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the business of giving birth has long been a dangerous one for most of human history
and estimated four percent of all women died in pregnancy or childbirth due to infections
hemorrhages and other complications starting in the mid 19th century improvements in sanitation
and new medical techniques steadily began to improve these odds such that today in
the united states approximately 15 women die per hundred thousand live
births but even as childbirth became increasingly safer for many decades it remained just as painful
as it always had been then at the dawn of the 20th century a miraculous new method for giving
birth emerged in germany which promised to change everything known as twilight sleep
the technique promised to banish forever the pain of childbirth which had plagued women kind
seemingly since there had been women kind and it was enthusiastically championed by early feminists
as a cornerstone of women's liberation but like so many miracle cures twilight suit proved to
be too good to be true and its use and abuse would lead to one of the most horrifying periods
in the history of obstetrics the widespread use of general anesthesia in medicine originated in
the mid-19th century when pioneering doctors such as horus wells william morton and james simpson
successfully demonstrated the use of substances like nitrous oxide ether and chloroform
for pain management but while anesthesia rapidly took off for use in surgery doctors were initially
reluctant to use it to ease the pain of childbirth much of this resistance was religious in nature as
christian doctrine saw the pain of childbirth as a divinely ordained punishment for the
original sin of eve as genesis 3 16 declared i will make your pains in childbearing very
severe with painful labor you will give birth to children your desire will be for your husband
and he will rule over you however this taboo was shattered in 1853 when queen victoria gave birth
to her eighth child prince leopold while under the influence of chloroform now bearing the royal seal
of approval the use of anesthesia in childbirth soon caught on among the upper classes and
eventually the rest of society but while definite improvement the use of chloroform was far from a
perfect solution for women in labor could not be completely knocked out lest they become unable
to actively push out the baby then in 1902 an austrian physician named richard von steinbechel
developed a unique solution von steinbachel experimented with a drug called scopolamine or
hyacine derived from the deadly nightshade plant used in small doses to alleviate motion sickness
in higher doses scopolamine is a powerful hypnotic inducing a disassociative state and amnesia such
that a patient remembers little or nothing of what happens while under the influence of the drug by
administering a carefully balanced combination of scopolamine and morphine von steinbachel sought
to alleviate the pain of childbirth without the need to render a woman completely unconscious
properly administered the drug combination would cause a woman to wake up from childbirth with no
memory whatsoever of the ordeal in 1906 bernard cronig and karl gauss obstetricians working in
freiburg germany refined von steinbachel's method into a technique that they called damaschla for
twilight sleep when a pregnant woman first began experiencing contractions she was given a dose
of 150th of a grain of scopolamine and half a grain of morphine 45 minutes later another dose
of scopolamine was given along with a memory test to determine the extent of the amnesiac effect the
procedure was repeated every half hour until the optimal dose of scopolamine was determined
with no further morphine being given for the remainder of the birthing process as copolamine
had a tendency to induce violent delirium the original freiburg method for twilight sleep placed
great emphasis on sensory deprivation women gave birth in darkened rooms often blindfolded with
oiled cotton pushed onto their ears while nurses wore uniforms designed to minimize noise all to
limit distractions and promote peaceful sleep later that year konig and girls presented their
technique at the national obstetrics conference in berlin where they revealed that the use of
twilight sleep resulted in fewer post-delivery complications and faster recovery times despite
initial hostility from the obcentric community the bear continued to refine the technique by
1907 carl gauss was using twilight sleep on all of his pregnant patients and within a few
years the state university women's clinic and barden where he worked boasted the lowest rates
of childbirth deaths and complications in the city as the popularity of twilight sleep grew patients
from around the world began traveling to germany to experience the miracle of painless childbirth
in 1912 an american woman named cecil stewart visited fryeburg to give birth to her second
child stewart later described the experience as being like a fairy tale and enjoyed the clinic and
its attentive staff so much that she stayed for a full month after giving birth but the popularity
of twilight sleep truly exploded in may 1914 when american journalist marguerite tracy and constance
lupe published an article titled painless childbirth in mcclure's magazine which praised the
technique and the work of the freiberg clinic the article triggered a flood of letters from readers
inquiring where they could find doctors willing to perform the procedure later that year the national
twilight sleep association or ntsa was formed to promote the technique in the united states
led by c temple emmett a member of the wealthy astor family and the first american to give birth
at the freiburg clinic the association launched a massive campaign to inform the american public
over the benefits of twilight sleep and pressure doctors and hospitals to adopt the technique the
ntsa produced pamphlets books lectures and even a film one of the first medical documentaries
ever made their materials were filled with glowing testimonials including from one woman who declared
i was so happy the night of my confinement would always be a night dropped out of my life before
long the crusade that twilight birth had taken on an almost evangelical further as first way
feminists and suffragists began championing the technique as a new weapon in the fight
for gender equality according to these activists twilight sleep freed women of the pain and danger
