Twilight Sleep, Nightmarish Delivery

BwJj8UTCAAAsqWuIn 1914 and 1915, thousands of American women testified to the marvels of having babies without the trauma of childbirth. As one of them gratefully put it, “The night of my confinement will always be a night dropped out of my life” (Leavitt 1980). For a better understanding of what twilight sleep is, it basically a dreamlike state induced by “scopolamine, a narcotic and amnesiac that, together with morphine” (Leavitt 1980). As a knee jerk reaction, I am puzzled with the handing over of bodily functions and consciousness being equated with gaining control-in any capacity. In essence I believe  that expectant mothers’ control over their birthing process must empower the her to value birth as a psychological experience, not only a biological one. If not, control is nothing more than handing over your body to an obstetrician to do what they want with it.

Now, as a woman in the 21st century, I can’t help but wonder what motivated women during this time to seek a birthing option that completely removed them from the process of birth?

Well there are a couple reasons:

1. First and foremost, pain. At the time the pain of childbirth was considered to be so unbearable that the resolution was found in twilight sleep. In fact, it not only alleviated the pain but it was believed to have women wake up “feeling vigorous”.

2. Trauma. Birth was considered to be a traumatic experience. I can’t argue with that.

3. Gain control of the birthing process. Women in 1914 and 1915 felt that by agreeing to participate in twilight sleep, they would give informed consent to not be a part of the birthing process.

Let’s investigate the first reason for participating in twilight birth, the pain. As far as I know, agonizing vaginal birth has been around for thousands of years. My mother did it, her mother did, her mother did it, and so forth. But what caused women in 1914 to find it so unbearable? Did the pain of childbirth somehow increase over time? Was there something that was happening in society that made women believe their pain was some how more horrendous? A way to possibly answer those questions would be to analyze the medical and societal expectations of the labor process at that time.

Physicians were already using “forceps, opium, chloroform, chloral, cocaine, quinine, nitrous oxide, ergot, and ether to relieve pain, expedite labor, prevent injury in precipitous labors, control hemorrhage, and prevent sepsis” during childbirth. These interventions made labor time shorter but women still experienced pain and high rates of maternal mortality. So when American women heard about Germany’s twilight sleep during birth in comparison to their “high-forceps deliveries”,  they flocked to it. Twilight sleep was marketed as a safe, comfortable option for upper class “modern” women who “responded to severe pain with exhaustion and paralysis”(Leavitt 1980). It was also not endorsed for “women who “earn their living by manual labor” and could tolerate more pain” (Leavitt 1980).

Now the image of labor during the early 20th century becomes clearer. Childbirth was villianized as a disturbing, dangerous, experience that was not to be experienced by dainty and vulnerable women of the higher ranks of society. The national movement towards twilight births was orchestrated by white, upper and middle class women, not by the majority, to buy their out of normal childbirth. This consequently damns women who were not able to afford twilight labor as backwards and of a lower social standing. So in essence, twilight labor wasn’t about empowering women as mothers. It was about prominent women using twilight labor as a symbol of their higher status.

The next motive behind twilight sleep was the notion that painful childbirth was traumatic. I am not going to make the statement that this is untrue, but rather, I would like to shed light on the process of twilight birth.  You can draw your own conclusion on what really is more traumatic.

Supposedly the advantages of twilight labor were that it was painless, reduced subsequent “nerve exhaustion that comes after a prolonged hard labor,” enabled better milk secretion, resulted in fewer cervical and perineal lacerations and fewer forcep deliveries” (Leavitt 1980). All the points previously listed were all ClAIMS. There was no  scientific and medical consensus on these assumptions. So the listed advantages were only unfounded promises that were not consistently tested.

To get a better understanding of twilight labor, here is the process expectant mothers would have gone through:

Process:

  1. Injection of scopolamine when woman appears to be in active labor, continued to be administered in intervals during labor and delivery
  2. “Calling test”-if doctor could not arouse the patient in a loud voice, then she passed (what happened if she didn’t pass?)
  3. “Incoordination test”-passed if movements were uncoordinated
  4. Placed into crib-bed to “contain her sometimes violent movements”

-Complete with bed screens, a canvas to cover the top of the bed-crib to shut out light, noise, and her ability to leave the device

bd(photo of the crib-like device)

5. At the onset of delivery, the pregnant woman is taken out of the crib device and placed in stirrups (which interestingly look similar to modern obstetrical services)

* Fun fact: Women were expected to remain in a sleeve, similar to a stray jacket, to “ensure that the patient did not interfere with the sterile field (Leavitt 150)

slv(sleeve jacket)

I suppose it makes more sense for the woman to be asleep, who in their right mind would want to be awake during that type of labor? It is even more amazing that this became the pedestal of what labor should look like. If you were a wealthy, white, expectant mother this image of labor was what you strived for. And if you weren’t any of those things, this ideal still would have been the standard you ascribed for.

Around 1914, women “thought pain in itself a hindrance to a successful childbirth experience and “demanded” that their physicians provide them with more positive, less painful, experiences in the future”(Leavitt 1980). Twilight labor offered them the ability to escape the normal experiences of birth by controlling their consciousness during the ordeal. But in fact, it just increased the efficiency of physicians, giving them “complete control of every- thing” (Leavitt 1980).  Women who participated in this process believed that their social and economic status enabled them buy out of pain. Yet twilight birth required more supervising on behalf of medical nurses and obstetricians, obstetricians were able to manipulate the entire birthing process without remarks from the mother or her family, they were able to devote more time to other important tasks-like catching up on reading, and to top it is all of-they benefited economically!

So was it worth it to trade pain for control? Should we encourage consumer motivated birthing options or safe options? Well for starters, I would not label twilight sleep as gaining control, but the waiving away of any jurisdiction women have over their body, and consequently, childbirth.

In opposition to Leavitt’s position, these women were succumbing to physicians and technology. Just because they asked for a way to allieviate pain and have a position in the birthing process didn’t mean they were empowered by it. Twlight sleep during labor did nothing to validate childbirth as a positive experience. Women were seen as more weak and vulnerable to medical intervention, they were blinded by the glory of faulty technology, and they further embedded childbirth as a privilege/comsumer driven process. “The twilight sleep movement helped change the definition of birthing from a natural home event, as it was in the nineteenth century, to an illness requiring hospitalization and physician attendance” (Leavitt 1980). Labor being considered something similar to a disease is more of a step back than a step forward from women’s rights over their bodies. If we want to advocate for choice in the birthing process, then EVERY woman regardless of her race, socioeconomic status, citizenship, or intelligence should have the ability to pick what they want –with doctors only acting as mediators in the process . Without educated choices, awareness of the phases of labor, consciousness, and the ability to challenge physicians, childbirth will continue to be seen as a detriment to the female race instead of a positive moment.

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