Fetal and Neonatal Pain and Long Term Implications
             Over the last decade, the perception of pain and stress in fetal and neonatal life has attracted great attention. This is partly due to an increasing understanding of fetal physiology and a greater number of invasive techniques used in today's medicine. The greater frequency of abortions, caesarean sections and intra uterine interventions have turned increased attention onto the subject after decades of common belief being that the fetus and neonate felt no pain.
             The most important evidence is anatomical. This shows that the neuroanatomical connections for nociception are in place by the 24th week of gestation. Many experts however believe that the fetus only experiences "mindless reflex responses" which are a mechanism of protection for an adapting organism that has not yet developed a mature sensory and effector system. There is evidence present to suggest that a single painful experience can alter development and sensitisation of the infant to pain and stress later in life.
             In the following essay I am going to review the evidence supporting the long term effects of painful and stressful experiences suffered by fetuses and the newborn. I will also assess whether there is a period of increased sensitivity to injury and analyse studies focusing on the use of analgesia to avoid these long term implications.
             There is a large amount of evidence showing that stressful events both during and just after pregnancy can influence the developing fetus and bring about a series of long term adverse effects in the infant.
             Recent evidence however has been conflicting and inconsistent. Research and investigation in this field is difficult however for a number of reasons. One of these reasons is that pain is not objective, but subjective. It is difficult to assess and measure pain in adults who can communicate and express their feelings. In a fetus the absence of feedback is a...