EP4: Before Birth: A Conversation with the Father of Fetal Surgery

Jun 26

Episode 04 · Now Streaming

The Fetal Frontline — The FTNN Podcast

Before Birth.

A Conversation with the Father of Fetal Surgery

Before birth, before delivery, and before anyone thought it was possible, Dr. Michael Harrison pioneered surgery on the fetus and helped create an entirely new field of medicine. His work at UCSF led to the world's first fetal treatment center and transformed care for families around the globe. In a conversation timed to Father's Day, the surgeon often called the Father of Fetal Surgery sits down with host Kris Rimbos to trace it all — the case that started it, the skeptics, the breakthroughs, the ethics, and the next generation now carrying the field into genetics and beyond. A masterclass in resilience, humility, and raw innovation.

35 min Jun 2026 Topic: The origins of fetal surgery Featuring: Dr. Michael Harrison

Host

Kris Rimbos

Guest

Dr. Michael Harrison

0:0034:54

The episode in five numbers

~1,500

Fetal-lamb operations

"We did, I think, 1,500 fetal lambs." Years of animal-model surgery built the data that finally convinced a skeptical field.

1st

Fetal treatment center

Harrison founded the world's first fetal treatment center — and the first multidisciplinary fetal care program in the US — at UCSF.

Barriers to break

Could you operate on a fetus at all — and which fatal diseases were worth taking on? Both had to be answered, one experiment at a time.

Michael Skinner

The first baby to survive open fetal surgery — a twin whose family named him Michael, after his surgeon. They keep in touch to this day.

Grandchildren

With his wife Gretchen and their children — the legacy Harrison says he's proudest of, "from a freshman in college to a couple months old."

Meet the voices

Tap either card to flip for a full bio.

Host Tap to flip

The Fetal Frontline

Kris Rimbos, MS, RNC-OB, C-EFM, NE-BC, FAWHONN

Fetal Nurse Coordinator · FTNN Board

Host · FTNN Conference Committee

Kris Rimbos, MS, RNC-OB, C-EFM, NE-BC, FAWHONN

Fetal Nurse Coordinator · Board member, FTNN

Host of The Fetal Frontline and a long-standing FTNN board member. Kris helped build FTNN's web presence and social channels, served as Membership and Publications Chair, and spent her career in women and infant services, including at a major US fetal center.

Across this season of The Fetal Frontline, she sits down with the clinicians behind fetal care — nurses, social workers, and the wider team — drawing out the day-to-day realities of a specialty most listeners have never seen up close.

Guest · Father of Fetal Surgery Tap to flip

Pediatric & Fetal Surgeon

Dr. Michael Harrison, MD

Founder, UCSF Fetal Treatment Center

Guest · The Fetal Frontline

Dr. Michael Harrison, MD

Pediatric surgeon · pioneer of fetal surgery

Widely known as the Father of Fetal Surgery, Dr. Harrison pioneered operating on the fetus and built the world's first fetal treatment center at UCSF — the first multidisciplinary fetal care program in the US. He helped connect the field worldwide through the North American Fetal Therapy Network (NAFTNet) and the International Fetal Medicine and Surgical Society (IFMSS).

He went on to found the Pediatric Device Consortium — the team he affectionately called the "D-VICE squad" — wrote The Unborn Patient, the definitive textbook on fetal therapy, and received the Jacobson Innovation Award. He counts being a father to his children with his wife Gretchen as the achievement he's proudest of.

What made fetal surgery seem impossible — and what changed it

Some grounding before the story. Four ideas that had to break before a surgeon could operate on a patient who hadn't yet been born.

The fetus was sacrosanct

Before Harrison, "the fetus was sacrosanct, and the womb could not be violated. It wasn't even thought possible." You waited until the baby was born, then did something. He asked: what if that's already too late?

A problem hiding in plain sight

A newborn died after a perfect operation for diaphragmatic hernia. The lung was too small — squished before birth. The real problem was pulmonary, and the only fix was before birth.

Prove it, don't preach it

"Most of their objections could be met experimentally." So the team ran a huge program — roughly 1,500 fetal lambs — to answer the skeptics with real data instead of argument.

Too big for one person

"This enterprise is not an enterprise for one person or one institution." It took a marriage of disciplines — surgery, obstetrics, perinatology, neonatology — meeting every Tuesday at 1:00 to make it real.

Necessity drives innovation.

Harrison's throughline. Operating on a fetus meant first solving how to open and close a gravid uterus, contain the amniotic fluid, and hold off preterm labor. "There was never a time when we said, 'Oh, this is it. We've fixed this.' It needs constant innovation." Each failure simply pointed to the next problem worth solving.

