Have you ever thought about what it would be like to give birth in Space? To labor and bear a child in the voids between celestial bodies? Quite possibly you have never really given much thought to giving birth at all, let alone beyond Earth’s atmospheric shell. But, here you are, ready to expel the newest link in your ancestral chain, in conditions wildly foreign to any mother you have descended from. You are the first in history to attempt this feat, in fact. There is much that is pitted against you and your imminent spawn (not to mention heroic obstetrics team). If we have colonized planets at this point or have developed the sufficient technology, you may be lucky enough to have gravity on your side. But whether you are in a space vessel or a grounded colony base, you are undoubtedly banking on a highly technically calibrated artificial environment designed to sustain life — from the gas concoction you are breathing to the galvanized walls holding back eye-popping vacuum.
The pregnancy state is marked by massive maternal physiological changes (cardiovascular, metabolic, uterine, etc.). The interactions between these physiological changes and the medical challenges of being in space (radiation, reduced gravity, nutrition, etc.) are complex and not fully understood. But, quite remarkably, here are you and your baby in a pregnancy ripened to forty-week fruition, about to enter labor in absolute textbook health! You have an adrenaline-fuelled, ridiculously qualified treating team exquisitely trained for this purpose. Let us say, however, that here your luck has run out and the following scene occurs in a micro-gravity spaceship (rather than in a wholesome gravitational field).
FIRST STAGE
Perhaps, though not necessarily likely, muscle atrophy secondary to prolonged lack of gravity is dampening the force of your uterine contractions and slowing cervical dilatation. When the amniotic sac breaks, the amniotic fluid will spill out. Slowly enough and surface tension will cause it to cling and creep along your lower body and anything else in contact. Violently enough and it will bleb into the cabin with the potential to cause havoc. Perhaps anticipating this, an attendee will have a towel held between your legs to mop the fluid as it flows. For tighter control, they may choose to artificially rupture the membranes.
You may be in pain and wishing for pain relief. Heat packs, massage and relief methods of similar ilk should initially be sufficient and unproblematic. Sadly, you will not have the luxury of a warm bath or shower. Things also get more complicated when the big guns are drawn.
Nitrous oxide gas is extremely common as pain relief in terrestrial birth suites but out of the question here. Gases must be highly regulated in such a closed-cabin environment where there is no colossal atmosphere for them to diffuse into. Here, gases are wont to enter into the circulatory system of the space vessel and remain to intoxicate other personnel. Even the provision of supplemental oxygen is hazardous as oxygen enrichment of the cabin atmosphere poses a potential fire risk. However, given that maternal oxygen consumption increases more than 60% in labor, tightly regulated low-flow oxygen may be acceptable to forestall maternal and fetal hypoxia.
Without gravity, fluids and gases will not separate according to their varying densities, meaning that what is in the drug vial or bag of I.V. fluid is actually akin to useless foam. The normal drawing-up of medication will therefore not suffice. As with spinal anesthesia, gravity affects the distribution of epidural anesthetic. In your circumstances, this may mean that it will be difficult to isolate the desired segments to be anesthetized. Epidurals and many other interventions also always come with a slew of low-risk but still possible complications. Reflex hypotension is one of the more common undesired effects of epidurals and spinals but (remember?) the terrestrially reliable bag of normal saline is full of bubbles in space. Vasopressors will probably be effective, but sympathomimetics will increase your metabolic rate and oxygen demands further. Severe infection or inadvertent administration of anesthetic into the CSF to the brainstem may be utterly beyond the scope of successful management in Space.
Hopefully, in the first stage of labor you have been moving about, both to stop blood clots and to encourage labor progression. Now, you are entering the second stage of labor and here you may be strapped to the bed to avoid floating off during contractions.
SECOND STAGE
The head is the heaviest part of a well-grown fetus, but weight is mass times gravity and there is no gravity in space; we are all weightless and so is your baby’s head. That is unfortunate because it is the greater weight of a baby’s head that causes it to settle into cephalic position over the cervical os during the final portion of pregnancy. Certain breeches are acceptable, and it is still possible that the baby would be a well-behaved cephalic. Otherwise, the second stage is not to be entered, and failing successful rotational maneuvers you would have been obliged to undergo a caesarean section.
