Extreme prematurity is the leading cause of infant death and morbidity. And, despite advances in neonatal medicine and surgery, the rate of prematurity has risen. The urgent need for a better way to support the extremely premature infant led to the development of an extrauterine system to better bridge the transition from fetal to postnatal life. The goal of this “artificial womb” is to maintain prenatal physiology in the extremely premature neonate to support normal development and reduce the complications associated with prematurity. This chapter discusses the development and applications of the artificial womb, as well as the limitations of this technology. It explores three current ethical challenges: ectogenesis, the boundary of viability, and the difference between physiological and clinical success.