TV: Life before Birth
Authors: Nicholas M Fisk
Journal: BMJ (2005)

Two things stand out about this kaleidoscopic odyssey from conception to birth. The first is the realistic animations, which make for gripping television. The second is the juxtaposition of the scientific with the touchy feely, which decidedly does not. Insightful demonstrations of the complex processes of fertilisation, embryology, and fetoplacental development are interwoven with fetal poetry. Novel, yes, but biological lucidity becomes stretched when the fetus announces in the first person its implantation in rhyming couplets when it passes from isn't to is, wonders aloud whether neuropore formation is the beginning of cognition, and pens an ode to its placenta. Genetic variation engenders “Will I be St Francis of Assisi or Al Capone?” and anomaly screening “If I'm not the perfect baby, will it be curtains for me?”

The graphics of implantation and organ development in the early fetus cleverly mix high quality, computer generated images with in vivo and in vitro footage. The seemingly implausible proportions of the later human fetus have always posed a challenge for medical artists, so some inaccuracy in graphical representation is to be forgiven, such as the chubby midtrimester face and uncoiled cord. Nevertheless, the elf-like, long, curled fingers, wide open eyes, and thin, downturned upper lip suggested something more akin to Gollum than anything I recognise from endoscopy and the delivery room.​room.




Figure 1



“Will I be St Francis of Assisi or Al Capone?”

Credit: CHANNEL 4




Is accuracy a necessary casualty of getting science across to the public? It shouldn't be. Simplification is welcome, such as sperm “sniffing their way up to the ovaries” to explain their molecular chemotaxis via olfactory receptor proteins. Similarly, fetal hearing and memory are well portrayed as mother's muffled voice and a preference for choral music over Snow Patrol.

Where this becomes dangerous, though, is when pseudoscientific claims of revolutionary new discoveries are unwittingly accepted by politicians, lobbyists, and the media. The culprits are 3D and 4D (real time 3D) ultrasonography and the message that fetal behaviour and development are much more advanced than previously thought. Rapid eye movements (easily seen on 2D scanning) purport to indicate dreaming; and a smile is surely a grimace, given that newborns don't smile for weeks after birth. Walking (conveniently only shown in the upright fetus) is allegedly practised in the first trimester, and purportedly non-random contacts between twins at 10 weeks are thought to form the basis of their lifelong bond. There is little science, let alone new science, here.

The programme's claim that 3D and 4D scanning has been the equivalent for obstetricians of the Hubble space telescope is preposterous. Our unit has the same machine as that shown in the glitzy private clinic. It lies around unused much of the day, as our 2D machines give better quality images and do so considerably more quickly. There is a clinical role for 3D and 4D scanning in delineating complex anomalies first detected on 2D and a research role in quantifying organ volumes. That aside, so far its use lies largely in catering to the photographic needs of the worried well.

Channel 4 knows a thing or two about documentaries, but perhaps not biology lessons. This feature length effort may well have engaged expectant parents for over two hours, despite its soporific prose and oft repeated images. For the rest of us, as any teacher knows, a good tutorial should be done and dusted within the hour.