4.04.2012

A Quick History of Medication in Maternal Health Care - (and the Business of Being Born)

originally posted on 5/12/07

Taking the lead from another great blogger I read often - try to find her ;o) - and from a recent viewing of the Business of Being Born - I wanted to touch on the dark blemish of American Obstetrical practice - routine medication for birth. (BTW, it is funny that this was shown as a screening in the midst of a High Risk conference for Vanderbilt - on the heels of a recent development plan).

While watching the Business of Being Born - a WONDERFUL look at childbirth practices in the US - I was struck by one very apparent thing: doctor's know nothing about bodies and birth. They know everything about risk - and, as one OB nurse told me, their job was to take away pain and have a healthy mom - not to get the best outcome.

That mentality was prevalent back in the late 1800's - early 1900's when OB's infiltrated the childbirth field and it is prevalent now. FRIGHTENING! Why is it frightening you say? Let me expound...

Let's start with the advent of anesthesia in general. It all began on October 16, 1846, at the Massachusetts General Hospital in Boston, in a room now called the Etherdome, when William Morton administered the first successful public demonstration of ether anesthetic. This was a great breakthrough for SURGICAL needs, and the news spread around the world quickly. So quickly in fact, that within a month the first modern anesthetics had been given on both ends of Europe, and within six months in Australia and China.

One doctor who heard of the use of ether was James Simpson. Breaking out of his social class, he put himself through medical school and later became the chairman of obstetrics at the University of Edinburgh. He is best known for the forceps which he devised to counter his initial use of ether on maternal patients.

His first maternal patient was a woman whose pelvis was deformed by rickets (a common issue in that time from malnutrition) who delivered on January 17, 1847. These deliveries can be especially difficult because of the manipulation needed to get a baby out of a deformed pelvis.

There was a great concern, though, for this use of ether because of the knowledge that ether often stopped contractions. As well, most babies born from ether-administered mothers had ether-smelling breath, ether smelling placentas, and tires/lethargic/unresponsive babies. So, Dr. Simpson created forceps, to pull babies from their mother's wombs before they were 'too drugged' and to minimize the incidence of failed labors due to ineffective or stalled contractions. Then why was it continued?

To understand the merging of surgical breakthroughs and maternal downfalls, we need to look at the social climate of the time. Two major events were happening: childbirth was taken out of the home and into the hospital (where disease and infection ran rampant), and the feminist movement was on the rise.

"Early feminists campaigned for social reform of all types, for the abolition of slavery and the abolition of the use of alcohol. They were also concerned about improvements in health care, particularly for women and children. They had good reason to be concerned. Although death rates for men and women had been falling throughout the nineteenth century, risks of a woman dying in childbirth had not decreased. In New York City, for example, 15% of deaths of women between the ages of 20 and 40 were related to childbirth. Although deaths from other causes had decreased, deaths from childbirth had not. By 1900, 30% of the deaths of women in this age group were attributed to childbirth." - now remember that those deaths were NOT due to childbirth - but malnutrition causing complications in birth, deliveries being moved to hospitals where illnesses and disease ran rampant, and before the advent of antibiotics - IT HAD NOTHING TO DO WITH MIDWIFERY and THE SAFETY OF HOME BIRTH.

Suffragettes saw maternal health care as a significant area that needed improvements. The only problem is that they focused on the labor of childbirth (pain/discomfort) rather than the true source of the maternal and fetal demise of the time. Not to fault them as the information and scientific breakthroughs were not accomplished yet; in their early industrialized minds, pain equated illness and death.

(Maternal death rates dropped slightly in the US between 1880-90, when doctors rooted out the nature of childbirth fever in relation to cleansing practices in the hospitals. They started washing their hands between women's beds and the death rates dropped. Then, the numbers steadily rose again until 1940, when they dropped once again (steeply and greatly) with the introduction of antibiotics).

