Pregnancy - Twilight Sleep and Painless Labor : Part 5

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

(Page 13 of 44)

12. While altogether too much has been claimed for "twilight sleep" at the same time many false fears have also been suggested, among which may be mentioned the fear of the mother losing her mind after the treatment; the undue fear of asphyxiation on the part of the baby; the fear of post-partum hemorrhage; and the fear that it will lessen the milk supply. We cannot deny that the child's dangers are often increased; but in other respects, this method (in properly selected cases) presents little more to worry us than the older methods of anesthesia.

13. We are inclined to the belief that this method has but little influence on the course of convalescence following labor. Certain nervous and highly excitable women certainly seem to do better, as a result of experiencing less pain and nervous shock; while other cases do not turn out so well. It certainly does not retard repair and recovery during the childbirth.

14. This method seems to have its greatest field of usefulness in those cases of highly intelligent but excessively neurotic women who have an abnormal dread of pain and child bearing; or women who have suffered unusually at the time of a previous confinement - perhaps in the case of the first baby - or from other complications; women such as these, and other special cases, are the ones to benefit most from the employment of "twilight sleep."

15. This method as has already been intimated, is most useful in the case of the first baby, or in the case of women who have established a record of tedious and painful labors. It has no place in normal and short labors; although it may be used to great advantage in certain cases during the first stage of labor - being carefully and lightly administered - while chloroform or gas is utilized at the end of the second stage just as has been our custom for a generation.

16. As noted under the special claims made for this method, it is (as also is nitrous oxide) the ideal procedure in cases of heart, respiratory, kidney, and other organic difficulties, the details of which have already been noted, and their repetition here is not necessary.

17. It must be remembered that scopolamine and morphine are more or less uncertain in their action; scopolamine is variable in its results, often producing such marked nervous excitement in the patient as greatly to interfere with the carrying out of an aseptic techniques; while morphine has been shunned by obstetricians for a whole generation, because of its well-known bad effects on the unborn child as well as its interference with muscular activity on the part of the mother.

In Germany, it is said, that a great many damage suits against prominent physicians have resulted because of the alleged ill effects which have followed the use of "twilight sleep."

18. In presenting these facts and opinions regarding "twilight sleep," the reader should bear in mind that we are not only endeavoring to state our own views and experience, but also to give the reader just as clear and fair an idea of what other and experienced physicians think of the method, both favorably and unfavorably; and we will draw these conclusions to a close by citing the opinion of one or two who have had considerable experience with the method and who, in summing up their observations, say:

The disadvantages of the method are entirely with the accouter and not to the mother or child. It requires his presence at the bedside from the time the treatment is undertaken until the completion of labor, not so much because of any danger, but to keep the patient evenly under anesthesia on a line midway between consciousness and unconsciousness, for if she is allowed to go above that line in several instances she will have several so-called "isles of memory," and will be able to draw a picture of her labor in her mind and therefore lose the benefit of the treatment.

These methods of anesthesia are very important and have merit. They should be used when properly indicated. No one should limit himself to a routine method. Each case should be individualized and the form of anesthesia best suited to the case in hand should be employed. For instance, in dealing with a primipara - one who is full of fear, who cannot stand pain, who is of an hysterical nature - morphine-scopolamine anesthesia is best suited in that particular case, because these drugs have a selective action when it comes to allay fear and produce amnesia. On the other hand, in a multipara who has had three or four children, whose soft parts are relaxed and who has short labors, the anesthetic of choice would be a few whiffs of chloroform as the head passes over the perineum.

It is ridiculous to try to give such women the "twilight sleep." Furthermore, take the cases you see for the first time at the end of the first stage of labor, or during the second stage; these cases are best treated with the nitrous oxide and oxygen method. You have to individualize your cases. The prospective mother now consults the obstetrician early to find out if her particular case is suitable for the "twilight sleep." She has been informed that certain examinations - urine, blood pressure, etc. - are necessary. She knows that these examinations have to be made at regular intervals. In other words, we get the patients early and we can give them good prenatal care.

This chapter has been devoted to "twilight sleep;" the following chapter will consider "nitrous oxide" and other methods of anesthesia in connection with labor, and should be read along with the foregoing discussion in order to obtain an intelligent view of the whole subject of "painless labor."

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.