Taking Great Pains
Written By Tina Cassidy
print
An abridged history of pain relief in childbirth.
circa 1914-1945: twilight sleep takes over
Chloroform, which physicans often used during labor in the 1800s, had a downside. It could make breathing diffcult, even deadly, for the newborn, and the drug was iffy to dispense; you splashed some on a handkerchief and hoped for the best. But by 1914 doctors in Freiburg, Germany, were using a much more precise technique called Daemmerschlaf, or "Twilight Sleep," in which the mother was injected with morphine and scopolamine (a drug that caused amnesia) so that she'd be in a state of finely balanced semi-consciousness, without feeling pain and with scant memory of what happened.
A few U.S. hospitals began offering the injections, but suffragists rallied for more. The end of birth pain, they felt, was part of their emancipation.
Despite physicians' initial reservations, Twilight Sleep became standard procedure. As Edith Wharton writes of a mother-to-be in her 1927 novel, Twilight Sleep: "She had the blind dread of physical pain common also to most of the young women of her set. But all that was easily managed nowadays. . . . There ought to be no Pain. Nothing but Beauty."
circa 1945-1960: cruelty in maternity wards
By the time the postwar baby boom got into full swing, the sheer number of women having babies under Twilight Sleep raised a new issue: The method dulled the pain, but at what cost? Women were restrained and strapped to gurneys for their own protection as they thrashed around in bed, freed from their inhibitions by the drugs. Some had their legs clamped in stirrups for hours in order to be ready when the doctor arrived.
Mothers began to speak out. In 1958, an article headlined "Cruelty in Maternity Wards" ran in Ladies' Home Journal, and described in detail the "tortures that go on in modern delivery rooms." A flood of women sent the magazine their own horror stories. "I've seen patients with no skin on their wrists from fighting the straps," a nurse from Canada wrote.
"Just let a few husbands in the delivery rooms and let them watch what goes on there," said one reader from Detroit. "That's all it will take — they'll change it!"
An Indiana mom claimed, "The whole thing is a horrible nightmare."
circa 1960-1975: enter natural childbirth
British obstetrician Grantly Dick-Read had grown up on a farm, and he did not believe women should have it any harder than domesticated animals. He was sure a natural labor could be joyous and not very painful. Fear and tension were to blame for suffering during labor, Dick-Read insisted, and if he could reduce anxiety through education and support, birth could become a positive natural experience. His 1933 book Childbirth Without Fear (published in the States in 1946) helped seed a revolution: Dick-Read is credited with coining the phrase "natural childbirth." But a hostile medical establishment marginalized him before his death in 1959.
There was one doctor, however, who was keen to build on what Dick-Read had started. Fernand Lamaze, a French obstetrician, knew Dick-Read's work. He also believed that women could give birth drug-free and in control. Lamaze, however, had a more hands-on approach. His technique was based on psychoprophylaxis, or mind over matter, taking a cue from the Soviet physiologist Ivan Pavlov (as in Pavlovian — think dogs salivating at the ring of a bell).
Like Dick-Read, Lamaze might have been dismissed — had it not been for Marjorie Karmel, an American in Paris who had sought out Lamaze to deliver her first child. Karmel took classes with Lamaze's assistant, Madame Cohen, who taught her that she could train her mind to suppress pain. "That is why we don't call our system 'natural' childbirth," said Cohen (imperiously, one imagines). "The final result should be better than nature."
Lamaze's trick was to breathe more often (some called it the small-dog panting technique). He theorized that much of the pain of labor was caused by the extraordinary activity of the uterus, which exhausts the supply of oxygen in the blood. Karmel's experience provided the basis for her 1959 book, Thank You, Dr. Lamaze. In 1960, Karmel and one of the book's admirers — Elisabeth Bing, a clinical assistant professor at New York Medical College — formed the American Society for Psychoprophylaxis in Obstetrics, to teach childbirthing classes. In 1967 a New York Times article on natural childbirth quoted a nurse from the Maternity Center in Manhattan saying that, when it came to the Lamaze Movement, "the fad element has been weeded out. Now it's in the middle of the road."
