Daily MOS: The Promise and Barbarism of Twilight Sleep

Content note- please be advised this column discusses abusive practices that were historically used in labor and delivery.

Standing upright and walking our way to bipedalism came with perks and downsides as homo sapiens. It came with these giant brains that are great for logic, reasoning, and keeping us up at night asking us if we remember that time in the fourth grade that we bombed a question about bee thoraxes in front of the entire class.

Thing about being a species with a big brain though? We’ve gotta give birth to babies with big heads. And that’s some business.

Today’s Moment of Science… our great grandparents gave birth super fucking high.

There exist many scientific theories on why human childbirth sucks, but here’s the obvious: shoving something the size of a basketball through an opening the size of a ginger ale bottle doesn’t sound like it merely tickles. Since the 1960s, the ‘obstetrical dilemma’ hypothesis has floated around. TL;DR version? As humans evolved, evolutionary pressures for a newly upright species pushed us towards larger brains, smaller birth canals, and more screaming at the father during labor.

But as has happened with many theories from the era before the space race, we were at least somewhat wrong. The hypothesis leaned on a pillar that there was a biomechanical advantage for efficient locomotion from having narrowed hips. Scientists looking to validate that part of the theory decades later found it to be bunk. It also assumed that childbirth has been an exercise in pain management since fetus prime of the species, and that was based on modern experiences in a handful of cultures.

I told you that story to tell you this story.

Whether childbirth is “supposed” to hurt because evolution did us dirty or we just haven’t found whatever magical combination of positions, waterbaths, and Gwyneth Paltrow’s bullshit that can make it not suck? We’ve done some lunacy to avoid pain in childbirth.

Have you heard what they did in the early part of the 20th century?

They just got women in labor super fucking high.

It was called ‘twilight sleep.’ Go to the hospital, get an injection, and the next thing you have any recollection of is a newly flatter stomach and a baby that you don’t entirely believe is yours.

Queen Victoria gave birth under anesthesia in the 1850s, and the public’s curiosity in the technique blossomed from there. German physicians Bernhardt Kronig and Karl Gauss refined the method into what they called Dammerschlaf, aka twilight sleep. Their clinic was in Freiburg Germany, subsequently the technique came to be known as the Freiburg method.

Women were given a cocktail of scopolamine and morphine. Morphine dulled the pain, while scopolamine had an interesting quality of helping them forget that they had ever been in pain, forgetting the labor entirely in many cases.

At first glance, it sounds like a pretty delightful way to evict a fetus. Which is exactly what they thought a hundred years ago with limited information.

Stories of women going to Freiburg positively thrilled with their experiences of having a painless baby stoked demand in the US. Feminist organizations popped up advocating for the right to control their bodies. Without a standardized approval process or testing, it was rolled out into delivery rooms across America.

Mistakes were made.

In the Freiburg Clinic, women were in small rooms, which seemed to reduce potential for feeling disoriented. They also had a larger team tending to them than for a typical delivery. Conversely, doctors in the US often treated the procedure like something that could be scaled up.

To be clear, women were not unconscious during twilight sleep. They were drugged in a semi-conscious state, and though they were on morphine, they could feel pain.

Doctors often figured that since women would forget the pain anyway, their complaints about labor pain would be noted and promptly dismissed. There were not enough doctors to keep up with demand, so nurses were trained (insufficiently) to manage patients and their medications.

Sometimes the women were left with rope burns from being tied down and writhing in pain. Sometimes the screaming was so haunting it alarmed neighbors of the clinics that performed twilight sleep deliveries. Watching the women in labor, semi-conscious, helpless and screaming may have been as traumatizing for some healthcare workers as living through it for some of the patients who were lucky enough to forget.

After a leading advocate for the procedure in the US passed away in childbirth, the public push for it stopped almost as soon as it started in 1916. It took another 35 years for various forms of the practice to come to an end in the US.

This has been your daily Moment of Science, asking you not to feel guilty about an epidural.

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