Twilight Sleep: Simple Discoveries of Painless Childbirth ~ Chapter 4 (1914)

Twilight Sleep

A Simple Account of New Discoveries
in Painless Childbirth

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

Written in collaboration with Dr. J. whitridge Williams,
author of “Williams’ Obstetrics”

CHAPTER IV

ARE LABOR PAINS A DISGUISED BLESSING?

This much, at least, is certain.  If the pains of labor are a disguised blessing, the blessing is singularly well disguised.  The argument of the preceding chapter led us safely to that conclusion, if to no other.  We saw that on the face of things the attempt to trace the purpose of labor pains, and to coordinate them with the scheme of life, led us to a hopeless contradiction.

But is there not some subtler interpretation that will enable us to reconcile the seeming contradiction?  Shall we not find, if we look deeply enough, that the suffering of women in childbirth serves a beneficent, even though an occult, purpose in the scheme of human evolution?

Otherwise, how harmonize the phenomena of painful childbirth with the accepted thesis of evolution through natural selection – the thesis according to which useful traits are the ones preserved?

The question is undeniably puzzling.  But an inkling of the answer is found when we learn that the women of primitive and barbaric tribes appear to suffer comparatively little in labor; coupled with the fact that it is civilized women of the most highly developed nervous or intellectual type who suffer most.

This seems at once to suggest that the excessive pains of childbirth are not a strictly “natural” concomitant of motherhood, but rather that they are an extraneous and in a sense an abnormal product of civilization.

Every one knows that the law of natural selection through survival of the fittest, which, as Darwin taught us, determined the development of all races in a state of nature, does not fully apply to human beings living under the artificial conditions of what we term civilization.  These artificial conditions often determine that the least fit, rather than the most fit, individuals shall have progeny, and that undesirable rather than desirable qualities shall be perpetuated.

When we observe certain characters or habits in connection with animal races in a state of nature, we may fairly assume that these characters and habits are beneficial to the species, harmonizing it with its environment; but it is never safe to draw a similar conclusion unreservedly regarding any trait or habit of civilized humanity.  Said trait or habit may be directly detrimental to the individual and to the race, and yet may be preserved, generation after generation, through the following influence of the hot-house conditions of civilized existence.

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?

I believe the answer must be an unqualified affirmative.

Considered from an evolutionary standpoint, the pains of labor appear not only uncalled for, but positively menacing to the race.

From the standpoint of evolution, it might rather be expected that the experience of childbirth would be the most pleasurable of human experiences.  That in point of fact it is the most painful, seems in itself to demonstrate that it is not a “natural” experience in the broad sense of the word.  Rather is it to be regarded as an abnormality, and one calling for the careful attention of the pathologist, that a means may be sought to eliminate it, as we seek to eliminate all other abnormal conditions.

SEEKING DIRECT EVIDENCE

This inferential conclusion as to the abnormality of painful childbirth is supported by a mass of direct evidence from two quite different fields.

On one hand we have the testimony of experimental physiologists and pathologists, who tell us that pain has a directly exhausting influence on the brain and nervous mechanism, lowering the vitality, and decreasing the powers of recuperation.  Arguing from such data, it would appear that the woman who suffers greatly during childbirth may be expected to make a retarded recovery, and is physically less well fitted to care for her infant than she otherwise would be.

Then there is the confirmatory evidence of those practitioners who have used anaesthetics to lessen or annul the pains of labor, supplemented now by the wide experience of Dr. Krönig and his associates at Freiburg, testifying that women who are not permitted to suffer, but are given the blessings of anaesthesia, or of the “twilight sleep,” rally quickly from the ordeal, recuperate rapidly, and in general make better recoveries than the average woman not so treated.

As to all this, and by way of summary as to the abnormality, so to speak, and the needlessness and harmfulness of painful labor, I cannot do better, perhaps, than to quote the comment of Dr. Krönig himself.  I am the more disposed to do so because the Freiburg specialist, in addition to pointing out the exhausting and harmful effects of painful labor on the women of sensitive organization, has something to say also about an aspect of the matter to which I have hitherto referred but very briefly – the fact, namely, that when women are given respite from the pains of labor, there is much less liability of the use of forceps.

But as to this, as well as to the main question at the moment under consideration, let Dr. Krönig speak for himself:

“Of late,” he says, “the demand made of us obstetricians to diminish or abolish suffering during delivery has become more and more emphatic.  The modern woman, on whose nervous system nowadays quite other demands are made than was formerly the case, responds to the stimulus of severe pain more rapidly with nervous exhaustion and paralysis of the will to carry the labor to a conclusion.  The sensitiveness of those who carry on hard mental work is much greater than that of those who earn their living by manual labor.

