the artificial womb” and “EXTENDING fetal physiology beyond the womb.” (The official name for their product is EXTEND™, for EXTrauterine Environment for Neonatal Development.)
The perfected bio-bag system is remarkably small and simple. It works like this: uncover your target fetus via caesarean-section (at a point equivalent to a human’s twenty-three-week gestation), then clamp and cannulate the umbilical cord so as to connect it, not to the mother anymore, but to the “artificial placenta — which is basically a lung.” Immediately submerge the cord and fetus in your artificial amniotic liquid, where twenty-eight days of simulated pregnancy will pass uneventfully (the maximum ethical guidelines for livestock allow) — an extraordinary improvement on the mere four hours (the previous record) that researchers, also in Philadelphia, were managing in 1998. Then remove the lamb, put it on a ventilator and (this is the bit that will not be replicated with humans next year) euthanize it for dissection.
As anyone who has recently wandered down South 33rd Street in Philadelphia will know, Partridge and her collaborators work in a newly renovated and dazzlingly glitzy hospital complex. Yet until now, they have operated without significant funding: relegated, with their plastic tubs and tubes and slimy livestock, to a space that resembles a fairly dingy school basement. This is where they brooded over their facsimile uteri; this is where they camped. Partridge clearly thinks it’s all about to pay off, big time. With an investigative device exemption in hand from the Food and Drug Administration, the bio-baggers are hoping to schedule trials with human preemies in 2020 or 2021.
Back in 2018, Partridge’s collaborator Flake had predicted that “the next obstacles we’ll need to overcome will be regulatory.” But later that year, the Trump Administration’s Department of Health and Human Services declared that “life begins at conception.” For the bio-baggers, this new political mood means they have to be especially careful in how they present their work. In an era marked by “personhood bills” and “fetal rights,” it is plainly in the interests of those seeking bio-bag funding to focus on its potential for saving preemie lives, and to see those water babies swimming inside the twenty-two-week amnion as human. It’s undeniably compelling: you could reach your finger out and watch them react to your tickle through the polyethylene.
A History of Frankensteins
Philly’s bio-bags are part of a long tradition of fantasizing about the artificial womb, the politics of which are complex. Most obviously, the tenacity of the dream of automating human gestation, across the centuries, seems attributable to “womb envy” on the part of those without viable wombs: an arrogant determination to annex, expropriate, and (crucially) even outperform the female-coded capacity to build human life. In an 1896 short story by Fred T. Jane, “The Incubated Girl,” for example, male scientists engineer an egg-shaped vessel and then break it open to reveal a fully formed person suspended inside who is more perfect than any human “of woman born” hitherto.
But there’s more to the trope, too, than male jealousy vis-à-vis the female. The mechanical uterus was imagined in the socialist debates and science-fiction bestsellers of the turn of the last century variously as: a feminist plot to overthrow men by escaping women’s domestic work burden; an anti-feminist plot to render women redundant and hence disposable; and, more diplomatically, a gender-neutral means of assistance to those unable (as opposed to merely unwilling, note) to gestate. Some saw in it the actualization of Dr. Frankenstein’s hubris, laid out in the much earlier science-fiction novel Frankenstein (1818).
Aldous Huxley was of this mind when, a full decade before penning the famous “hatchery” scenario of Brave New World, he wrote a character in Crome Yellow (1921) who predicts the dissolution of “the family system” at a dinner party, in favor of “vast state incubators”: “rows upon rows of gravid bottles… supplying the world with the population it requires.” But it was common, a hundred years ago, and not only among fashionable cosmopolitan men and women, to espouse opinions on how best to legislate and regulate artificial womb technology. Communists like Charlotte Haldane and J. B. S. Haldane; socialists like Dora Russell and Eden Paul; pacifist moderates like Huxley or Vera Brittain; and crypto-fascists like D. H. Lawrence and Anthony Ludovici all believed that procreation, for better or worse, would fairly imminently be freed from the necessity of passing through nine months in the “female” body.
