“Twilight Sleep:” Is The Past Prologue for Today’s Debates Over Birthing Choices?


Two weekends ago, "Mad Men" fans were shocked
by the way in which Betty Draper gave birth to her third child, Gene. While
viewers perhaps perceived the process to be a long shot from a natural or hospital
birth today, they were taken aback by the trippy hallucinations Betty had in the delivery room
involving her parents and a dying Medgar Evers, and by her writhing and
shouting while tied down to her hospital bed without either her doctor (who was out
drinking) or her husband Don (who was hanging out in the waiting room) there to advocate
for her. When Betty regained full consciousness, her baby was in her arms and
the hallucinations forgotten. Needless to say, it was a harrowing viewing
experience, but perhaps even more horrifying than watching Betty was realizing
how common her situation was for women of her time.

Lauren at Feministe has a really excellent post breaking it down for readers:

Let’s break
out the Childbirth 101: As Betty is depicted, fifty years ago it was common for
women to be given a drug that would induce “twilight sleep” during a hospital birthing procedure. The amnesic
drug did not behave like a true analgesic pain killer, but instead induced a
state of disorient that managed pain by making the mother forget the entire
process of childbirth.

"Twilight
sleep" (induced by a mixture of morphine and scopolamine) was
introduced in the early part of this century to replace chloroform as an
anesthetic during childbirth, and was advocated by medical professionals and
women who thought it managed labor pain well and oddly enough, believed it
produced healthy, intelligent babies. But when it became standard protocol in
hospitals throughout the country in the 1930s, the kind of birth Betty went
through became de rigeur. Aunt B wrote a graphic description of it here.
Essentially, women like Betty were shackled or tied down and sometimes padded
because during their hallucinations, they would thrash wildly or bang their
heads, driven into a frenzy by the pain–which they were very much
experiencing–and the effect of the narcotics in their system.

Incidentally, as several feminist bloggers have pointed out, the fact that Don
and the other expectant fathers were always relegated to the waiting room was
ostensibly because of gender roles or social customs. But this practice
conveniently meant that women had no one to witness the awful side effects of
procedure, or demand that it stop. So "Twilight Sleep" remained
"the thing to do."

Maureen Corry, Executive Director of Childbirth
Connection
–a 91-year old nonprofit which in its current incarnation
seeks to inform and educate women about their childbearing options–describes a
friend giving birth in the 50s who refused Twilight Sleep and asked to
breastfeed (Betty, like most women of her time, doesn’t do this either) and was
treated as if she was crazy. Lauren writes that her mother gave birth under
the procedure. My own grandmother, who gave birth twice in the late 40s recalls
a dismissive nurse, somewhat like the sadistic nurse in the "Mad Men"
episode, arriving with a needle and injecting it over her protests, telling her
it was what the doctors insisted upon. Neither my grandfather or her own mom
were allowed in the room with her.

Another effect of  "Twilight Sleep," besides the physical
cruelty and pain, was a psychological sense of detachment for the new mom, a
bizarre blank where the birth should have been, which was one of the triggers
that led women to question the procedure. The backlash against procedure was
already in effect by the time Betty gave birth, ten years after my grandmother.
In the late 1940s, Childbirth Connection brought Grantly Dick-Read, British author of
"Childbirth Without Fear" to speak to American women. "His
premise was that women could have babies without going through the horrors of
twilight sleep,  screaming and writhing in pain," says Corry.
"He felt women need to be educated and they could deal and cope with
childbirth if trained to do so."

As Tina Cassidy reported in a piece about the history of pain
relief in childbirth
, five years before Betty gave birth to Gene, Ladies Home Journal ran an expose:

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."

Despite this rising awareness, "Twilight
Sleep" didn’t go out of vogue until the late 60s or early 70s–so Betty’s
experience is far from outside the realm of possibility. But by the
mid-seventies, things had certainly changed. As Corry points out, Lamaze,
started by a natural birth advocate who had studied Dick-Read’s work, was
"pretty widespread" at that point and epidurals, the current
anesthetic, arrived midway through the decade. Like chloroform before it,
"Twilight Sleep" went into the dustbin of history.

But more than being ushered out by medical advances, the practice ended because
"Women were empowered to make the change," says Corry. "They
wanted to birth in a way that gave them a sense of control, so they spoke
out."

