Pain, pleasure, and American childbirth. From the Twilight Sleep to the Read method, 1914–1960

With reason, women at the beginning of the century were terrified by the pain and danger of childbirth until Twilight Sleep, introduced to America from Germany in 1914, promised deliverance. The aim of the method was amnesia, not anaesthesia. Mothers were supposed to "drift into motherhood lightly and imperceptibly.. .wiping the whole incident of birth-giving out of a woman's life." This state was induced by the right dose of scopolamine and morphine at the right time, and a labour conducted in a room in which visual and auditory stimuli were minimal. But mothers vary, and so do labours. For some, amnesia was not achieved; for others, struggling for consciousness was said to be worse than pain. Under Twilight Sleep, birth attendants were often presented with a mother irrationally thrashing about during contractions, and deeply asleep in between; not to mention an infant with profound respiratory depression. Nevertheless, there were people who said Twilight Sleep was a milestone in the history of medical care-"the first time.. .that the whole body of patients have risen up to dictate to their doctors." The theoretical basis of Twilight Sleep was the belief that pain was a functional necessity; the method tried to abolish not pain itself, but the memory of pain. When the method was abandoned, total abolition of pain was demanded. Throughout the twenties and thirties analgesia or anaesthesia was achieved by a very wide range of drugs (notably opiates and barbiturates in combination) and anaesthetic agents. They contributed significantly to maternal and neo-natal mortality. This was not the only reason, as we shall see, but a reaction to the comatose, drugged mother was probably inevitable. It came in the person of Grantley Dick Read, whose impact on obstetric care on both sides of the Atlantic is due for reassessment. Fortunately, a large collection of his papers is preserved in the Contemporary Medical Archives Centre at the Wellcome Institute for future researchers. It seems likely that Read's influence was greater in the United States than in England. Read first published his Natural childbirth in England in 1933, and in the States in 1944; but it was not until 1948 that his method had a significant following in North America. The basis of Read's system was the belief that all women, from childhood, were conditioned to fear childbirth. Fear bred tension, tension bred pain, and all three added to the dangers of childbirth. The …