Twilight Sleep

Simple Discoveries
in Painless Childbirth

By Henry Smith Williams, B. Sc, MD, LLD ~ 1914

In collaboration with Dr. J. Whitridege Williams, author of Williams Obstetrics

CHAPTER II 

TO BE AND NOT TO BE 

This condition of twilight sleep – this being awake and yet registering no mental record of events – is so interesting a psychological condition that I am tempted to dwell on it for a few minutes before going on to consider other aspects of the problem of painless childbirth.

Be it understood that the patient under scopolamine at the Freiburg Hospital gives every outward evidence during her confinement of acute suffering.  She cries out as others do under suffering; tells the doctor perhaps that her pains are severe beyond endurance.  And the doctor smilingly admits that this is true – unperturbed because he knows that an hour later, and throughout the future, the patient will have no recollection of having suffered at all.

And the curious question arises as to whether, under such circumstances, the woman has really suffered.

The more you consider it, the more puzzling the matter becomes.  So large a share does memory play in all our mental processes that it might well be claimed that we should not really exist at all, as conscious personalities, were we without this capacity to reproduce our mental states and view them in retrospect.

An organism that lived only in the immediate present could have nothing even remotely approaching what we term conscious mentality.  Only when the transient effects of a given moment are viewed with a background of memory pictures, more or less distinct, can we be said to be really conscious.

To live, in any full sense of the word, is to remember past experiences.

It is a curious question, then, to what extent any of us would care for our best-prized pleasures, or would dread the worst calamities, if it were assured us in either case that the events would be absolutely forgotten as soon as they transpired.  We must not carry this line of reasoning too far, however, lest it prove too much.  It might seem to prove, for example, that a person who suffers tortures that presently terminate his life – say a martyr at the stake – has not really suffered because death itself abolishes all memory of the suffering.

No one would wish to carry the analysis quite so far as that.

Yet it is undeniably true that pains and disagreeable experiences in general would lose very much of their terror if we knew that they were absolutely transient, and would leave no record in memory.  And, making application to the case at hand, I think most women will be disposed freely to admit that they would regard the pains of childbirth as at least relatively trivial if they knew that these pains would be absolutely forgotten as soon as they were over.

Probably to some persons it will seem that under such conditions it might properly enough be said that pain did not really exist, even though there were reflex actions that to an onlooker seemed to give evidence of their existence.

Every one who has seen a person under an anaesthetic knows that at times the patient may move about and moan as if from pain.  Observation of a restless sleeper will often give evidence that conditions in his organism are such as would be the concomitants of painful sensations if he were awake.

Yet no one pretends that an anaesthetized subject or the restless sleeper, if they retain no recollection of what occurred while they were unconscious, have really suffered.

The case of the twilight sleeper may be said to be closely comparable to that of the somnambulist.  There come to her brain certain impressions that produce conditions that would normally lead to conscious sensations, but through some weird effect of the drug the telephone wires that link these centers with the centers of conscious activity are for the time being out of order.  So the conscious personality of the individual is temporarily eliminated.  Reflex activities go on normally, but the normal self – the conscious ego – is in abeyance.

If the paradox be permitted, the individual personality may be said to be and not to be at the same moment

THE PHYSICAL BASIS OF TWILIGHT SLEEP

            But let us not puzzle too much over such subtleties.

Let is suffice that the woman in labor who comes under the beneficent guidance of the Freiburg physicians, finds presently that her baby has come into the world without her knowledge, and that she either remembers nothing at all of what took place during the hours of delivery, or – exceptionally – retains a vague mental picture of pleasing hallucinations as meaningless and as unsubstantial as dreams.

But a highly important question must be asked by the physician who studies the twilight sleep, and wishes to gauge the Freiburg method: the question, namely, as to whether the patient who has undergone this treatment shows any unpleasant after-effects of the narcotic.

And here, fortunately, it would appear that the answer is altogether gratifying.  It is claimed that an analysis has been made of more than three thousand cases that have taken this scopolamin treatment at Freiburg, and that the statistics show that in general women who have had this treatment make better and more rapid recovery than women in general who go through the ordeal of labor in the old-fashioned way.

Parenthetically, I may add that it is claimed as a matter of course that the babies suffer no injury; but that is another story, to which I shall revert.  At the moment we are considering the effect on the mothers themselves.

It is claimed that not a single fatality can be charged to the scopolamin method as practised at Freiburg, notwithstanding the conceded dangers that would attend the use of this drug in reckless or unskilful hands.  Again, it is claimed that the use of forceps has been reduced to a minimum at Freiburg, thereby lessening greatly the dangers of injury or infection.  And it is further claimed that the patients make astonishingly rapid recovery, their nervous system seeming to have been spared the shock that ordinarily attends the ordeal of childbirth, and their nervous energies thus having been conserved.

Tales are told of women sitting up to eat a hearty meal within a few hours after delivery; being up and about their rooms for a few minutes next day; going for drives on the fifth day; and being out returning calls of congratulation by the end of the week.

The cautious physician, schooled in less radical methods, will question the advisability of quite so rapid a convalescence.  But I cite the facts here as suggesting that the Freiburg treatment has the essential merit of conserving the energies of the patient.

It would appear that the patient is without the memory of pain, because the physical disturbance in the brain that is the underlying physical concomitant of pain did not take place or was greatly modified.

The experiences of the twilight sleep have left no imprint on her brain.  They are not consciously experienced, and so, as a matter of course, they cannot be re-experienced in memory.

All this is rather abstruse – perhaps needlessly so.  For the average mother it perhaps suffices to know that the twilight sleep is a condition from which she emerges as from a restless sleep, conscious only that in some miraculous way the child that aforetime nestled beneath her heart is now crooning at her bosom and that the wondrous transition has caused her no suffering.

The mothers of an elder day would perhaps have had qualms of conscious after such an experience, lest some evil befall them because they had seemingly bid defiance to a Scriptural mandate.  But the mothers of our day are freed more or less from the old bonds of superstition, and are ready to welcome emancipation from that primal sentence which, whatever its original significance, was assuredly carried out in full measure generation after generation from the earliest recorded periods of civilization to our own day; but which, in future, thanks to the twilight sleep or some equivalent, must be forever abrogated.

Continue: Chapter 3