And the social upheaval of the 60s, which "Mad Men "is gingerly
approaching, helped enable them to do so. "So many things were happening: women
were being educated in math and science, they were coming out of school and
working." says Corry. "It was the "our bodies, ourselves,"
era. Women’s rights were coming into play. Birth control was available, which
meant self-determination for women and the ability to control our reproductive
health."

Indeed, it’s telling that Roe was
legalized around the same time as Lamaze was making major inroads– as Rh
Reality Check and its writers have long been documenting, the rights of expectant mothers and
other reproductive rights come from the same place: acknowledging women as
people and their right to control their reproduction as a a human right.

While today’s birth have far less similarity to a torture chamber as they did
in Betty Draper’s day, today a similar lack of agency can affect women giving
birth, particularly at hospitals, says Corry. Because of the insurance and
medical system, doctors make more money by performing more procedures, which
leads to what many feel is an over-medicalization and intervention-heavy
birthing process from heavy epidurals to forced cesareans to women simply not
being informed of their options.  For some women in many areas of the
country, laws or the lack of options in their region severely limit their
ability to control the process.

Whether it’s trying to have a vaginal birth after a cesarean (VBAC) or
choosing to forgo drugs or have a natural birth, it can be difficult for women
to figure out and speak up, particularly in an institutional setting.
"It’s challenging for a woman to get her hand on trustworthy
information," says Corry. "How do you decide what’s good for you,
based on the best evidence rather than someone’s opinion? Even the most
motivated woman still has to deal with hospital protocols and staff who are
used to intervening in birth."

Just as "Twilight Sleep" ended as a result of women’s raised voices,
so must the issues women still face in childbirth today. Even if it’s not as
melodramatic as morphine-induced hallucinations, feminist are fighting a
medical system that reduces women’s agency over their bodies by presenting alternatives and by arguing for systematic reform.


In this video, Mad Men creator Matt Weiner and January Jones, who plays Betty,
talk about portraying "Twilight Sleep" on TV and about Don’s
experience in the waiting room.

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Follow Sarah Seltzer on twitter: @sarahmseltzer

  • redrosespiral

    After reading this article I found some that fit in frighteningly so with the subject:

     

    “Some day you’ll get to do this too.”-Mom whispering in 1968 into her newborn daughter’s ear, refering to her nonmedicated, natural birth just minutes before.“Oh no she won’t! By then they’ll all be Cesareans.” -OB, from his seat at the end of the delivery table where he was sewing up a tear.

     

    http://myobsaidwhat.com/2009/09/28/by-then-theyll-all-be-cesareans/

     

    Even back then some doctors were pushing for unneeded surgery instead of letting a natural and relatively process happen.
    I just hope that I’m able to birth my future children the way I want and not have unnecessary surgery thrust upon me.

  • heather-corinna

    Sarah, this is SUCH a fantastic piece.  Thanks so much for putting it here.

  • jillunnecesarean

    The positive in the situation is that information and experience on anesthesia and operative vaginal deliveries was gathered, just as infant formula was optimized. However, it wasn’t ethical to use women, fetuses and infants as subjects in a widespread experiment by framing it as healthy, progressive and optimal.

    At least when we look back in 30 years, we’ll have hopefully gathered information about what it really means to women’s health to see 30, 40, 50 and 60 percent cesarean rates as many hospitals have. That’s the only positive in this sick repeat of obstetric standardization that we call the rise of the cesarean section rate. Same song, different verse. Thank goodness for all of the vocal consumer groups who spoke out against Twilight Sleep and promoted breastfeeding! Hopefully this context gives people insight into WHY women are disgusted with the lack of options for birthing women.

    Because seriously… do OBs really collectively think they’re helping anyone besides themselves by overusing the cesarean? Because they’re not. I hate to sound like I’m continually calling a diverse group’s ethics into question but… come on. Want people to stop decrying the cesarean rate? FIX IT. KNOCK IT OFF.

    Also, I liked Amy Romano’s commentary on the Mad Men episode, too.

  • gordon

    I do not watch Mad Men, but when comments on "The Fog" hit the blogosphere, I assumed it must have happened in the early 60’s. The late 60’s/early 70’s were the time when my same-age friends started having babies, and I cannot recall a single one telling me she had twilight sleep. I am sure things didn’t change overnight, nor everywhere at the same time, but the complaints I remember about hospital birth in those days were always about the shave and the gallon-size enema, which I think were still standard procedure until the mid 80’s.

     

    Is it just my imagination, or did these sorts of things go out the window about the same time significant numbers of women joined the ranks of practcing obstetricians?

  • ctbirthadvocate

    What a great piece!