Queen Victoria used ether when she delivered Prince Leopold in 1853. From Inside Surgery:

"Queen Victoria went into labor on the morning of April 7, 1853. As her physicians readied her for the birth of Prince Leopold, John Snow positioned a handkerchief moistened with 30 drops of chloroform over her nose and mouth. The Queen had an immediate response to it. Over the next fifty three minutes he reapplied the anesthesia fifteen times, using between 15 and 20 drops each time. The birth was without complication and the child was pronounced healthy, although at the time no one knew that he was afflicted with hemophilia.When accounts of Queen Victoria's labor anesthesia reached the general public, John Snow became an instant sensation and was much in demand by the social elite of London."

The National Twilight Sleep Association was formed in order to support the use of a new maternal anethesiac development begun by a young obstetrical doctor by the name of Carl Gauss. Around 1900, Gauss combined two drugs that had been in the medical armament for a long time to treat childbirth pain. One main component was morphine, used to alleviate pain during surgery. It had, thus far, been avoided in obstetrics because of its effect on the uterus, its effect on the newborn, and its effects on bleeding and infection. The other drug was scopolamine, which causes amnesia - in the past, these had been used as poisons in high doses. Hamlet's father was killed by one of scopolamine's cousins.

Gauss mixed these two drugs and administered them in 'small doses' to his patients - the morphine provided relief from pain while the scopolamine provided the women with amnesia of their labors and what was done to them. The problems? Oh, there are many!!! Scopolamine caused women to lose their inhibitions. They would have no memory of what went on, nor did they realize what was happening, so most of them screamed during labor. They became uninhibited and psychotic. They would thrash about on the bed, causing injuries to their heads. So, their heads were wrapped with blankets or towels, turban-like. They would attempt to claw at the walls or their medical providers, so they were put in straight jackets or their wrists were strapped to the beds. Then, so that they would not fall out of bed, they were put in 'labor cribs' - and were allowed to labor, screaming, tied down, blinded and bound - often in their own urine and feces, and sometimes for days on end, until it was time to birth. The women had no memory of this, the husbands were not allowed in to see their wives, so they didn't know what was happening - and everyone was happy.

Gausses concoction was tried out first in Europe and was found to be less than satisfactory for maternal care. It would probably have died out there had it not been for an infamous article in McClure's magazine. Two female reporter's who were also staunch feminists, accompanied their friend to Germany, where she was traveling to be 'treated by Dr. Gauss'. The woman was administered Twilight Sleep and was ecstatic with it. She simply woke to a baby - with no memory of the labor or birth. The three women decided to liberate American women through Twilight Sleep.

Every woman wanted to have that type of birth. Medical research was not sought as to the safety, and feminist drive demanded quick results. So - the U.S. because predominantly a Twilight nation between the years of 1914-1945 (although my grandmother recounts her story of TS in 1956 and there are reports as late as the 1980's).

Thankfully (and sadly because of what it took) this time in American history quickly collapsed when Frances Carmody died under Twilight Sleep. Although there had been numerous women who had died under Twilight Sleep, she was the wife of a Brooklyn lawyer and happened to also be a huge rally organizer for the Twilight Sleep Campaign. Her husband and her OB assured everyone that her death had nothing to do with Twilight Sleep, but, with a key organizer gone from the game, at the very time she was using something she was promoting, the campaign began to fall apart.

Women began to have windows of remembrance, and by 1948, the baby boom got into full swing and the huge number of women having babies while under Twilight Sleep raised the issue of comfort at a cost. Women began reporting their birth trauma - both physical and emotional/mental. Moms began to speak out. And, in 1958, an article headlined "Cruelty in Maternity Wards" ran in Ladies' Home Journal. It detailed the "tortures that go on in modern delivery rooms.". The response? 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."

Women began desiring and demanding safer births - the OBs were fraught with the problem that they could not guarantee a medicated, but safe, birth. So, in the 1960's and 1970's - many women went back to natural birth. This was short lived, though, as Obstetrician's saw income diminishing... Cue the epidural.

