Pregnancy - Twilight Sleep and Painless Labor : Part 4

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

(Page 12 of 44)

8. That by prolonging the second stage of labor and by sometimes giving too much morphine, the number of forceps deliveries is greatly increased, with their attendant and increased dangers to both mother and child.

9. That the prospects of passing through labor which may be rendered painless by artificial methods, tends to produce an attitude of carelessness and indifference towards those natural methods of living and other hygienic practices which so greatly contribute to naturally painless confinements.

10. That this method as sometimes practiced greatly increases the dangers of a general anesthetic, if such should be found necessary later on during the labor.

11. That "twilight sleep" is contra-indicated (should not be used) in the following conditions: primary inertia (abnormally delayed and slow labor); expected short labor - especially in women who have already borne children; when the fetal head is known to be large and the mother's pelvis small; placenta praevia (abnormal placental attachment); accidental hemorrhage; absent or doubtful fetal heart beat; when labor is already far advanced; and in threatened convulsions and eclampsia.

Conclusions Regarding Twilight Sleep

Having presented the evidence both for and against "twilight sleep," it may be of assistance to the lay reader to have placed before her the personal conclusions and working opinions of the authors. We, therefore, undertake to summarize our present attitude and outline our practice as follows:

1. "Twilight sleep" as a method of obstetric anesthesia in certain selected cases and in well-equipped hospitals, and in the hands of careful and experienced practitioners, has demonstrated that it is a scientific reality - and has probably come to stay - at least until better and safer methods of affecting a relatively painless confinement are discovered; although we are compelled to state that it is not the panacea the lay press has led many of our patients to believe. (That we believe a much better and safer method has been devised, the next chapter will fully disclose.)

2. We do not expect this method ever to become general in its use; we do not look for a chain of special "twilight hospitals" to stretch across the continent and then to overrun the country. We expect much of the recent forced enthusiasm to die down, while scopolamine-morphine anesthesia takes it proper place among other scientific methods of alleviating the pangs of labor.

3. We know that standard and fresh solutions - as already noted - are absolutely essential for the success of this method.

4. We are certain that no routine method or techniques can be developed. Each patient must be individualized. The method does not consist in injecting scopolamine every so often. The patient's mental and physical condition - as also that of the unborn child - must control the administration of "twilight sleep."

5. The patient must be in a quiet and partially darkened room. She must not be disturbed; while the physician, or a competent trained nurse, must be in constant attendance.

6. While this method of treatment is best carried out in the well-appointed hospital, there is no real reason why it cannot be fairly well carried out in a well-regulated private home, provided the necessary preparations have been made, a trained nurse is present, and provided, further, that the physician is willing to remain in the home with the patient the length of time required properly to supervise the treatment.

7. Even when the treatment is not instituted early in labor, it can, in certain selected and appropriate cases, be utilized even in the second stage of labor - thus saving these special cases much unnecessary pain; in fact, some authorities regard it as a valuable adjunct in the management of "borderland contractions" as it allows the patient a full test of labor.

8. In our opinion, this method has little effect on the first stage of labor if properly administered; but it does undoubtedly prolong and tend to complicate the second stage; in fact, we are coming to look upon "twilight sleep" as being more distinctly a first stage procedure; that it bears the same relation to the first stage of labor that chloroform bears to the second stage - relieving the pain but not stopping the progress of labor.

9. That when safe amounts of the drug are used the pain is greatly lessened in all cases - the subsequent memory of pain is absent in the majority of the patients - but the labor is not always entirely painless as is popularly supposed.

10. We do not believe that this method when properly administered increases the number of forceps deliveries - at least not in the case of high forceps operations. It undoubtedly does cover up the symptoms of a threatened rupture of the uterus, and therefore increases danger from that source; nevertheless it may be safely stated that this method does not in any way greatly interfere with any other measures which might be found necessary to institute in order to bring about a successful termination of the labor.

11. The baby's heart beat must be carefully and constantly watched; sudden slowing means that the treatment must be discontinued and the child delivered as soon as possible; even then, difficulty may be experienced in getting the baby's breathing started after it is born. In the vast majority of cases where the baby does not cry or breathe at birth, the usual methods employed in such cases serve quickly to establish normal respiration, and the baby seems to be but little the worse for the experience.

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.