“As a consequence of this nervous exhaustion, we see that precisely in the case of mothers of the better class the use of the forceps has increased to an alarming extent, and this where there is no structural need of forceps.

“When one goes into the records of the cases of women like these concerning their previous confinements, one is almost driven to the conclusion that spontaneous birth is, in their cases, practically impossible.  It is by no means unusual to hear that the forceps had to be used at every previous confinement.  Neither structural difficulties nor muscular weakness has indicated the necessity for operative interference.  The forceps had been used simply and solely to shorten the pains of labor.

“On the occasion of a meeting of the Berlin Obstetrical Society, it came to light that obstetricians practising in the best society in Berlin were obliged to use the forceps in nearly forty per cent. of their cases.

THE DANGERS IN THE — USE OF THE FORCEPS

 “Although in the hands of a skillful operator the forceps is not so dangerous as in those of an inexperienced one, yet for those who know how great is the local susceptibility to infection it is hardly necessary to say that the chances of a favorable confinement and recovery are considerably diminished by any operation.

“If you follow the lyings-in, even in the best hospitals, you will find the number of cases of temperature considerably higher where there was not spontaneous delivery.  In the unfavorable external circumstances of ordinary practice, all these injurious results increase.  The great increase of the spread of puerperal fever corresponds to the increasing frequency of operations shown in the statistics of the larger towns.

“It might have been thought that the introduction of asepsis in obstetrics, and its careful application outside the hospitals as well as in, would have decreased the number of deaths in childbirth in comparison with those under former conditions.  But we note a not inconsiderable increase.  Every one agrees that the absence of reduction in the number of cases of puerperal fever is chiefly caused by an enormous absolute increase in the number of operations, and especially a huge increase in deliveries by the use of forceps.

[In the Frauenklinik, since the introduction of the Twilight Sleep method, the frequency of forceps cases, we are told, has settled down to an average of from six to seven per cent.]

“In theoretical medical instruction, the ‘rescuing’ forceps finds no place.  In practice the conditions are different.

“The cases available for obstetric study in the hospitals consist, for the most part, of women of no great intelligence, who earn their bread by manual labor.

“In private practice we not infrequently have to do with women of nervous temperament who declare themselves incapable of enduring the pains of labor to the end.  A medical man often, in such cases, finds himself before the alternative either of ending the delivery operatively with the forceps, or of retiring in favor of another doctor.

“If we take the trouble to sit at the bedside of women of some sensitiveness during the whole course of labor, and to observe the state of their nervous system, we are compelled to admit that all power of will to hold out till the end of birth is paralyzed.

“I hardly believe that any one who takes the opportunity of observing a birth in the case of one of these women, from beginning to end, would afterward agree with the statement that the pain of birth is a physiological pain which is really of advantage to the mother and must not be reduced.  Such a statement can only be made by those clinicians, who, having to do with too large a number of cases, have not taken the trouble to follow the nervous condition from beginning to end of labor, and who content themselves – as, indeed, is necessary when working on a large scale at high pressure – with ascertaining occasionally how the case is going on.

“Acute pain at birth cannot, in the case of sensitive women, be termed physiological, for it frequently occasions a condition of severe exhaustion even after birth.

“Any gynecologist who considers that he ought to be something more than merely as good an operative manipulator as possible – who thinks, that is, that he should observe the nervous condition of the mother – will not infrequently note that neurasthenic symptoms appear in immediate connection with the delivery.  One is only astonished that long-continued exhaustion does not occur more frequently, when we realize what a sensitive woman has to endure during her confinement, even taking into consideration the mental impressions alone.

“The preliminary pains are probably stood well.  But with their increasing frequency and violence the moral resistance breaks down.  She feels her strength giving way, and does nothing but beg the doctor to use the forceps and put an end to her agony, and longs only for the moment when she will be released from pain by the chloroform or ether.

“If, as often enough happens in private practice, the forceps is used without an anaesthetic, because the doctor is afraid to trust the continued administration of the anaesthetic to an unexperienced helper, then, in addition to the ordinary pains of birth, the woman has the pain of the operation.  The loss of blood, especially in the case of a first child, is relatively great, and bodily exhaustion is thus added to mental.

“It is true that robust women can stand all this without consequent injury to their nervous system; but it is equally undeniable that, if there is the slightest inclination to a neuropathic condition, such severe bodily and psychical injury is the cause of a long period of exhaustion.”

I think we may take it as settled, without further discussion, that the agonies of childbirth do not benefit the mother.  No one has claimed, I believe, that they benefit the child.

Shall we not say unreservedly, then, that painful childbirth in this age of scientific medicine is an unwarranted anachronism?

And when we have said this, why not go farther and say that it is a reproach to medical science and a blemish on our boasted twentieth-century civilization?

Continued: Chapter 5