Twilight Sleep: The Forgotten 20th Century Method Of Childbirth That Erased Memories

For a long time, childbirth sucked. It sucks now too, but in the not too distant past, it was oh so much worse.

Before proper pain relief, C-sections, and antiseptics, there were infections, intense pain, and – if you were lucky – chainsaws to widen your pelvis. So when doctors in Germany began promising patients that they could relieve pain and erase their memories of the experience while they were at it, it's easy to see why it took off.

In 1906, obstetricians Bernhardt Kronig and Karl Gauss came up with the idea of giving the drugs scopolamine and morphine to help with childbirth. Morphine would provide pain relief, while scopolamine – a component of plants in the nightshade family – would cause drowsiness, amnesia, and euphoria. The idea was that they would give the patient enough of the two drugs that the pain would be reduced without rendering them unconscious, as well as giving them complete amnesia afterward.

Kronig and Gauss, satisfied with their trials as they showed fewer complications than natural childbirth, began to offer the drug combination to patients at the Women’s Clinic of the State University of Baden in Baden, Germany. By 1907, Gauss was giving it to all his pregnant patients. Word began to spread of the treatment being hyped as the end of the pain of childbirth, and before long, women were traveling all the way from America to Germany to give birth in a state of "Twilight Sleep".

Thousands of mothers were pleased with the results and testified that they had given birth without pain. Some would go on to have more babies under the same procedure. From the outside, it all sounded too good to be true. And it was.

When the patients first began to experience the pains of labor, Gauss would give them a dose of morphine and scopolamine. From then on, he would only give them doses of scopolamine. While this would prevent them from remembering the pain, it didn't in any way prevent them from feeling it. He was well aware of this, given that he was forced to restrain women to their beds – using straight jackets or straps on the arms and legs, bandaging their eyes, and inserting cotton into their ears – to stop them injuring themselves and others by thrashing around. 

The screams were also a pretty big clue that the process wasn't as painless as the women remembered.

"She may seem to be conscious of the birth of her child, and may give evidence of apparent suffering," Dr Henry Smith Williams wrote in 1914. "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."

Nevertheless, the method made it across the Atlantic to the US, largely due to the high demand from mothers themselves. Here, there were added dangers due to the ways the drugs were administrated.

In Germany, the patients had been assessed for dosage methodically before administration of the drugs, in America this wasn't the case. Whereas in Germany top-up doses were given according to the needs of the patients, in America it was divided into doses and provided at set intervals.

"The baby was pinkish lavender in color and did not breathe for about ten minutes," Dr Stella Lehr wrote of a birth she witnessed in 1915. "During that time various means 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 used."

"After witnessing this I naturally concluded that the twilight sleep was to be used very conservatively or better still not at all."

The demand for the procedure – understandable given the pain-relief available at the time – far outstripped the doctors qualified and willing to give it, with the task of administering doses often left to nurses without sufficient training. Given that the drugs could cross the placenta, this could result in babies being born with depressed breathing, which likely wouldn't have happened via natural birth.

The demand for Twilight Sleep diminished in 1915 when Francis Carmody, who helped popularize the method in the US, died giving birth. This had resulted from an unrelated hemorrhage but still led to the practice becoming less popular. It was still used right up until the 1960s in some areas, however, until journalists exposed the conditions inside the wards, and the burn marks left by women struggling in their drugged state against their restraints.

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