Childbirth, Pain and Women's Movement(s)

Yahweh asked the woman, “What is it that you have done?”The woman replied, “The serpent tempted me, and I ate.”Yahweh said to the woman, “I will multiply your sorrows in childbearing. You shall give birth to your children in suffering...”Genesis 3:13,16

Apparently, some women decided to get a second opinion. Just over three months after William Morton introduced ether for anesthesia at Massachusetts General Hospital in Boston in 1846, obstetrician James Young Simpson administered it to a woman in labor in Edinburgh, Scotland. And, barely a few months after that, on April 7, 1847, Fanny Appleton Longfellow (Henry’s wife), in Cambridge, gave birth using ether with the assistance of Nathan Keep, who had experience using it in dentistry.

Despite the terror that many women felt regarding the prospect of labor, the controversy about using anesthesia persisted. Some felt that it represented a violation of God’s will. Many physicians expressed concerns regarding safety and “interrupting a natural process”. When, in 1853, Queen Victoria gave birth to her eighth child using chloroform (which had become more popular in England) the acceptability of using anesthesia was given the visibility that it needed. By 1900, approximately 50% of physicianattended births used ether or chloroform. Relief was limited, however, to the delivery itself, and labor pains prior to delivery had to be dealt with by the patient.

In 1902, von Steinbuchel of Gratz, Germany introduced the combination of scopolamine and morphine to produce analgesia and amnesia during labor and delivery, using the newly developed hypodermic syringe. To protect their amnesic state, the women needed to be kept in a darkened, quiet room and watched carefully to assure that they did not fall out of bed. Dubbed “Twilight Sleep” the technique spread quickly in Europe, but in America, doctors again felt that the safety issue was not settled and were reluctant to adopt the procedure.

Following the publication of a two-part series in McClure’s Magazine in 1914 and 1915, Twilight Sleep Associations formed in the US. Rallies were held, pictures of healthy babies delivered under Twilight Sleep were displayed and leaders declared that “modern science has abolished the primal sentence of the scriptures upon womankind”. After a burst of enthusiasm in the era before 1920, the use declined as reports of depressed infants and mothers began to emerge. Still, Twilight Sleep was considered an option for the next half century.

Beginning in the 1950s, publications by Fernand Lamaze in France and Grantly DickRead in the US sought to introduce techniques of education, coaching, and breathing to better prepare women for labor and mitigate the severity of pain. After a woman from New York was delivered by Lamaze in France she sought the same approach here and, unable to find a doctor able to help her, wrote an article in the Women’s Home Journal. The Lamaze movement was launched, and the American Society for Psychoprophylaxis was formed.

This movement became even stronger in the early 1970s as the women’s liberation movement sought to assert more control over women’s health care. The first edition of Our Bodies, Ourselves by the Boston Women’s Health Collective noted that drugs should only be used in labor for a real medical emergency and cautioned that the use of drugs could “deprive a mother of one of the most joyful of human experiences”.

At the time, regional anesthesia, such as an epidural, was available but was discouraged by the Collective except under unusual circumstances. They noted that it was not always available, was costly, and might prolong labor.

As experience with epidurals increased, their safety was established, and they became more available (though still expensive). Patients’ viewpoints changed and today approximately 80% of deliveries are with epidural anesthesia. Queen Victoria would likely approve…

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