Why you should care

Because some think that pain during childbirth is downright medieval.

A German nurse led Charlotte Carmody to the “dearest room imaginable,” with blue and white walls and white frilled curtains. She was expecting a baby boy, and the beauty of the room — with its dainty white bassinet — overcame her. It didn’t feel like a hospital delivery room, because there were no shiny instruments or operating tables, just comfortable surroundings.

It was the summer of 1914, and Carmody had traveled from her native Brooklyn to the Frauenklinik in Freiburg, Germany, for what seemed like a miracle: childbirth without pain. German doctors were offering something called Dammerschlaf, or Twilight Sleep, the name alone evoking a fairytale-like promise of an ideal delivery. Pregnant women were told they’d never remember the horrible pain of childbirth, and be less at risk of death or injury.

The scopolamine induced amnesia, liberating women from normal self-control mechanisms, while the cocaine took the edge off.

Carmody lay down on the bed to receive her first injection, a cocktail of scopolamine — a painkiller that causes delirium and hallucinations — and morphine, which caused her brain to become less excited so that she could enter a sleep-like state. She would still be able to feel the baby and push, doctors said, but would wake up without any recollection of the pain and suffering she had endured. And that’s exactly what happened. Afterward, she awoke in her room and felt so well she thought “I must be dead,” Carmody recounted months later, to an auditorium filled with women curious about the procedure.

She didn’t remember what had happened during her labor, but doctors and reporters chronicled the not-so-peaceful experiences they observed. Women still felt the full force of contractions; some became violent and thrashed in their beds, their faces flushed red — sometimes even blue — as they screamed. “The scopolamine induced amnesia, liberating women from normal self-control mechanisms, while the cocaine took the edge off,” says Dr. Patty Stokes, assistant professor of women’s and gender studies at Ohio University. The result was sometimes dangerous, and women had to be strapped down and carefully observed to ensure they didn’t hurt themselves.

When it was over, Carmody told everyone this was the best birth. She had walked the first day after her son Charlemagne was born, and had taken an automobile ride a few days later. She quickly returned to the U.S. with her husband and new baby after the outbreak of World War I and began spreading her new gospel, giving lectures around the country about how wonderful the treatment was. It wasn’t hard for her to gain a following. In 1914, almost every American woman knew someone who had died in childbirth, says Dr. Carole McCann, professor and chair of gender and women’s studies at the University of Maryland, Baltimore County, and author of Birth Control Politics in the United States, 1916-1945. “Confinement — when women rested before delivery — was referred to as going down to the valley of the shadow of death,” McCann says. Twilight Sleep, on the other hand, offered hope: Women no longer had to be afraid of childbirth, didn’t have to deal with the pain and could enjoy a quick and easy recovery. Carmody helped found the Twilight Sleep Association with other prominent New York women, in a bid to promote what they deemed was a “safe and efficacious means of securing painless childbirth.”

A lot of doctors also believed in making childbirth less painful for women. They thought it could prevent tearing, which reduced the risk of a deadly bacterial infection in the days before antibiotics. They also thought it could make delivery more comfortable for a woman, meaning she could get back to taking care of her family sooner. But many leading obstetricians were not sure Twilight Sleep was the answer. The combination of morphine and scopolamine made labor last longer; one doctor noted how cases in Freiburg were weakened but prolonged. A longer labor increased the risk of the mother bleeding uncontrollably, the baby suffocating and the doctor having to use instruments like forceps to extract the baby.

Still, U.S. hospitals began using the procedure not long after the hospital in Freiburg; by the fall of 1915, however, doctors at prestigious Johns Hopkins Hospital had already abandoned the method, and many others soon followed, because they found it too dangerous. But proponent Carmody wanted another “painless” childbirth in August 1915, and still believed Twilight Sleep to be safe. She died in labor, due to a hemorrhage, and while her doctors and husband claimed it had nothing to do with the drug, such bleeding was a known complication of the procedure.

Twilight Sleep was deemed unsafe. But it had forever changed how women viewed childbirth: They wanted the process to be as pain-free as possible, and Twilight Sleep had offered them their first glimmer of hope. Decades later, in 1942, the spinal epidural would make that dream a reality.

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