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Putting Twilight Sleep to Bed

March 28, 2024
Ahma & Co Team
Image Credit: Lucas Mendes
Image Credit: Lucas Mendes

The year is 1966. It is November. My grandma arrives at the hospital forty weeks pregnant with her eighth child, my mother. She is thirty-eight years old, and has been through this procedure seven other times, so she is well versed in the labor happenings. As she enters through the doors of the hospital, she is greeted, and responds to the nurse that is present,

“I’m ready for my cocktail!”

Promptly after, she is wheeled away from any family members that were there and heads through the double doors. She is given two different drugs and is put into a light sleep. Hours later she awakes, my mother in a bassinet by her side, with no recollection of the event prior.

This ‘cocktail’ my grandmother received is called twilight sleep. This procedure was officially created by two German obstetricians Bernhardt Kronig and Karl Gauss in 1906. Through an individually determined amount of morphine and scopolamine, the person giving birth would be injected so that she would eventually fall asleep and give birth with no pain. As the morphine aided in relieving pain, scopolamine caused the woman to enter a state of sleep and experience amnesia. For many years, women had desired a pain-free birth, and this was their answer--or so they thought.

While having a pain-free birth seems ideal, what many women went through under twilight sleep was far from painless. Due to the combination of these two drugs, women became unconscious of their surroundings and uninhibited both physically and mentally. The resulting unrestrained nature led to medical professionals having to physically restrain them with straight jackets, labor cots, and towels until they became unconscious. Though such practices prevented women from self harm, such as hitting their heads and clawing at themselves, these methods of restraint were unethical and arguably nonconsensual.

Twilight sleep labor began to decline around 1915 due to multiple reasons, the main one being that the amounts of morphine and scopolamine had to be precise -any mismeasurements could easily lead to overdose. Alongside this, many doctors did not want to provide this form of labor due to the side effects and risks of morphine and scopolamine; the request was at the hands of many pregnant individuals. The death of Francis Carmody, who was widely known for her advocacy of twilight sleep, during the birth of her third child under twilight sleep also led twilight sleep to decline. Though there was no proof that twilight sleep led to her death, this event inclined many to be skeptical. Still, the practice continued well into the middle of the century up until women were able to recall what happened while supposedly unconscious. Following this, nurses and other medical professionals spoke up about the stories of their experiences and what they witnessed.  

A New Age for Hospital Births

Though traumatizing to lots of women, the advent of twilight sleep did transform the ways of labor and birth. Prior to the 1900s, a majority of births had occurred in the home, surrounded by female family members and a midwife. The emergence of the facilitation of drugs during birth to prevent pain became widely popular and yearned for by many women. As pain-relieving medications started to become available at hospitals, more mothers chose to give birth in the hospital rather than the home.

Today, women have a wide variety of birthing options to choose from and can plan their birth the way they want to, pain-relievers or not. Women who are at risk in any way can take precautions, and be treated in such a way that those risks are mitigated. The technology involved with pregnancy, birth, and labor has improved immensely, with tests, screenings, monitoring, c-sections, and inductions now widely available and providing valuable insights in risk-prone situations. Alongside these advancements, traditional labor elements such as birthing centers, doulas, and midwives are making a return that are often incorporated into hospital settings to offer mothers choices from old to new.

Today’s Hospital Options

Hospitals have developed and advanced in various ways over the last century. Though birthing at the hospital is largely bucketed into having a vaginal birth or c-section, there are many factors that influence the experience of each option.

If you’re planning on having a vaginal birth, there are lots of decisions to consider. A pain-free labor and birth could be the way to go for you. If so, consider an epidural that is injected into your spine and numbs you from the waist down. Narcotics and nitrous oxide are two other drugs that can be administered to rest your mind and body for a little while. If you are not interested in using drugs during birth, it is important to educate yourself on how to prepare yourself for labor and how to ease pain without medication. Relaxation is an important part of birth--both with or without medication. Furthermore, many hospitals now offer birth centers, water birth options, and often give free reign to move at your leisure that could help ease any pain. With these options in mind, you can experience the vaginal birth that you desire.

Cesarean sections have become increasingly more popular. Due to this, you can schedule your cesarean well in advance. Having a date in mind may ease some of the nerves and unknowns that come along with having a baby. There are still options to consider for c-sections and it’s important to be well prepared before, during, and after labor. There are some cases in which c-sections are unplanned. This change in birth method may be due to many reasons including a lack of labor progression, distress, infant positioning, if you are pregnant with multiples, health concerns, and previous c-sections.

Similar to a scheduled cesarean is a scheduled induction. While inductions may happen during any typical vaginal birth, you can also plan for it. For the mama that wants to plan and have a vaginal birth, this may be the option for you! Pitocin is a form of oxytocin that engages contractions and is administered through an IV. Because of this, more pitocin can be administered throughout labor. Another form of induction happens by breaking your amniotic sac. Typically, the breaking of one’s water symbolizes the start of labor, however sometimes this does not happen, and it must be broken manually. A way to help induce labor naturally is through nipple stimulation. This action releases natural oxytocin, the same hormone in pitocin. Any release of oxytocin will be beneficial for contractions and speeding up the birthing process.

In all of these methods of labor and birth, there are so many options to consider. If you want to give birth pain-free, epidurals may be the way to go! If you are an at-risk parent, consider a c-section. If you want to have a waterbirth and want to have the security of the hospital, that option is likely available! There are loads of factors, but the person who knows best is you. Today, we are so fortunate to have a plethora of options, and the autonomy to choose how, where and when we want to give birth.

Ahma & Co Team

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