For parents who have buried infants born too soon, a device like the AquaWomb is a miracle in waiting – and an impossible choice, reports The Guardian.
Scientists worldwide are racing to buy more time for extremely premature babies, and in 2017, researchers in Philadelphia unveiled an experimental lifeline: an artificial womb, engineered to gestate babies outside the human body.
In their study’s photos, foetal lambs floated inside what looked like overgrown Ziploc bags, eyes closed and hearts pumping as if they had never left their mothers. That prototype was only tested on animals, but the technology is edging closer to human use.
In September 2023, the US Food and Drug Administration convened an advisory committee to consider whether to green-light the first clinical trials. If approved, the first candidates will be babies born between 22 and 24 weeks of gestation, or less than two-thirds of the way to full term. (FDA representatives declined to comment on whether or when these trials might begin.)
But growing a child outside the body also cuts to the core of how people imagine pregnancy and parenthood.
“This kind of device would create a new stage of human development, something we’ve never had to describe or regulate before,” said Elizabeth Chloe Romanis, a medical law scholar at Durham University.
In this way, artificial wombs tug at a taut tightrope of questions that scientists, bioethicists and legal experts are scrambling to cross before human trials begin: how will this technology affect how we intervene in preserving life, or define life itself?
Concept design
The prototype, initially, doesn’t look much like a womb – more like an aquarium.
The glass tank rests on a waist-high platform in a laboratory in Aachen, Germany, one of the sites affiliated with AquaWomb, the Dutch start-up that is developing devices to improve health outcomes for the smallest, sickest infants.
About the size of a household fish tank, the vessel sits under fluorescent lights so technicians can monitor every movement inside, though in practise it would be covered to mimic the dimness of the womb. Tubes coil from the sides into filters that cycle synthetic amniotic fluid in rhythmic glugs.
The design feels apt for extremely premature infants, who often arrive looking as though they belong to another world entirely – skin translucent and gelatinous, limbs thin as matchsticks. In this tank, those babies could float, drink, urinate and grow without touching air.
Myrthe van der Ven, a technical physician and the co-founder and CEO of AquaWomb, said their prototype mimics the constant shelter of pregnancy. The amniotic fluid holds at 37.6C, just above a mother’s core temperature. A double-layered bag hangs in the tank’s centre.
Its inner sac flexes as the baby grows, from pomegranate-sized at 23 weeks to the heft of an eggplant by 28. The outer silicone layer is stiffer, with just enough give to resist the baby’s kicks and encourage its muscles to stretch and strengthen.
The tank, Van der Ven saids, is the simple part. The lungs are the true liability.
During a typical birth, a newborn’s first gulp of air triggers the breathing reflex, often announced with a wail that signals lungs at work. That moment comes too early for extremely premature infants: their runty lungs can’t sustain even a whisper, much less nourish the developing brain and body.
In today’s neonatal intensive care units, doctors can only step in after the fact, using ventilators and incubators to force these fragile organs to function. That mechanical intervention brings its own risks of lasting injury. And once exposed to air, the lungs are irreversibly activated; you can’t throw the fish back into the water.
Artificial wombs aim to bypass this crisis altogether. In AquaWomb’s design, the baby is delivered via Caesarean section into a fluid-filled pouch, where it can be transferred from mother to machine. Once inside the transfer chamber, clinicians reattach the umbilical cord to a human-made placenta, a fist-sized device lined with catheters delicate enough to pull carbon dioxide from the blood and cannulas robust enough to push oxygen and nutrients in.
If it works, the placenta buys time that the baby’s lungs cannot yet provide. If it fails, the clock runs out in two minutes, the limit before oxygen deprivation risks permanent brain damage. The baby must remain immersed in fluid throughout this entire sequence, never realising it is being born.
“It’s like juggling 10 balls,” said Frans van de Vosse, a Professor in Cardiovascular Biomechanics at Eindhoven University of Technology who advises the project. “Only, the balls are on fire and dropping one is not an option.”
If perfected, an artificial womb could rewrite the limits of viability. Perhaps this is why the handful of labs working on these machines hesitate even to name them.
AquaWomb describes its prototype as a “womb-like life support system”. (They are wary of the political and science-fiction associations attached to the term “artificial womb”.)
And the Children’s Hospital of Philadelphia (CHOP), considered the closest group to human clinical trials, called theirs a “biobag”.
CHOP’s device made headlines in 2017, when researchers kept foetal lambs alive for 28 days, proving an artificial womb could sustain blood circulation and organ development in a living animal.
The entire field operates under a veil of secrecy. CHOP representatives declined to comment for this story. (Vitara Biomedical, the private company that licensed CHOP’s artificial womb technology, has raised more than $125m, a sign they might be preparing for clinical trials.) Some researchers told The Guardian that CHOP scientists have agreed to collaboration meetings, then backed out.
The guardedness reflects both the scrutiny surrounding reproductive technology and the knowledge that, as Van der Ven puts it, “in science, there’s evolutionary and there’s revolutionary”. An artificial womb would be the latter.
Her team is not trying to win the race at all costs. “We don’t need to be the first. We want to be the best,” she said. For her, that means designing a system where parents can interact with their gestating babies, a priority she feels other researchers have overlooked. One AquaWomb prototype includes access ports that let parents touch their infants.
Another features a “uterus phone”, which pipes voices, music or heartbeats into the fluid at the same muffled pitch a foetus would hear in the womb.
Those parent-child interactions – pressing a fingertip against a foot, speaking into the fluid, feeling a shift inside the bag – could improve long-term health outcomes for premature infants. But the stakes of parental bonding during pregnancy go beyond survival statistics.
Research on families’ experiences with in-vitro fertilisation and surrogacy suggests that when pregnancy departs from the normal course, parents, especially mothers, may struggle to feel like proper caregivers. Extremely premature births can invoke similar feelings, in part because prematurity is usually caused by medical complications with the mother rather than the child.
“They may not feel they’ve fulfilled their ‘duty’ to protect and carry their child,” said Romanis. She argues that any ethical alternative to “natural” pregnancy must address parents’ emotional needs alongside infants’ physiological ones.
In other words, seeing your baby suspended in a tank or sealed in a bag could alter not only how you connect with them, but how you see yourself as a parent.
Today’s artificial womb prototypes are neither capable of nor designed to supplant natural pregnancy. Nonetheless, when CHOP published its research on biobags, it birthed a stream of sensational speculations around “complete ectogenesis”, where fertilisation to birth occurs entirely outside a woman’s uterus.
Researchers have tried to tamp down those associations, positioning their work as a giant leap forward for science but an unremarkable tiptoe for parenthood.
“The concept of complete ectogenesis is so far away that it’s not worth talking about in relation to the current work,” said one scientist working on artificial wombs. (He speaks to The Guardian on the condition of anonymity.) “Premature babies die every day, and this technology could save at least some of them.”
Other experts believe these concerns can’t be brushed aside.
“There is no such thing as ‘not worth talking about’ when it comes to procreative futures. Science fiction and science fact aren’t so far divorced when it comes to thinking about what might be a problem,” Romanis said.
She added that, even in its earliest form, an artificial womb would confront parents with agonising choices: driven by the desperate hope of saving their child and yet understanding the implications of placing the newborn in a highly experimental device.
See more from MedicalBrief archives:
Ethical and legal conundrum of artificial womb technology
Call for more action as one premature baby born every two seconds globally
Biotech company plans to create embryos for organ harvesting
World’s first ‘vagina chip’ designed to better understand women's health