Twilight Sleep

Simple Discoveries
in Painless Childbirth

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

In collaboration with Dr. J. Whitridge Williams,
author of the Williams Obstetrics textbook; professor of obstetrics, Johns Hopkins University Hospital; Dean of the Johns Hopkins School of Medicine

CHAPTER I

THE TWILIGHT SLEEP

“In sorrow, thou shalt bring forth children.”

Never, I suppose, was a sentence written that was destined to have more baleful influence over humanity than this “primal curse” of the ancient Hebrew.

Probably the edict as originally written was not supposed to have the force of a mandate, but only expressed the interpretation of an observed fact.  The women of ancient Israel, in common with those of other civilized nations of antiquity, were observed to “bring forth children in sorrow,” and the philosophers of the race interpreted this phenomenon as representing the fulfillment of a mandate of the God of their fathers.

It is a curious trait, shared by children and philosophers, this tendency to find reasons for things.

The child mind is always asking “Why?” And in so doing the child but follows the lead of his ancestors of remote antiquity, who, in the time of childhood of the race, put a question mark after every obscure phenomenon, and then evolved out of their consciousness the answer that seemed best to serve the purpose.

Thus it was that all manner of fantastic explanations were given of natural phenomena that served as statements of final fact for generation after generation, until in the course of time science ferreted out true explanations of one mystery after another, and thus supplanted the superstitious guesses that the ignorance and credulity and desire for knowledge of our forebears had fostered upon the race.

And among these superstitions there was perhaps none that had more harmful influence than that which interpreted observed human ills as due to a curse that had been put upon humanity by an offended Deity.

Man had in reality evolved from a lower order of things and was groping his way toward a still better order than that which he had attained.  But unfortunately the Hebrew philosophers, confronted by the mystery of human existence, made a wrong guess and assumed that civilized man is a fallen angel rather than a risen brute.

And this misconception permeated the entire structure of ancient thought.  It found record in the writings that came presently to be accepted as the sole authoritative interpretation of ethical standards.  And it put its imprint so effectively on the thought of mankind that it was destined for thousands of years to serve as a dominating influence in determining the interpretation of human conduct.

And I repeat that there was perhaps no single phrase among the many misapplied verdicts of a faulty philosophy that was destined to exercise a more baleful influence than the interpretation of the observed agony of woman in childbirth that found expression in the phrase “In sorrow shalt thou bring forth children” – a phrase that passed into common speech and became a byword throughout Christendom for half a hundred generations.

SCIENCE versus TRADITION

So firmly established had the tradition become that the pains of childbirth represent a primal curse to be expiated anew by each and every mother, that when Dr. Morton gave the blessing of anesthesia to humanity toward the middle of the nineteenth century, there was an outcry from many a pulpit against the use of this blessing to assuage the sorrows of childbirth.

And while the outcry was disregarded by many a practitioner, yet its echoes are heard to this day, and I make no doubt that the prejudice thus engendered is in good part responsible for the fact that even in this second decade of the twentieth century the generality of women bring forth their children in sorrow, quite after the ancient fashion, un-solaced by even a single whiff of those beneficent anesthetic vapors through the use of which, in the poetic phrasing of Dr. Oliver Wendell Holmes, the agonies of tortured humanity may be “steeped in the waters of forgetfulness.”

How many millions of women, I wonder, first and last, when in the utter extremity of anguish they have pled for an anesthetic, have been met with a cold-blooded quotation of the malevolent phrase that the ancient scribe sent down to us, paraphrased, perhaps, or supplemented with the assurance that the suffering of childbirth is a natural phenomenon that “does good” to both mother and child?

A “natural phenomenon”!  In a sense, yes; since these agonizing pains are the regular attendant of childbirth with the vast majority of civilized women.  But to say that this suffering does good, in any ordinary interpretation of the words, is to travesty language.

To prate such words is but to make up a cheap paraphrase of the Scriptural dogma that the pains of childbirth are the fulfillment of a primal curse.

And the modern world, thank fortune, does not take much stock in “curses,” primal or otherwise.  Thanks to the progress of science, we are coming to understand a little more clearly man’s place in the universe and his relation to a normal environment.  When we are just a little more enlightened, we shall blush to think that we could ever have been so credulous as to associate the sacred duties of maternity with the thought of punishment meted out by a supposedly beneficent Omnipotence.

PAINLESS CHILDBIRTH AT FREIBURG

Perhaps I shall make inquiry before I am through as to how it has really come about that this most natural and most essential function should have come to be associated with so much seemingly useless suffering.

But such an inquiry, whatsoever its interest, may well be deferred until something has been told of the wonderful effort that has been made by a band of wise physicians in Germany to give solace to the expectant mother, and to relieve the culminating hours of childbirth of their traditional terrors.

The wise physicians in question are associated with the University and Hospital of Freiburg.  For years they have labored to perfect a method that shall make childbirth painless.

Some thousands of mothers from all parts of the world stand ready to testify to the success of this beneficent quest.  These women will tell you that they have had “painless babies” in the hospital at Freiburg.  A good many of them have gone there to have a second child, some of them even a third child – for the Freiburg method has been in vogue for several years.

And when you ask these mothers what they intend to do when next they find themselves blessed with prospective motherhood, they will tell you that their one thought is to go again to Freiburg, where they may run the gauntlet of childbirth and retain none but pleasant memories.

“If you had another baby, which way would you choose to have it?” was asked of an American mother who had been in Freiburg for her most recent confinement. 

