Pregnancy - Twilight Sleep and Painless Labor : Part 2

The Mother and Her Child
by William S. Sadler, M.D., Lena K. Sadler, M.D.

(Page 10 of 44)

What Is Twilight Sleep?

"Twilight sleep" is a recent term which has become associated in the public mind with "painless labor." The reader should understand that "twilight sleep" is not a new method of obstetric anesthesia. While this method of inducing "painless labor" has been brought prominently before the public mind in recent years by much discussion and by numerous magazine articles - being often presented in such a way as sometimes to lead the uninstructed layman to infer that a new method of obstetric anesthesia had just been discovered - it has, nevertheless, been known and more or less used since 1903. Later known as the "Freiburg Method," and as the "Dammerschlaf" of Gauss, and still later popularized as "twilight sleep," this "scopolamine-morphine" method of obstetric anesthesia, has gained wide attention and acquired many zealous advocates.

"Twilight sleep" is, therefore, nothing new - it is simply a revival of the old combination of scopolamine and morphine anesthesia. While many different methods of administering "twilight sleep" have been devised, the following general plan will serve to inform the reader sufficiently regarding the techniques of this much-talked-of procedure.

The scopolamine must always be fresh, although different forms of the drug are used. It tends quickly to decompose - forming a toxic by-product - and, according to some authorities, this decomposed scopolamine is responsible for many undesirable results which have attended some cases of "twilight sleep." Various forms of morphine are also used.

Techniques of "Twilight Sleep"

The "twilight-sleep" injections are not started until the patient is in the stage of active labor. The initial injection consists of the proper dose of scopolamine and morphine (or some of their derivatives), while the patient's pupils, pulse, and respiration are carefully noted, as also are the character of the uterine contractions and the character of the fetal heart action.

Usually within an hour, a second dose of scopolamine is given, while the application of so-called "memory tests" serves to indicate whether it is advisable to administer additional injections. Some leading advocates of this method claim that the majority of the unfavorable results attendant upon "twilight sleep" are the direct result of failure to control the dosage of the drug by these "memory tests;" and they call attention to the large percentage of "painlessness" as proof of probable overdosing. If the patient's memory is clear and she is not yet under the influence of the drug, a third dose is soon given. If, however, the patient is in a state of amnesia (lack of memory), this third injection is not commonly given until about one hour after the second injection. The amount of amnesia present is used as a guide for repeated injections at intervals of one to one and a half hours. As a rule, the morphine is not repeated.

It must be evident that the success of such a method of anesthesia must depend entirely upon thoroughgoing personal supervision of the individual patient by a properly trained and experienced physician; and it is for just these reasons that "twilight sleep" is destined to remain largely a hospital procedure for a long time to come.

Experience has shown that those cases of "twilight sleep" that are not under the influence of scopolamine over five or six hours do vastly better than those under a longer time. When employed too long before labor this method seems to favor inertia and therefore tends to increase the number of forceps deliveries.

The number of injections may run from one to a dozen or more, and patients have come through without accident with fifteen or more doses, running over a period of twenty-four hours.

The Claims of "Twilight Sleep"

While "twilight sleep" as a method of anesthesia is not altogether new, many of the claims made for it by recent advocates are more or less new; and, to enable the reader clearly to comprehend both the advantages and disadvantages of this method, both the favorable and unfavorable facts and contentions will be summarized in this connection. The favorable claims made for "twilight sleep" are:

1. That eighty to ninety percent of all women who use this method can be carried through a practically painless labor.

2. That there is practically no danger to the mother (some degree of danger to the child is admitted by most of its champions) other than those commonly attendant on the older and better known methods in general use.

3. That "twilight sleep," being almost exclusively a hospital procedure, would result in more women going to the hospital for their confinement - if it were used more; and would, therefore, tend to bring about more careful supervision and individual care on the part of the attending obstetrician.

About the Author

Dr. William S. Sadler M.D. was a well-known American psychiatrist and college teacher in the school of medicine at the University of Chicago. For over sixty years he practiced his profession in Chicago, thirty-three years being associated in practice with his wife, Dr Lena Kellogg Sadler. The doctors were pioneers in the research on the mysterious Urantia Papers.