Mothers giving birth in the late 1970s and '80s had more options than ever. They could have a medicated or unmedicated birth. They could deliver in a freestanding birthing center, a hospital, or at home (in most states). They could be attended by a midwife, an obstetrician, or both (in some states). And, through all of these options, they could have their husbands by their side.

What led up to the advent of the epidural? In 1898 German doctor August Bier injected cocaine into his assistant's spinal column. It numbed his lower body, but the next morning he awoke with horrible vomiting and headaches (cue the spinal headache). It took the next 80 years to perfect this. But, by the 1970s, lidocaine was dripped into a tube inserted by needle into a woman's spinal column. By the 1980's, it was all the rage! The hitch? The procedure numbed women to their chests, causing breathing issues and, at times, heart problems.

My question - and the question that Ricki posed in her documentary is this:

What will we find in the near future is the clinically proven downside to epidural births? We NCB advocates already know of the obvious, though seemingly unimportant to many women when compared to an easy labor, risks... But think of it...

- In the late 1880's early 1900's it was chloroform / ether - which inhibited neonatal breathing attempts, caused forceps to be necessary (which caused many horrible scarring issues with babies), maternal reproductive harm, and heart failure routinely.
- In the early to mid 1900's, it was forceps - which were necessitated from the use of 'knock 'em out medications. These scarred women's cervix's, making them incapable of dilating at all or efficiently in later pregnancies, tore ears, noses, and scalps off of babies, and created severe perineal and labial scarring in women. Forceps are still used today!
- In the mid 1920's, it was Twilight Sleep - causing maternal mental, emotional, and physical trauma, more of the same as chloroform did, AND caused a number of incidences of stillbirths.
- In the mid 1950's-60's, it was thalidomide, prescribed to pregnant women routinely - causing the widespread incidence of 'flipper babies' - children who were born with severe malformities, including phocomelia (short limbs and deformed extremities).
- In the 1970's, it was early spinal/epidurals where the needles were too large and the puncture too deep, causing a whopping 50% of women to get debilitating spinal headaches that, at the time, were not treatable.
- In the 1990's, it was Cytotec, used to induce labor (off-label and unapproved). With a HUGE risk rate, it can/did cause stillbirth, neonatal distress, uterine rupture, severe postpartum hemorrhage, and more. Cytotec is still used today!

What do all of these things have in common? NONE of these procedures are tested before they are tried out on pregnant and laboring women. We are used as guinea pigs. So, my, and Ricki's question, again, is: What will we find in the near future is the clinically proven downside to epidural births? And, at what cost?

We have a huge increase in ADHD, ADD, Autism, early and late-onset Jaundice, asthma, and allergies/intolerances... how can we know that these are not a result of our maternal health practices now? We can't. BECAUSE, we are a society driven on comfort and ease rather than health and well-being. Well-being does NOT equate to ease or comfort. And, until we demand better health care, we are doomed to repeat history on different levels - until we learn to choose better for our bodies and our babies and leave the testing to the REAL guinea pigs.

See here and here (pic) for more information on this history.

*Edited to add the great information sent to me by some readers!

12 comments:

kris said...

wow! that's a fantastic post. i have read about the thrashing and fighting in twighlight sleep, that's just horrific.

and you're so right, well being does not equal comfort. we are too spoiled and selfish.

man i can't wait to see the business of being born!

Rachel said...

Great post! If I could add one small note, it's that what I often see left out of lists on practices that were later proven harmful is DES, used to try to prevent miscarriage and causing increased risk of a number of reproductive problems in the daughters of those who were prescribed it. Not exactly labor-related, but relevant to overall issue, I think.

mm said...

Brilliant.
Please step up to the soapbox again! I LOVE THIS!

Navelgazing Midwife said...

Very emotional, and for the most part, well-written.

There are inaccuracies, however.

Scopolomine was used into the very early 80's. 1972 was certainly not *near* the last it was heard of. Beginning birth work in 1983, I obtained the records of my best childhood girlfriend and she was "scoped" in 1980. During the screening of BoBB in my own offices, a woman my age said she was scoped in 1982.