Bing, now 92, is philosophical about this sea change: "It wasn't really a movement by Lamaze or Read or me. It was a consumer movement. The time was ripe. The public doubted everything their parents had done."
circa 1975-today: the epidural era
Mothers giving birth in the late 1970s and '80s had more options than ever. They could have a hospital birth — with or without pain-relief drugs. They could deliver in a freestanding birthing center or at home, as their grandmothers had. They could be administered to by a midwife, an obstetrician, or both. And, perhaps the biggest change of all, they could have their husbands by their side throughout the whole ordeal, a shift in hospital policy that only kicked in widely around the mid-1970s.
They could also have an epidural. Backstory: In 1898 German doctor August Bier injected cocaine into his assistant's spinal column. It numbed the fellow's lower body, but the next morning he awoke with horrible vomiting and headaches. Apparently, it took the next 80-odd years to finesse the method. By the 1970s, when epidurals were first widely used in obstetrics, the numbing agent lidocaine was dripped into a tube inserted by needle into a woman's spinal column. The hitch? The procedure numbed women to their chests, causing breathing diffculty and, sometimes, heart problems.
The method got further refined as doctors learned that the needles had to be smaller, so that less spinal fluid would leak from the dura, the thin membrane that surrounds the spinal cord and the brain. Such leaks caused the fluid level to drop, which can make the brain sag, pulling on the connective tissue. The result: throbbing head pain, an infamous side e<>ect, and the hefty price one sometimes paid for the drug's numbing comfort. But the better the epidural got, the more women wanted it. In 1975, 20 percent of American women chose to have an epidural; today that figure has risen to 70 percent, spiking as high as 90 percent in some U.S. hospitals. To offer some context, the epidural rate in Japan is still in the single digits.
But as with every phase of obstetrical history, when women have felt that one way of giving birth was the way — whether decreed by religious, medical, or cultural norms — a backlash has resulted. And so it seems certain that one day, maybe soon, we will abandon the epidural, just as we have given up on coca leaves and chloroform. The question is: What will replace it?
This Just In...
Patient-controlled epidurals, which allow women in labor to adjust the
timing and frequency of their anesthesia with the push of a button, have been around since 1988. What's newsworthy is this: Researchers have recently confirmed that women use an average of 30 percent less anesthesia with this method than with the continuous infusion method, where an anesthesiologist decides the dosage. Not too surprisingly, women may need less medication when they feel more in control of their pain.
The Pain Talking
1946-1948
"With my first, there was no sharp pain at all under Twilight Sleep. Just a lull and I'd drift off. Then my eyes would open and I felt like I was floating. My second baby came too fast for Twilight Sleep. I felt like my hips were ripping apart, and I ripped the sheet on the delivery table. The nurse tied me down, both wrists."
1960-61
"I wanted no anesthesia but they gave it to me anyway. It was awful with my first baby, just awful. You don't remember anything that's happened. You're not aware — and I wanted to be aware. With my second, I had nothing. It was a wonderful, wonderful experience to push a baby out of you and feel it."
1974
"I took Lamaze classes, and got a doctor who'd deliver at home. Our friends and family were there, 24 people in all. I could smell cooking, onions and garlic being sauteed downstairs. My pain was intense but manageable; I did my breathing. By the end, everyone was in our room singing and chanting, candles lit everywhere. It was wonderful."
1992
"I didn't take drugs because I felt like I was already drugged. Pain was the drug and I couldn't imagine adding another substance to the mix. It felt like dying and being reborn. I liked the intensity. Afterward, I liked the Percocets."
2001
"I joke that the epidural is the best thing that ever happened to me. It let me be present in a way that I wouldn't have been if I'd been focused on the pain. I remember feeling like the anesthesiologist was bathed in light and thinking 'You are my hero.'"
2003
"Most people say you don't enjoy childbirth, but I did. The pain goes away right after birth. I was like, 'Let's do it again!'"
