Med thumb sleep

Twilight Sleep was a forerunner to modern anesthesia. And while retro is usually cool, this is definitely not one of those cases.

Throughout much of the early- to mid-20th century, mothers-to-be, about to give birth, were most often the patients who underwent “twilight sleep” — or Dammerschlaf as it was called by German physician Carl J. Gauss, credited with inventing it in 1903.

The process, in which doctors used a combination of drugs to keep patients in a state somewhere between sleep and wakefulness — a twilight zone, if you will — was regularly used during labor deliveries

What were the drugs used?

Gauss combined two drugs, morphine and scopolamine. Morphine, you’re probably familiar with. Scopolamine, perhaps less so.

The powerful compound is derived from South American nightshade plants (or the Borrachero tree, according to other sources). Under the influence of scopolamine, the patient is semi-conscious, open to suggestion and — according to lore — very candid when asked a question. The substance was one of the original “truth serums.”

The blend of drugs provided just enough pain-killing morphine to disinhibit mothers in labor, plus sufficient scopolamine to induce a state in which they were alert enough to follow a doctor’s orders. Most importantly, they were not sufficiently lucid to remember anything about the experience. This memory lapse was how Gauss and other physicians who championed the method passed it off as providing “painless childbirth.”

As a side note, scopolamine has continued to make colorful history. Recently it’s been written about as “the most dangerous drug in the world,” called “Devil’s breath.” Because the drug renders victims into a “zombie-like” state, coherent but with no free will (and no memory of events), it’s become the drug of choice to aid and abet thousands of crimes in South America.

Back to those moms…

Yes, the moms. As you might guess, not remembering pain doesn’t mean one did not experience it. Indeed, there were indications that women undergoing childbirth in this manner were in utter agony.

Mothers writhed, thrashed and often hallucinated while under the drug’s effects. If you were a fan of the show Mad Men, you may remember Betty Draper freaking out while delivering her third child, Gene. That was meant to illustrate what the terrors of twilight sleep could be like.

Nonetheless, Gauss continued to experiment and refine his “Freiburg Method” (so named because Gauss was based in Freiburg, Germany) and, by 1911, he and others had used the technique in 8,000 to 10,000 births.

Midway through the decade, a journalist named Hanna Rion (later known as “Mrs. Frank Ver Beck,” relinquishing her identity as required in those days) enthusiastically endorsed the technique in a book published in the U.S. This led to the popularization of twilight sleep on these shores.

Didn’t anyone hear the moms in distress?

Because social norms of that time kept dads out of delivery rooms, only the medical staff witnessed birthing mothers in twilight sleep. The use of this method began to ebb when a 1958 expose in Ladies Home Journal titled “Cruelty in Maternity Wards” recounted “horror stories” from nurses and others who’d seen twilight sleep deliveries firsthand.

These terrible tales, along with emerging studies about the drugs’ depressive effect on babies’ central nervous systems, caused the practice to fall out of favor by the late 1960s to early 1970s.

Today, for procedures that don’t require general anesthesia, doctors safely combine local anesthesia (which acts as a nerve block) with IV sedation, which induces a sleepy-like state. Patients don’t experience pain and typically don’t recall the events of a procedure.