Twilight sleep was a historical medical practice used in childbirth, designed to alleviate the memory of labor and delivery. It involved administering a combination of drugs to put the laboring woman into a semi-conscious state. While once considered a significant advancement in obstetric care, this method is no longer in use today.
Historical Development and Application
The practice of “twilight sleep” originated in the early 20th century at the Women’s Clinic of the State University of Baden in Freiburg, Germany. Obstetricians Bernhardt Kronig and Karl Gauss developed this method in the early 1900s. This development emerged from a growing desire to manage the pain of childbirth, as women had been seeking anesthetic options since the mid-19th century.
The technique quickly gained considerable traction, particularly among wealthy German women who traveled to Freiburg for their deliveries. Its popularity spread to the United States, where American women also journeyed to Germany seeking this “painless” birth experience. By 1914, “twilight sleep” became a social movement in the U.S., leading to the formation of the National Twilight Sleep Association, which advocated for its widespread adoption. Many saw it as a medical advancement.
The Experience of Twilight Sleep
The procedure involved a combination of two drugs: scopolamine and morphine. Morphine was administered for pain relief, while scopolamine was used to induce amnesia. The drugs were administered via injections, with scopolamine doses repeated to maintain the amnesic state.
The intended outcome was a drowsy, semi-conscious state where pain might still be present but would be forgotten later. However, patients often exhibited agitated and disoriented behavior, including screaming and thrashing. This required constant monitoring and physical restraints, such as leather straps on padded beds, with women sometimes placed in dark rooms with their eyes covered and ears plugged to minimize external stimuli and prevent self-harm.
Risks and Discontinuation
Despite its initial appeal, “twilight sleep” carried risks for both the mother and the infant. For mothers, the drug combination frequently led to prolonged labor, increasing the duration of exposure to the medications. The agitation and disorientation experienced often necessitated the use of physical restraints. There was also an increased likelihood of instrumental delivery, such as with forceps, due to altered labor progression. The memory loss, while a selling point, also caused some mothers to feel a profound detachment from their childbirth experience and hindered early bonding with their newborns.
For infants, the drugs could cross the placenta, leading to respiratory depression, sedation, and lethargy. This sedation could result in difficulties with initial alertness and establishing breastfeeding, potentially impacting the crucial early mother-infant bonding period. Furthermore, accurately dosing scopolamine and morphine was complex, and imprecise measurements carried a high risk of overdose for the mother.
Growing medical and ethical concerns, coupled with the inherent dangers and the lack of true pain relief without amnesia, led to the practice’s decline. The death of Francis Carmody in 1915, a prominent advocate for “twilight sleep,” further fueled public skepticism, even though her death was attributed to a hemorrhage unrelated to the drugs. As safer anesthetic options emerged and the medical community became more aware of the adverse effects, “twilight sleep” was largely abandoned by the mid-20th century.