Summary

Twilight Sleep was a controversial obstetric practice in the early 20th century that used morphine and scopolamine to induce sedation and amnesia during childbirth, leading to a range of negative outcomes for mothers and infants before its eventual decline and replacement by epidural anesthesia.

Abstract

Twilight Sleep, a childbirth method introduced in 1906 by German obstetricians, involved administering morphine and scopolamine to laboring mothers, causing them to experience profound sedation and amnesia. This practice, which was intended to alleviate the pain of childbirth, resulted in women exhibiting erratic behavior akin to demonic possession and often suffering from physical trauma, while newborns were frequently born in distressing conditions, sometimes leading to their demise. Despite its initial popularity, driven by the desire for painless childbirth, Twilight Sleep fell out of favor by the late 1970s due to its dangerous side effects and the advent of safer anesthetic methods like the epidural. The practice's decline was also influenced by exposés detailing the horrific experiences of mothers under Twilight Sleep, which led to a shift in the definition of medical progress, focusing more on the health outcomes for both mother and child.

Opinions

The author describes the practice of Twilight Sleep as horrifying and suggests it was a traumatic experience for both mothers and newborns.
The use of Twilight Sleep is portrayed as a misguided attempt at progress, highlighting the historical tendency to prioritize pain relief over safety and well-being.
The OB's quoted in the text express a sense of resignation and dissatisfaction with the practice, indicating that despite its popularity, it was not universally endorsed by medical professionals.
The author reflects on the evolution of obstetric practices, implying that each era's definition of medical progress is subject to change and improvement.
There is an underlying criticism of the lack of informed consent and the withholding of information from patients regarding the risks and realities of Twilight Sleep.
The author sympathizes with the pioneers of Twilight Sleep, acknowledging their good intentions in seeking to alleviate childbirth pain, while also recognizing the practice's ultimate inadequacy.

Twilight Sleep: Madness in Labor and Delivery

A horrifying way to have a baby

Photo by Jonathan Borba on Unsplash: A Tired OB

I was a first-year medical student in 1974 which meant I was all books, no clinical experience. There was a summer break, so I signed up for a program to let me work with “rural practitioners” in little towns where they really needed new young doctors. The second place I went I got to scrub in on some deliveries which made me really excited.

When I walked into the labor room I saw a lady about forty with sweaty tangled black hair. Her legs were twisted up and she was waving her arms and yelling all kinds of stuff, most of it **** in nature. Her behavior VERY strongly suggested demonic possession. This was all a new thing to me and if she rose off the table and slowly flew out a window I would have been perplexed but ready to accept this as “one of life’s mysteries”. I mean this was the first woman in labor I had ever seen.

There were two OBs in the room and one of them turned to me with a slight smile blessed with wisdom and understanding.

“You get the husband out and they don't remember nothing see?”

There followed an hour of moaning and thrashing. One OB would lean over the rails and hold her while the other did vaginal exams to chart the baby’s progress or at least tried to; she was bucking like you were trying to put short pants on a goat. Finally came the blessed event and the baby looked mighty blue and honestly near dead. They pinched him, shook him, stuck tubes down his nose, and bagged him and soon I guess he was OK though I fear his future GRE scores took a big hit.

“God I hate this but it's what the mothers want,” said the OB looking like he needed to take a smoke break and hit his Johnny Red flask.

“They are snockered and wake up all cheerful and perky like.”

So that was delivery by Twilight Sleep and I had seen the tail end of the practice. By 1980 it was as gone as the great auk. But what the heck had I seen? Nobody said anything about it then and I was afraid to ask. Surely having a baby wasn’t always like this!

Scopolamine

Twilight sleep was induced by the intravenous injection of morphine and Scopolamine, a component of belladonna from the deadly nightshade plant. It was developed in 1906 by German obstetricians Kronig and Gauss. They had noticed the scopolamine caused a bit of raving madness so they bandaged the woman’s eyes, put cotton in her ears, slipped on a straitjacket, and put her in a padded bed. It was all worth it Kronig reported, because after the birth the baby was brought to the mother, sometimes a little droopy in its looks, and she would refuse to believe the baby was hers, having no memory of the labor.

Twilight Sleep Crosses the Atlantic

After a few years, women who had gone to Germany to let Kronig and Gauss deliver their baby demanded that twilight sleep come to America. The American doctors embraced the practice, but they were pretty clueless and gave too much Scopolamine and gave it too often. They decided on the right dose by testing the patient’s memory.

After that the patient is tested from time to time as to her capacity to remember. She is shown an object, and a few minutes later is shown it again and asked if she has seen it before. If she remembers, another dose is indicated. If she has no recollection of having seen the object, this indicates that her condition is just what it should be, and no other dose is required until memory is again restored.

Doctors were certainly happy about the prospect of painless childbirth. They waxed philosophical, as illustrated in this quote from a treatise written in 1914 talking about pain and having babies.

That question answers itself. For clearly, if every woman brought to childbed were to make such interpretation of the warning (pain), and never repeat the experiment of motherhood, the human race would dwindle at a geometrical ratio, and incur every probability of elimination;

And this from the same missive.

Is there not fair warrant for the assumption that the pains which civilized women — and in particular the most delicately organized women — suffer in childbirth may be classed in this category? (of Bad Bad Very Bad Things).

But matters sometimes went astray for the newborn infant in question. Babies were being born blue or a pasty white refusing to cry even when held upside down, slapped, poked, or dunked. There wasn’t any Narcan to reverse the Morphine and of course, a lot of Morphine is part of a good euthanasia plan for a reason, it suppresses respiration. Record-keeping was a bit spotty in those days but certainly, some babies did not make it.

The End of Twilight Sleep

Of course, the whole key to Twilight Sleep was that the husband or ‘significant other” was not there to see the yelling and thrashing. He was pacing in the waiting room or out buying cigars if you can believe cartoons. But nurses were there and, no longer afraid to talk, they helped writers publish an expose in Ladies Home Journal in 1958 that described all the horrors such as mothers with bruises, broken bones, and head trauma. By the late 1970s, Twilight Sleep was less popular and by 1980 it was replaced by epidural anesthesia that put the husband right next to the labor bed no matter what. I had seen a slice of medical history that day.

Medical history is a halting shuffle toward progress. But each era defined progress in its own way. Twilight sleep was progress because it removed the pain from childbirth. Now we see obstetrical progress in terms of outcomes and infant survival, reducing suffering is just one small component. In one hundred years some of our medical treatments will be open to criticism and ridicule and I want to emphasize that I do not condemn the German doctors who developed Twilight Sleep. They were saddened by childbirth pain and sought to relieve it. Most likely they would have endorsed epidural anesthesia and foresworn scopolamine had they still been alive when it became available.