But this dream has been continually disappointed. In reality, the closest thing to fetuses subsisting, alive, outside of the human womb, is when delicately swaddled preemies receive an infusion of Dr. Thomas Shaffer’s perfluorochemical surfactant liquid to fill their lungs. Otherwise, it’s just dry incubator technology. It was a doctor from Germantown, Philadelphia, Charles Chapple, who patented a simple incubator prototype in March 1938 that was later developed into the Isolette model now used in neonatal intensive care everywhere. The lamp-warmed Perspex boxes most people are familiar with in a hospital setting are, undeniably, nothing like the miraculous “goldfish bowls filled with chemical fluids” (as one daily newspaper described the New York Medical Society’s proto-bio-bag prototype in 1952) that the media relentlessly raised false alarms about in the 1950s. Yet nothing has ever stopped newspapers from describing even the driest, most rudimentary methods of preemie incubation as uterine. When, in 1894, the wife of a Madison Avenue millionaire died while giving birth to an infant that weighed only two pounds, its life was saved by placing it in a hurriedly warmed suitcase with a viewing-window cut into it. A suitcase! — yet the New York Daily News still reported this improvised response as “an artificial womb.”
It’s worth noting that even dry incubators, which have officially existed since 1880 and been subject to only minor tweaks and improvements, never really stopped commanding the mesmerized attention they did in their first guise as carnival attractions. Preemie display-cases and “hatcheries” served as massive money-spinners for quack doctors and certified physicians — who funded their research by selling tickets — in the freak-shows of Coney Island as well as the great international inventors’ Expositions in Berlin, Chicago, and London.
The Children’s Hospital of Philadelphia, with its genuinely innovative wet tech, is open about its worry that the weird “optics” of the sealed, marinated “preborn” human will “put parents off.” But their aqueous version of incubation evidently represents the future of a highly marketable opportunity to “look in wonder” at “prenatal sublimity,” as the scholar Nathan Stormer puts it. The question remaining, however, is whether the bio-bag has more to do with ectogenesis than its dry predecessors did; whether it automates something that warm-air capsules do not.
If Philadelphia’s bio-bags have the potential to realize the old dream of the artificial womb, they also force us to return to an old question: Why would we want to automate gestation in the first place? In our own era, people have a variety of answers to this question.
For some of us, the fact that 300,000-odd people still die of their pregnancies every year, while millions more incur injuries, represents a glaring humanitarian problem in need of urgent remedies. In this view, given the extreme harm and danger gestators risk (especially black and working-class ones) in gestating their own young, researching alternatives that would enable people not to gestate if they don’t want to — while still making babies together, perhaps in non-dyadic ways — is not only justified, but highly ethical.
On the other hand, there are many who see artificial womb technology as a means of shoring up the power of the patriarchal private nuclear household, removing all doubt about biogenetic paternity from the equation and indeed removing the human gestator — especially her (already legally and biologically constrained) ability to harm and/or kill the fetus — from the scene of gestation. For them, ectogenesis is the “solution” to the “abortion debate” in that, once it’s perfected, it would theoretically obviate the “need” to kill fetuses of any age. It points to a world (not so far removed from this one as I would wish) in which a pregnant person might be entirely deprived of the right to decide whether or not the living thing inside her stays alive. In this lens, the glass and plastic is there, not to alleviate the labor of the “mother,” but to save the “baby” [sic] from her.
The official line agreed upon by scientists like Dr. Emily Partridge is that these questions are irrelevant, since improving care for preemies has nothing to do with the pursuit of automated pregnancy. The translation of the lamb-in-a-bag findings to neonatal clinical practice is not, they believe, about replacing anything. It is merely about “supporting,” “transitioning,” and “bridging” preemies from the twenty-three-week gestational mark (considered just above the threshold of viability) to the twenty-eight-week mark (where their chance of survival can be over 90 percent).