traditionally forced upon them by the obligations of motherhood and allowed them to regain agency
over their own bodies ntsa member mary boyd whose lectures on twilight sleep regularly drew crowds
of over 300 women framed the fight for twilight sleep as a battle against the patriarchal medical
establishment declaring twilight sleep is the dawning of a new era for women and through her
for the whole human race but you women will have to fight for it the mass of doctors are
opposed to it for the first time the whole body of patients have risen to dictate to the doctors
meanwhile many american obstetricians remain skeptical of twilight sleep not only because
of scopolamine's unpredictable side effects but also the german origins of the technique with
the first world war raging overseas many saw women who used twilight sleep as being
disloyal to the united states yet many doctors came to public pressure and traveled to fryeburg
to learn the trendy new method but unfortunately for an entire generation of women the technique
did not transplant well to america thanks to the efforts of the ntsa the demand for twilight sleep
far outstripped the supply of doctors and nurses capable of performing the procedure
thus while the original freiburg method was a highly personalized and attentive affair
its practitioners taking years to learn and perfect the technique few american hospitals
were able to lavish such care and attention on any given patient in america the technique
was largely administered by overworked poorly trained nurses and while german doctors took
the time to customize the scopolamine dose for each patient american patients all received the
same standardized dose the results were horrifying under the influence of the
drug cocktail women often became delirious or even psychotic forcing them to be confined in
special padded delivery beds and tied down with leather straps or straight jackets to prevent
them from thrashing about and injuring themselves they would be left in this state for days until
they gave birth often wallowing in their own vomit and excrement and while twilight sleep
was billed as being painless the small amount of morphine administered meant that most patients
were still very much in pain with one doctor explaining to the new york times there is as
much pain as in the ordinary childbirth the only difference is the patient does not remember having
the sensation of pain there were other problems as well while the mothers were technically conscious
throughout the ordeal the confusion and delirium induced by the scopolamine prevented them from
assisting in the birth process resulting in most twilight sleep babies being delivered mechanically
through the use of forceps this in turn increased the risk of injury and other complications for
both mother and child the morphine could also cross the placental barrier resulting in babies
being born with depressed breathing as described in this 1915 account by one dr stellaler the baby
was pinkish lavender in color and did not breathe for about 10 minutes during that time various
methods of resuscitation were used the baby was suspended by the feet and body vigorously slapped
then laid on a table and chest rhythmically pounded then body immersed alternately in
hot and cold water and finally intratracheal catheterization was used after witnessing this i
naturally concluded that the twilight sleep was to be used very conservatively or better still not at
all but perhaps the most alarming side effect was the very amnesia the entire technique was built on
as dr henry smith williams wrote in 1914 she may seem to be conscious of the birth of her child and
may give evidence of apparent suffering yet when a few moments later the child is brought in by
the nurse from the neighboring room where it has been cared for and placed in the mother's arms the
patient does not recognize the child as her own or realize that she has yet been delivered the effect
could be bewildering and even traumatizing for the mother as one mrs sergeant described in 1915. the
next thing i knew i was awake and then i thought to myself i wonder how long before i shall begin
to have the baby and while i was wondering a nurse came in with a pillow and on the pillow was a baby
and they said i had had it perhaps i had but i certainly could never prove it in a courtroom
the sense of disconnection and alienation from the baby and the birthing process itself resulted in
elevated rates of what is now termed postpartum depression amongst twilight sleep mothers yet
despite these myriad disturbing side effects the popularity of twilight sleep would persist
until august 1915 when francis carmody a prominent advocate for the technique died while giving birth
to her third child while carmody's husband and doctor maintained that the death was due to a
hemorrhage and unrelated twilight sleep this event was enough to turn a large part of the
public and the medical establishment against the technique and its popularity quickly faded
yet twilight's sleep didn't go completely away well into the 1960s it was rare for a woman to
give birth without being placed under some kind of sedation it was not until the 1970s and 80s that
movements emerged promoting more natural births and new techniques like epidurals injecting
painkillers directly into the spine allowed for more localized pain control without the need for
general anesthesia but while twilight sleep is no longer used its legacy is still with us as late as
the 1940s only one third of births took place in hospitals with the vast majority of women still
giving birth at home in the traditional manner twilight sleep however can only be administered
in a controlled clinical environment and its brief popularity was instrumental in triggering
the mass shift towards hospital births this was the final step in a nearly century-long process
wherein childbirth was increasingly pathologized stripped from the hands of midwives and pregnant
women themselves and placed under the control of largely male obstetricians but while much
work remains before women can fully reclaim the birthing process we can at least be thankful that
the experience no longer involves the terrifying combination of hypnotic drugs straight jackets and
memories being wiped clean so i really hope you found that video interesting if you did
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