Surgical instruments and a slender custom device on a deep navy field

Chapter guide

Eighteen chapters, each with a pull-quote and the three things worth walking away with. Tap "Open deep dive" to unpack the context — the diaphragmatic hernia that started it all, what NAFTNet and IFMSS are, how spina bifida reframed the goal of surgery.

The only way to really save these babies is to fix the problem before birth. When I said that, he almost fell down — it was so radically unconventional.

Dr. Michael Harrison — on the idea that started a field

Milestones in a pioneering career

From a single devastating case to a worldwide field — eight turning points in the story Dr. Harrison tells.

The spark

A baby who shouldn't have died

As an intern at Mass General, Harrison watches a newborn die after a flawless diaphragmatic-hernia repair. The lung never had room to grow — the real problem began before birth.

The move

UCSF and the "Wild West"

He chooses a young, unbound medical school where a radical idea could actually be pursued. "You never could have started something this radical" at the East Coast institutions where he trained.

The proof

~1,500 fetal lambs

To answer skeptics with data, the team runs a vast animal-model program — first proving you could operate on a fetus at all, then that the correction actually worked.

The first

The first open fetal surgery

After reviewing real cases with real families to work up the courage, the UCSF team performs its first procedures — "mind-bending at the time," and a lesson learned from every single case.

The patient

Michael Skinner

The first baby to survive open fetal surgery — a twin whose family named him Michael, after his surgeon. Decades later, they're still in touch.

The reframe

Spina bifida

The first condition the field took on that wasn't life-threatening but can significantly impact quality of life — shifting the goal of fetal surgery from saving a life to protecting a way of life.

The network

A worldwide field

Too big for one person or institution, the work spreads through the North American Fetal Therapy Network (NAFTNet) and the International Fetal Medicine and Surgical Society (IFMSS).

The future

Genetics, metabolics & AI

The frontier moves from anatomy to genetic and metabolic disease. Gene therapies given after birth, Harrison believes, may one day be done better before it.

Step 1 of 8

Drag, swipe, or tap arrows

A marriage of disciplines

Fetal surgery was never a solo act. Harrison's enterprise "interdigitated" specialty after specialty — the disciplines that had to come together, meeting every Tuesday at 1:00, to make operating before birth possible.

Pediatric surgery

Harrison's own discipline — and the operating skill at the center of it all. But, he's quick to say, only one piece of a much larger whole.

Obstetrics & perinatology

"The crucial piece" — the people who looked after fetuses for a living, without the idea of surgery. Their expertise on the pregnancy made the surgery survivable.

Neonatology

The specialists who cared for the babies these conditions produced — and who helped review problems in the neonatal ICU, week after week.

The subspecialties

OB/GYN and the many subspecialties already used to looking after babies with these problems — folded in from the very beginning.

Ethicists

Brought in from day one to ask "should we be doing this?" Some baby ethicists became, in effect, the field's first fetal ethicists.

Engineers

"We conspired with engineers." The problem-lovers who helped solve the mechanics of the gravid uterus — and seeded what became the Pediatric Device Consortium.

How Harrison worked

Four principles that run through the whole conversation — the method behind the breakthroughs. Tap through each.

Every advance, he insists, has to begin with a real patient and a real problem — never with a theory or a device.

Start with the patient

"It has to start with the patient. You have to really feel for the patient and feel the patient's problem — and that's what drives your work and innovation." The whole field began this way: a single baby who died, and the refusal to accept that nothing could have been done.

Skepticism isn't answered with argument. It's answered with data.

Meet objections experimentally

"Most of their objections could be met experimentally." So the team built models of each disease, corrected them in utero, and documented that the fix worked — roughly 1,500 fetal-lamb operations to convince a doubting field with real evidence.

Two patients at once — a mother and her unborn child — means the ethics can never be an afterthought.

Ask the ethicist first

Ethicists were in the room from the beginning. "We always asked the ethicist: should we be doing this? Is this the right thing?" That ongoing, sometimes very emotional discussion — and the willingness to answer "no, not this" — is what kept the work honest.

There was never a finish line — only the next problem worth solving.

Keep innovating

"There was never a time when we said, 'Oh, this is it. We've fixed this.'" Each failure pointed to the problem to solve next — managing the gravid uterus, the amniotic fluid, preterm labor — and necessity, he says, is what truly drives innovation.

The innovator's playbook

A path of luminous stepping-stones leading across dark water toward a glowing horizon

"Keep your head down and keep moving."

The rule under everything Harrison did. Believe in the work, ignore the naysayers, and keep plowing ahead — meeting every objection, one experiment at a time. Seven principles from a lifetime of pioneering.