Cytotec was not used in the 1980's, but in the 1990's. The warning from the makers came right at the turn of the century, but the discovery of problems began being researched in 1998, as Marsden Wagner explains in the BoBB.

Forceps were used for many, many years past 1945. Myself, I was born by mid-forceps in 1961 because my mom had a spinal, de rigeur because back then, they didn't give a block until second stage! Women would be scoped through much of their labors, but as second stage began, the medication was allowed to wear off and the women were given spinal or saddle blocks. Epidurals were extremely rare in obstetrics until the late 1980's.

You didn't mention that Queen Victoria was the first woman to use anesthesia in labor and birth. When she delivered Prince Leopold in 1853.

From http://insidesurgery.com/index.php?itemid=173&catid=35 comes this:

Queen Victoria went into labor on the morning of April 7, 1853. As her physicians readied her for the birth of Prince Leopold, John Snow positioned a handkerchief moistened with 30 drops of chloroform over her nose and mouth. The Queen had an immediate response to it. Over the next fifty three minutes he reapplied the anesthesia fifteen times, using between 15 and 20 drops each time. The birth was without complication and the child was pronounced healthy, although at the time no one knew that he was afflicted with hemophilia.

When accounts of Queen Victoria's labor anesthesia reached the general public, John Snow became an instant sensation and was much in demand by the social elite of London.

Here is a picture of how chloroform was administered to obstetric patients.

http://www.general-anaesthesia.com/images/obstetric-chloroform.html

An amazing piece on the history of general anesthesia can be read here:

http://www.general-anaesthesia.com/ (for those freaky people like me who thrive on this stuff.)

Hope you don't mind my adding some detail to your really good post!

Nonbreeder said...

Navelgazing Midwife is definitely correct about the twilight sleep drugs still being used after the 1960s. I was born in 1970 and my mom has no memory of my birth because she says the docs put her under twilight sleep (scoped). The first day of my life and I'm on drugs already. Nice going, mom.

Susan Rankin said...

I find this blog to be very interesting, I myself am a mother of two and a labour and delivery nurse.
Although it is very true that there was been some history of tragic instances in the world of L&D, but let us not forget that the overall mortality and morbidty rate has GREATLY decreased over the years and we see way more positive outcomes.
Please be careful when you label the medical profession as a whole as 'not knowing anything about bodies and birth' and how the nurses job is to get rid of the pain. That is only one experience (yes, I know there will be others!) but if it soooo bad in the hospital, why are women still doing it? Some women feel more comfortable at home, som in the hospital. We fight everyday for the right to choose, don't be prejudiced to others decisions.
Susan Rankin

Anonymous said...

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Dawn said...