In framing their enterprise this way, EXTEND™ attempts to sidestep the thicket of political issues that the ectogenetic resonances of their device immediately call up. “I want to make this very clear,” states Partridge’s collaborator Alan Flake, “We have no intention and we’ve never had any intention with this technology of extending the limits of viability further back.” Seeking to artificially manufacture fetuses from scratch is not (repeat, not!) the aim, here. The aim is to look after preemies we are “caring for anyway” — even while Flake himself elsewhere calls the possibility of handling fetuses younger than twenty-two weeks “a pipe dream at this point.”
The doublespeak is not conscious, the stated motivation not exactly a lie. Partridge, Flake, and their colleagues are, I believe, motivated by tragic professional encounters they’ve experienced with specific beings over the years, proto-persons who simply weren’t “supposed to be here yet” and who, they sense, are “desperate for solutions and for innovation.” Still, there is a remarkably schizoid character to these assurances, where, on the one hand, the imputation of any kind of ambition to replace biological maternity is sharply repudiated while, on the other hand, the scientists happily state on camera that “our system is essentially a re-creation of the environment a fetus normally resides in” and that “the lamb is getting everything it would be getting inside Mom.”
Re-creation. Everything. Mom. The simultaneous avowal and disavowal of life-giving ambition goes hand in hand with comments like neonatal unit director Kevin Dysart’s: “compared to where we’d like to be, we’re still not close.” Adopting this delicately ambivalent tack places the hitherto underfunded initiative in what they no doubt calculate is the optimal position for receiving support from a “pro-life” federal administration vehemently opposed to using “fetal parts” in research, but highly enthusiastic about ministering to the “pre-born.” The situation-in-flux is certainly anxiety-inducing for neonatologists. No wonder, then, that when I betrayed an interest in ectogenesis, the bio-bag unit shut me out.
Towards the Queer Gestational Commune
The work of a gestator is not reducible, as Dr. Emily Partridge implied, to that of a lung. Partridge even tacitly admits this. Undeniably, something of late-stage ovine gestation is being automated, down the road from my house, at the Children’s Hospital of Philadelphia. But only something: in our species at least, pregnancy is a multifaceted and part-consciously creative undertaking. It is defined, as Irina Aristarkhova writes in her book Hospitality of the Matrix (2012), by a quality of nursing — a complex, bidirectional, sometimes loving, sometimes abusive (and usually both), orchestration of touch.
And, for better or worse, the machine, at least for now, cannot nurse. For better or worse, polyethylene sheath + salt-solution + electronic oxygenator ≠ gestation. Unaccounted for in seeing the bio-bag as an extension of the uterus are the bidirectional flows, nonverbal communications, and symbiotic becomings and violences that characterize human placentation, which is “naturally” very colonizing and aggressive.
Unaccounted for, too, are the transitive and intransitive valences of the verb “to gestate” — the fact that gestatees gestate, as co-participants in their gestation, and that they gestate us back. I have a hunch that the utopian political horizons of the artificial womb — as explored in feminist works ranging from Shulamith Firestone’s classic The Dialectic of Sex (1970) to Marge Piercy’s science-fiction novel Women on the Edge of Time (1976) — has everything to do with the extent to which the dreamer grapples with this interpenetrative character of prepartum nursing — the sense, even, that fetuses are in some ways a strange species, demanding all of the same ethical agonisms of a multispecies companionship.
Today, the perfection of intensive techniques for forcing preemie survival has nothing whatsoever to do with reproductive justice struggle. But I would love to one day see the queer gestational commune in which “bio-bags” of some kind enabled gestators to pause, share, transfer, redistribute, and walk away from pregnancies. I would love to see these technologies help denaturalize motherhood and liberate those with uteruses from the imperative to gestate. This would require the expropriation of the means of safer obstetrics and maximally assisted reproduction currently monopolized by capitalism’s elites. I hope we do it, and I hope we will know what it’s like to manufacture our children with the help of a wet technology enabling a form of common gestational touch that inflicts no more harm to a fetus’s many parents than we can collectively accept.