"If you believe in something, you just have to ignore the naysayers and keep plowing ahead, meeting all their objections."

When colleagues called fetal surgery impossible, Harrison's answer was persistence — and the discipline he traces back to cold mornings rowing on the Housatonic.

"Most of their objections could be met experimentally. We had to convince people with real data that it could be done."

Roughly 1,500 fetal-lamb operations answered two questions: could you operate on a fetus at all, and did the correction actually work?

"Is this the right thing for the fetus? For the mother? For the family? Often the answer was no — and then we didn't do it."

Innovation can step out of bounds. Ethicists were involved from the start, and many explored cases were studied, discussed, and deliberately not done.

"Each time we failed, we had to solve the problem that didn't work. That's really what drives innovation — the necessity to solve a problem."

Operating on a fetus demanded new devices to open and close the uterus and contain amniotic fluid — work that became the Pediatric Device Consortium, the "D-VICE squad."

"This enterprise is not an enterprise for one person or one institution. It's just too big for that."

A marriage of surgery, obstetrics, perinatology and neonatology — meeting every Tuesday at 1:00 — and the whole team was always involved in every case.

"We don't give them problems… they see the problems and they take them on themselves."

His method for mentoring — including surgeons like Dr. Diana Farmer — was to attract people who love problems, then let them find and own the work. "They were the game."

"I didn't bring work home. The evening was for the family. I essentially never broke that rule."

In a field notorious for consuming surgeons' lives, one simple rule kept his whole — and he names his family as the achievement he's proudest of.

The discipline of the river

Brand-new to rowing when he arrived at Yale, Harrison captained the lightweight varsity crew. The lesson wasn't speed — it was going out on the Housatonic in the dead of winter, then returning to a full day of work. "It teaches you that you can do it." That discipline became the stamina to endure decades of professional pushback.

A single rowing shell gliding across calm water at dawn

Reflections from the field

Four threads from the close of the conversation — where he stands now, what's changing, and what he hopes the next generation carries forward.

On stepping back, and loving the view. Asked what ethical challenges tomorrow's surgeons will face, Harrison demurs — he's happy in a new role.

A happy innocent bystander

"I'm an innocent bystander now" — and yes, he likes that role
He loves watching the new young clinicians take on new problems
The field has shifted from anatomy to metabolic and genetic disease
"I wish I could keep up" — said with a smile, and real admiration

The most exciting part of fetal intervention is no longer the anatomic problems he took on — it's a brand-new field.

A whole new discipline

"It's thrilling to hear about the new genes and the new gene therapies." As the work moves toward metabolic and genetic interventions, the tools keep becoming more available — and treatments now given after birth may, he believes, be done better before birth.

The moment that proves it was all real.

Living proof

Michael Skinner — the first baby to survive open fetal surgery, named after the man who operated on him before birth. They've kept in touch for decades. "It's hard to be more intimate than to be working on someone's fetus."

If listeners carry one thing forward from his career.

Keep questioning

"The thing I hope has rubbed off is the constant questioning. Not the answers — but how can I do this better? How can we save this fetus?" And the rule beneath it all: start with the patient, and let that drive the work.

It's hard to be more intimate than to be working on someone's fetus.

Dr. Michael Harrison — on the bonds with the families he treated

From the scalpel to the gene

The field Harrison built around anatomic problems is giving way to a new one. The work that excites him now is genetic and metabolic — gene therapies, regenerative medicine, even AI. Therapies given after birth, he believes, may one day be done better before it. "There's a huge open field for those interventions."

A surgeon's scalpel dissolving into a glowing DNA double helix

Thanks for listening.

If this conversation with Dr. Harrison moved you, share it with a colleague. Subscribe so you don't miss the next conversation on The Fetal Frontline — and learn more about the Fetal Therapy Nurse Network and the people and ideas shaping fetal care today.

Learn about FTNN

Gary Ricke http://orbisdesign.com

EP4: Before Birth: A Conversation with the Father of Fetal Surgery

Before Birth.

The episode in five numbers

Meet the voices

Kris Rimbos, MS, RNC-OB, C-EFM, NE-BC, FAWHONN

Dr. Michael Harrison, MD

What made fetal surgery seem impossible — and what changed it

Necessity drives innovation.

Chapter guide

Milestones in a pioneering career

A marriage of disciplines

How Harrison worked

The innovator's playbook

"Keep your head down and keep moving."

The discipline of the river

Reflections from the field

A happy innocent bystander

From the scalpel to the gene

Thanks for listening.

Chapter

How to subscribe

Quick Glossary

EP3: Hope, Advocacy, and Healing: Social Work in Fetal Care