I believe this article is extremely biased against relief in childbirth. I see only a few, of the thousands of births, as being problematic.As another poster said, death in childbirth is almost unheard of in my era,1950's on, and mothers and children are healthier than ever.Most doctors were men and could care less if you lay there and gave birth with nothing to kill the pain.They were present only in the last moments to basically cut the cord.That's the easiest for the doctor with no malpractice suit opportunity.For those who think it's a good thing to give birth with nothing, I say good for you and go for it, but I would also say that makes about as much sense as pulling your teeth with no anesthesia.That was also a practice of the past.That makes about as much sense to me as the women who think they are so much better off "being brave",when you're in so much pain, how do you think that makes your baby feel?I am 60 years old, had to drive 80 miles to find a doctor who would use Twilight Sleep, delivered a baby boy, now a fine businessman, 39 years old,Masters Degree in Business, who has made me a proud grandmother of a 4 year old granddaughter, perfectly healthy and very intelligent.I had NONE of what you're talking about in this article.I put my makeup on for childbirth and fixed my hair, when I came out, I was the same. It was wonderful.I had witnessed the natural childbirths with nothing for pain, and they scared me beyond words. Talking about screaming and thrashing about..if you think that's beautiful, think again,it's sadistic in this day and age.I was scared out of my mind and wanted a doctor who would help me through all of that.I had an easy birth with no problems.My daughter-in-law was given all of this scare talk about needing a natural birth and she got my blessing and advice to arrange for pain relief and to NOT believe the garbage being dumped on the young women of this day.She has thanked me more than once.So please,give a fair and balanced article the next time, for this one is NOT.I am now 60 years old, a retired school teacher and married to the same man for 40 years. Born very poor, but didn't stay there, the fifth of six children.Being born later in age to my mother,she had four of her children at home with no help(her ONLY CHOICE at the time) and two of us at the hospital.She said to get some choloroform on the end, if I could get it, because it most surely helps (she had done it both ways).I feel I did even better and am so thankful for the help I got from a caring doctor. For those who want to blame their mothers for everything wrong with them, grow up and take responsibility.It wasn't her fault.My son has never had a drug or emotional problem.So there. You've heard it from one who actually has been there and done that and got good results.Sorry to shake up those out there who think they've got all the answers.I simply could not let this article go unchallenged as it is so far from the truth as it is being told to young women today.I challenge all young women to be critical and think for yourselves as to what makes sense and what does not make sense.Do your own investigations into matters of importance.Nobody cares about you more than YOU.

Nicole D said...

Hi Dawn -

I am happy that you had a good experience and are happy with your births. OTOH, this is not MY history, it is THE history of childbirth and pain medication.

The Twilight article that I am talking about, along with it's side effects and reported issues are fact, not rumor or legend. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920649/

is a great read, in the event that you are interested in doing some research on it.

For quotes directly from it, including from nurses and doctors who watched these women, see here: http://www.glorialemay.com/blog/?p=282

on the other hand, as a doula, mw apprentice/assistant, and childbirth educator, I have NEVER seen a woman writhe and scream in agony over labor when she is able to move and be unrestricted during her birthing time. NEVER.

"For those who want to blame their mothers for everything wrong with them, grow up and take responsibility.It wasn't her fault.My son has never had a drug or emotional problem.So there."

Really? What sources do you have? Because I have a TON to back me up. Take a look at the research, there is a TON out there on the use of medications and synthetic hormones causing an increase in drug abuse and emotional/mental disorders including ADHD and short-term developmental delays, to name just a few.

"and mothers and children are healthier than ever."

No, they're not. Study after study shows that women who are able to birth with MW support and little to no intervention have the best healthy outcomes in comparison to the highly interventive childbirth practices of the 1920's and on... We, the US, have one of the worst maternal and fetal mortality and morbidity rates out of all of the developed nations. That is saying something - we are doing things WRONG.

"Most doctors were men and could care less if you lay there and gave birth with nothing to kill the pain."

Not true. It is more difficult and time consuming to labor WITH an unmedicated woman... it requires one-on-one care and she usually wants/needs much more than a medicated woman who sleeps through her labor. This means that many NCBers are considered 'difficult' or 'high-needs' in labor. The easiest and most profitable way to do it, in their eyes, is to medicate mom, put a whole bunch of wires and technology onto her, then go monitor her and the other 5-20 women on the floor from the convenience of the nurses station.

"but I would also say that makes about as much sense as pulling your teeth with no anesthesia."

Take a look at Dr. Sarah Buckley's report on Ecstatic Birthing... she talks about how the hormones of labor and birth are so necessary... and they are triggered by discomfort. So, inhibit the perception of that, and we loose the production of those hormones... it is NOT the same as pulling a tooth without anesthesia...

Dawn, I appreciate you taking the time to write such a heart felt comment, but I can read a lot of frustration and personal vehement in it. I strive to give education through facts/research... and that is what I have done.

Anonymous said...

I had have given birth 2x very successfully all natural at a birth center. It went very well. While yes I had pain, the midwives and my husband did very well to keep me calm and comfortable as possible. It was the most joyous thing to see my child be born and to hold them as soon as they were born. I wept with joy. Thank you for this post.

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