Now your cervix is a gaping 10 cm dilated and all sorts of interesting bits of fetal anatomy would have had similar odds of being the presenting part. However, your treating team had long ago ruled out a malpresentation, for labor would not have been allowed to progress to the second stage had that been the case. You continue to slowly push the baby out, with or without sufficient pain relief. Eventually, the presenting part will show and someone will have to carefully guide it onwards. This will be to prevent your freshly brewed progeny hurtling through the room from the unfettered force of your ultimate uterine contraction, tethered only by umbilical cord. The cord will be cut and clamped, and hypoxia and the force of being pushed through your vaginal canal will hopefully induce your baby to take its first breath. On Earth, the normal partial pressure of oxygen triples from the oxygenated blood-carrying umbilical vein in utero to the arterial blood of the birthed infant. This contributes to post-delivery reduction in pulmonary vascular resistance and closure of the ductus arteriosus. The cabin atmosphere will need to encourage this physiological transition from an ‘in parallel’ to an ‘in series’ circulatory system, or else supplemental oxygen must be provided to the new child.
THIRD STAGE
You are clutching your squalling, weightless infant whilst the treating team actively manages the third stage. Active management of the third stage confers much lower risk of postpartum hemorrhage than passive management, and just as normal saline is unsuitable for resuscitation, any sort of massive transfusion protocol is unlikely to be possible (see note two).
An inevitable amount of blood will erupt with the birth of the placenta, as in the second stage of labor. Ideally, the total blood loss will be less than 500mL. As the blood spills out, it will form droplets. Suction equipment will not function properly as this technology relies on gravity-induced separation of gases and fluids. An attendee will need to be on standby to manually mop up blood as with the amniotic fluid.
BEYOND
Congratulations on your beautiful new child. It has developed wonderfully, considering that radiation, nutritional deficiencies and the insidious effects of micro-gravity were all toying with it in utero. Now that it has been birthed, these forces are not diminished. Unless an adaptive response develops, chronic radiation will raise its risk for cancers, sterility and decreased cognitive capacity. Hopefully suitable food can be attained for dietary nutrition and U.V. light sources exist to promote vitamin D sufficiently. If the cabin atmosphere is low in oxygen, chronic minor hypoxia may stunt your child’s growth and pubertal development. Its lungs may adapt. Its otolith organs may develop differently from those of its terrestrial peers, as optimizing balance in space cannot rely upon normal gravity-driven intracellular sedimentation within the vestibular system. Your child will have to do bone loading exercises to try to maximize bone mineral density. Should it ever return to Earth or interact with a larger population than it was exposed to in childhood, it may be at higher risk of acquiring serious infection from microbes it never had a chance to develop an immune response to.
NOTES
1. This is based on happy, normal, terrestrial vaginal birth. More complicated obstetric scenarios (placental abruption, shoulder dystocia, pre-eclampsia/eclampsia, multiple pregnancy, etc.) will all need their management to be re-evaluated for the space scenario.
2. Packed red blood cells only last for six weeks in storage. External refreshment of the space vessel’s blood bank will therefore only last six weeks from last contact. Beyond the six-week margin, any onboard blood bank will need to be resupplied from within by fellow crew mates. Blood group compatibility and crew anemia will need to be considered.
3. An indwelling catheter is likely to be placed at some point, as you going to the Space toilet will become increasingly impractical.
4. The majority of women defecate during childbirth. Something will have to be organized to prevent errant fecal matter from becoming aloft in the cabin.
5. Carrying items into space is extremely expensive and medical equipment will have to be necessarily spartan. The treating team cannot rely on having the same host of medications and apparatuses that may have been available on Earth.
6. Infection in space is less of an acute problem than terrestrially. What makes the environment hostile to humans is a similar impediment to microbial existence, and astronauts are screened thoroughly for infectious disease prior to their launch from Earth. However, isolation and limited medicines make the risks of infection in space higher and, as such, aseptic technique is likely to be used in the same scenarios as terrestrially.
Final disclaimer: Space medicine is still a relatively embryonic field and my understanding of it is passionate but amateur. If anyone is superiorly enlightened in this area and wishes to correct an existing misapprehension, my intellectual arms welcome you. Whilst conveniently bypassing the huge complications surrounding conceiving and maintaining a healthy pregnancy state in space, hopefully this piece has reflected some of the issues we face before we begin creating aliens among the stars.
Contributing Writer
Monash University
Emily is a final year medical student at Monash University in Australia. She is looking forward to seeing the hologram broadcast of the first human birth in Space.