“Which way?” she is said to have answered.  “Which way? If I had another baby, I would have it in Freiburg if I had to walk all the way from California.”

An interesting testimonial that.  A testimonial that must appeal – as having directly personal interest – to every woman who expects some time to be a mother.

And what, then, is the Freiburg method, which brings forth such enthusiastic comment from those who have shared its benefactions?

Stated in the fewest words, this method consists essentially in the hypodermic administration of certain drugs, given just at the incipiency of the acute pains of childbirth, and calculated to render the patient oblivious of the pains – or, to be quite accurate, to modify her consciousness in such a way that she has no recollection of suffering when the ordeal is over.

The treatment does not give entire unconsciousness, like the narcosis of ether or chloroform.  Just what it does accomplish will be explained in some detail in a moment.

The drug chiefly depended on to produce this condition of painless childbirth at Freiburg is known as scopolamine.  With it is associated, in the first dose, the more familiar drug morphine, or, more recently, another opium derivation called nacrophin.

The success of the treatment depends largely upon the skill with which the doses of the drugs, and in particular the successive doses of scopolamine, are adjusted.

Scopolamine is not a new drug, but it has been comparatively little used in medicine until recent years.  It belongs to a rather long series of drugs that act on the nervous system in a striking way when administered in very small quantities.  It is not a drug that can be handled with impunity.  Under no circumstances should it ever be given except by a skilled physician.

The possible utility of this drug as a narcotic, in particular as a substitute for chloroform and ether, has been under consideration since about the year 1900.  But, although it was used by Dr. Korff in a tropical climate as a substitute for volatile anesthetics, it did not commend itself as a safe drug when given in sufficient doses to annul the pains of a surgical operation.

But it occurred to a Freiburg physician, Dr. Von Steinbüchel, at that time connected with the Freiburg Frauenklinik, that scopolamine might have sufficient narcotic power to ease the pains of childbirth; and he was first to put the matter to a test.

It should be explained that a drug to be satisfactory for such a use must be one that, while assuaging or annulling pain, does not retard the muscular contractions that are essential.  In moderate doses opiates partly fulfill this condition, and it was thought well to combine the alkaloid morphine, a derivative of opium, with the scopolamine.

The results in Dr. Von Steinbüchel’s skilful hands were gratifying.  And subsequently, when Dr. Bernhardt Krönig, a famous gynecologist from Jena, came to Freiburg as director of the Frauenklinik, he continued the experiments, and, with the aid of Dr. Karl Gauss, perfected a system of dosage that ultimately led to the perfection of the now famous Freiburg method of painless childbirth.

PARTIAL NARCOSIS

A distinguishing peculiarity of the scopolamine treatment, as thus perfected at Freiburg, is that it does not produce complete narcosis.  If it were merely a question of giving hypodermic injections of a drug, until the patient became unconscious, the case would be quite different.  But scopolamine is not a drug that lends itself to such use as this.  With a patient thoroughly narcotized the muscular contraction would cease, and the birth of the child would be retarded, even if the life of the mother were not jeopardized.

So it is necessary to restrict the dosage, and to regulate it very carefully.  In fact, therein lies the entire secret of the Freiburg method.

Perhaps the word “secret” should not be used in this connection, for it must be understood that the methods used at Freiburg are open to the observation of the profession, and details as to the method have been fully published in medical periodicals.  It may fairly be said, however, that there is a “knack” in the use of this drug that largely determines the measure of its effectiveness in assuaging the pains of a woman in labor.

Dr. Krönig and his associates have worked out elaborately the exact method of administering the drug, and it is held that by their method alone can success be hoped for in its use.  At all events, the fame of the Freiburg method depends largely upon the exact rules of procedure that have been elaborated by these skillful physicians.

The essence of the matter is that when drugs are given in just the right quantity, the patient retains consciousness, and (except that she may fall asleep between pains) is at all times more or less cognizant of what is going on about her, but is singularly lacking in the capacity to remember any of the happenings that she observes.

She may seem to be conscious of the birth of her child, and may give evidence of apparent suffering.  Yet when a few moments later the child is brought in by the nurse from the neighboring room where it has been cared for, and placed in the mother’s arms, the patient does not recognize the child as her own, or realize that she has yet been delivered.

This curious evanescence of memory is precisely the test according to which the dosage of the drug is graduated at Freiburg.

The first dose of morphine and scopolamine in combination is given at an early stage of labor.  Half an hour or so later, a second dose, of scopolamine alone, is given.  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.

This, obviously, is a very curious condition of sleep-walking.  In some ways, it suggests the hypnotic state.  Yet the Freiburg physicians are convinced that the condition is not genuine hypnosis, but the actual and definite result of the action of scopolamine on the central nervous system.

In the German language this curious condition, which is the essential condition that gives success to the Freiburg method of painless childbirth, is termed the “Dämmerzustand,” or “Dämmerschlaf.”  In the English language, the condition is characterized as the “Twilight Sleep.”

Twilight Sleep!  A pleasing and suggestive term, is it not?  To scores of English-speaking women, it has come to be a synonym for painless childbirth.  And enthusiasts are not lacking who express the hope that in future it may become a household word throughout the English-speaking world.

Thousands of women have experienced the blessing of having the agonies of childbirth assuaged to the point of annulment by the Freiburg method.  Why should not their millions of suffering sisters throughout the world be given also the boon and blessing of the twilight sleep or its equivalent?

Why not, indeed!

Continue: Chapter 2