The Real Story of Twilight Sleep and How it Shaped Obstetrics and Hospital Birth
How It Began
In 1913 two female reporters from McClures Magazine in New York, Marguerite Tracy & Constance Leupp, went to the Frauenklink in Freiburg Germany to witness and write about “Dammerschlaf,” the apparent miracle of Painless Childbirth. The Frauenklink was the Women’s Clinic of the State University of Baden, directed by Dr. Bernhardt Kronig and Dr. Karl Gauss.
Early Experimentation
Dr. Kronig had both a scientific and humanitarian interest in the pain of childbirth and had been obsessed for a decade with the development of Twilight Sleep. He believed labor pain was destructive – causing complications and trauma. He especially deemed this true for “modern” (weak, vulnerable) vs. “peasant” women (strong-willed, hardened).
Twilight Sleep was based on the earlier research of Dr. Richard Steinbuchel. Scopolamine, derived from a highly toxic plant (henbane), was gaining acceptance in general surgery, but many obstetric experiments ended badly or in overdose. Reports recorded the desirable sedated state but also the problems and side effects: slowed pulse, decreased respiration, delirium. Experimentation continued, with repeated small injections of varied doses of scopolamine and morphine.
Kronig & Gauss presented a series of papers on Twilight Sleep that included the drug’s ability to erase the memory of the birth at a national obstetrics conference in Berlin in 1906. They were met with indifference, hostility and rejection. City doctors balked at the small town “country” doctors’ experiments, and cited the dangers of scopolamine.
For the next several years, as Kronig & Gauss kept publishing their successes, wealthy German women started traveling to Freiburg for “painless babies.” Finally a team of city doctors went to investigate [and hopefully bring an end to] the treatment. They did poor research trials, and ultimately concluded in their final reports that Twilight Sleep was “a poison…incalculable in its effects.”
Twilight Sleep disappeared as a topic of consideration in the German medical world, but Kronig & Gauss quietly continued their work in Freiburg.
In these first years of experimentation, a few U.S. doctors also went to Freiburg, returning with mixed reactions. Dr. Joseph DeLee, Professor of Obstetrics and Founder of the Chicago Lying-In Hospital, was unimpressed, citing long labors, hemorrhage, delirium, and fetal death. Another Chicago doctor warned that Twilight Sleep in the hands of untrained doctors could be dangerous.
Kronig and Gauss eventually found that given carefully with a single small dose of morphine, scopolamine produced a “clouded consciousness with complete forgetfulness.” Women woke up with no memory of the birth. The doctors attributed their improved outcomes (fewer complications, quicker recovery) to the eradication of pain and fear. Soon the clinic had the lowest maternal and neonatal deaths in the state of Baden.
American Women Revolt
In 1912 an American woman named Mrs. Stewart gave birth to her second child in Freiburg and described her experience as “a fairy tale:” luxury room, compassionate doctor, sleeping through the birth, wonderful food, mountain view, “like a beautiful hotel.” She stayed for a month.
When journalists Tracy & Leupp arrived at the Frauenklink in 1913, they were turned away by doctors and staff. Not to be thwarted, they talked to local women, who spoke glowingly of their clinic birth experiences: comfortable suites, wonderful staff, awakening from labor to find their babies born.
In order to gain access, the two reporters sent a pregnant Mary Sumner Boyd to give birth at the clinic in 1913. She was attended by Dr. Gauss, who was unaware of the undercover ploy. Sumner Boyd received the state-of-the-art care bestowed on the wealthiest, most privileged women of Germany.
The McClures article, published in May/June 1914, ignited an already volatile Feminist Movement in the U.S. Describing the 1912 birth of Mrs. Stewart, along with Mary Sumner Boyd’s experience, the article presented Twilight Sleep as a new miracle discovery, rather than the return of a 12 year old medical controversy rejected by most American doctors and hospitals. The article criticized the medical world for withholding the miracle and urged women to rise up and fight against the oppression of medical men.
The Feminist Backstory
The 1914 article was received as a call to action. All hell broke loose. Wealthy women went to Freiberg and returned with glowing reports. American media and women’s magazines demanded that obstetricians follow their enlightened German colleagues and adopt Twilight Sleep. The battle for Twilight Sleep symbolized the battle for Women’s Rights.
This was the period when the early Feminists were demanding the right to vote, serve in the army, receive equal pay for equal work, use birth control, form women’s colleges, and end male domination.
At the same time, the Anti-Feminists were the wealthy, well-connected women, who called Feminist demands such as equal pay, voting, and especially birth control “unnatural.” They were likely afraid of their privileged lives being derailed; they also held an upper class racism that sought to out-reproduce the immigrants and working-class.
The cause of Twilight Sleep united them both. The prospect of painless childbirth cut across battle lines, uniting feminists and anti-feminists in a shaky coalition.
Feminists saw Twilight Sleep as a liberation from male oppression, while the Anti-Feminists saw it as good for childbearing women – an encouraging step toward fulfilling a woman’s “god-given” duty to reproduce. In 1915, Mary Sumner Boyd (of the wealthy, traditionalist camp) and Marguerite Tracy (single reporter of the feminist camp) wrote a book together, Painless Childbirth. The overwhelming response resulted in the formation of the National Twilight Sleep Association. High-profile women like Madeleine Astor, well-known suffragettes, and a prominent Chicago obstetrician, Dr. Bertha Van Hoosen, took on the crusade. Interestingly, Van Hoosen and other painless childbirth advocates incorporated a very anti-sex mentality: “Painless childbirth will eradicate prostitution, abortion, divorce, childlessness, venereal disease, sexual excess in marriage.” Van Hoosen was a firm advocate of using anesthesia to break the link between the brain and the sexual organs. In her practice, some women slept through labor; others became hysterical. Van Hoosen developed a canvas crib-like bed, to cage them in.
Ladies World, Readers Digest, Ladies Home Journal and other such magazines presented only the blissful outcomes; movies such as “Science’ Greatest Triumph” were shown throughout the U.S.. Twilight Sleep was the biggest topic in the nation alongside World War I. Kronig and Gauss were dismayed by the publicity.
Controversy
While the 1914 lay press raved about Twilight Sleep, the medical literature continued to report the problems – asphyxia, agitation, inhuman suffering of women, morphine-slowed contractions, headaches, thirst, uncontrollable delirium requiring restraints or straitjackets. Some hospitals tried it and abandoned it within months. Women kept insisting on it. Champions of Twilight Sleep insisted that the side effects stemmed from incompetence. The popular press excluded details of violent kicking, thrashing, screaming, restraints, caged animal behavior, depressed newborns. Their information came from patients like Mary Boyd, who had no memory of the birth, thanks to the highly skilled, one-on-one care of the Freiburg doctors. Articles implied that women drifted to sleep after one shot, and awakened refreshed, 12-24 hours later, with a healthy child. Some disclaimers, such as a long article in the NY Times, sounded notes of caution.
Most U.S. doctors were anti-Twilight Sleep, angry at the avalanche of demand from “ladies’ magazines.” The 1914 New York Medical Journal warned that doctors were being rushed into “indiscriminate administration” of a procedure “tested and found wanting.” But the speed of demand was unstoppable, as the popular media simultaneously presented huge local successes. With enormous public pressure and potential loss of clients who were switching to doctors offering the “Freiburg Miracle,” hospitals from New York to San Francisco began scrambling together Twilight Sleep units.
Part Two coming soon.