The Miracle Drug
"Of course there ought to be no Pain...nothing but beauty...It ought to be one of the loveliest, most poetic things in the world to have a baby," (18).
~Pauline Manford
Twilight Sleep was a drug used during childbirth, which by some was thought to make childbirth a painless experience. It was developed in the early 1900’s in Germany by a Dr. Van Steinbuchel (Johnson). The drug was made up of morphine scopolamine. The morphine was thought to dim the pain and the scopolamine to actually erase the memory of childbirth altogether (Finkbeiner). Twilight Sleep was not the first anesthetic ever used during childbirth. Others before it were chloroform and other combinations of drugs such as di-ethyl ether (Caton). (It was not an exact science). Doctors first began really discussing the drug called, Twilight Sleep, after Dr. William Holt suggested scopolamine in medical journals in America (Johnson). Dr. Holt made sure to explain that while Twilight Sleep resulted in the patient experiencing amnesia, it did nothing to actually relieve the woman’s pain. These facts caused him to decide to no longer use it. However, after many American women wrote about their perceived experiences with Twilight Sleep in Germany in widely read magazines, the method began to gain popularity (Johnson). Obstetrics' struggle against the women advocating for this drug began.
What is Twilight Sleep?
How Does Twilight Sleep
Work?
Unbeknownst to the women advocating for this "miracle drug" the drug did the opposite from keep them from feeling pain, instead it just impeded any memory of the birth.
Many of the horror stories told by people who knew what happened during a birth under the influence of Twilight Sleep would share that these women would be almost completely by themselves during childbirth. Only the nurse would stay. This is because births under anesthesia required someone to administer the anesthesia (di-ethyl or chloroform) with every contraction for many hours at a time (Caton). While the malpractice of using certain forms of anesthesia and in the wrong way can be seen as a blemish on our history, it did spark improvement. It encouraged the idea of schools teaching women physicians and improving the teaching of obstetrics. According to Dr. Caton, well-known author of At Least She Had Chloroform, “At that time there was a widespread belief that the experience of pain, including the pain of childbirth, in and of itself had cumulative and permanent debilitating effects on a person’s health.”
According to The Lancet medical journal, the complications that can arise from Twilight Sleep are: “tendency to produce frequent asphyxia and death of the child, prolonged labour with the danger of post-partum hemorrhage on the part of the mother.”
The dosage of the drug itself provides many results. Scopolamine causes loss of memory. “The woman perceives the pains at the time to a greater or less degree but completely forgets them, and on waking up half an hour or so after the birth of the child is totally oblivious to the fact that she has had any pains (Obstetrics).”
A direct example of the lack of information concerning what is exactly to be expected when administering Twilight Sleep comes from a study by Bethany Johnson and Margaret Quinian,
"One laboring woman climbed onto the windowsill of her room; after three nurses subdued her, she remained in shackles for four days (Wolf, 2009). Aside from the rare occurrence of delirium, scopolamine’s side effects included dilated pupils, flushed skin, extreme thirst, and elevated pulse (Hamilton, 1914; Polak, 1915). In some cases, forceps were necessary for delivery when labor slowed."
The process of successfully administering Twilight Sleep is also a laborious process. The first injection must be timed correctly with the contractions, otherwise it could cause problems for the uterus, but if it is injected too late, then there will not be enough anesthesia given. The second dose must also be given at the correct time (approximately 45 minutes after the first) and more if the memory has been tested and does produce the desired results. It is clear that this drug could not be used on everyone when it is said, “a method of this kind which requires the constant supervision of the patient by a medical man, if all risks are to be eliminated, is obviously only available for a small number of patients,” (Obstetrics).
Click on this image to watch a short video of Judy Norsigian and Miriam Hawley, members of the Boston Women's Health Book Collective, discussing how women were treated by doctors in the 1960's and 70's. Because of this treatment, they explain the Women's Movement helped inform and improve those involved in the medical field. (Hysterectomies)
Here are some real cases of doctors administering Twilight Sleep from a Canadian Medical Association Journal.
History of American Medical Practices
In the late 1800’s and early 1900’s, medical schools in NYC did not have the same educational standards as one another, which meant some doctors were taught certain practices while others were not or vice versa. The exams were not standardized either, which caused a lack of equality of information mastered by doctors. Further similar issues arose concerning regulated standards when these graduated doctors would start their own private practices. In an effort to improve these issues, a man named Abraham Flexner conducted a study that shed light on the lack of qualified doctors in this 1910 time period. This report led to the modernization of America’s medical system (Johnson).
Another issue with the medical system was the distinction between midwives and physicians. Doctors of this time considered midwives “irregular practitioners” even though these midwives attended more than 50% of births (Johnson). The midwives struggled to achieve equality among physicians and obstetricians. Due to a 1907 report by a nurse names Elizabeth Crowell, new restrictions were placed on midwives and more laws made concerning how birthing would be done. In 1916, more and more middle and upper class women were giving birth in a controlled hospital environment.
As an encourager to bring more people to their hospitals, New York City obstetric practitioners considered the idea of using medicine to give pain relief during childbirth, which could only be properly done within that hospital. This method would also convince people to no longer be drawn to the idea of using a midwife (Johnson).
However, whether or not this pain relief method was actually properly done was the issue. Doctors would experiment with various drugs such as: “bromethyl, chlorethyl, nitrous oxide, antipyrin, cocaine, and medullary narcosis via a spine injection”. One Dr. named M.W. Knapp even tried to persuade physicians to use only heroin (Johnson). During the experimentation of various pain relieving drugs, one sparked much controversy: Twilight Sleep.
Twilight Sleep in the Novel
Pauline Manford praises the drug, Twilight Sleep, and encourages her daughter-in-law Lita to use it during childbirth. She believes that if one is financially able to erase any form of pain, then it should be done. Truthfully, Pauline would desire antthing if it meant upholding her famiy's status in society and at this time Twilight Sleep was all the rage. Mrs. Manford would of course need to be fully knowledgeable on this subject.
It is described in that novel that in preparation for her daughter-in-law’s birthing that she, “knew the most perfect ‘Twilight Sleep’ establishment in the country, installed Lita in the most luxurious suite, and filled her room with spring flowers…” (18). It is clear that women of this time felt that they could trust this drug and that it ensured a painless birth. It is also mentioned that Lita did not want it to “hurt” her at all and that women of her “set” often felt this way. This mindset is what most women in the 1920’s believed childbirth could be like.