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Concept
Twilight sleep
Résumé
Twilight sleep (English translation of the German word Dämmerschlaf) is an amnesic state characterized by insensitivity to pain without loss of consciousness, induced by an injection of morphine and scopolamine, with the purpose of pain management during childbirth. The obstetric method originated in Germany and gained large popularity in New York City in the early 20th century.
In the Freiburg technique, considered the gold standard of twilight birth, patients were first given an intramuscular injection of of scopolamine and of morphine. Forty five minutes later, a second scopolamine injection of the same dosage was administered. A memory test was then given, and subsequent smaller doses of scopolamine were given based on the individual's performance on the memory tests. When performed properly, the drug combination caused a drowsy state and relieved the pain only partially, whilst creating amnesia such that the woman giving birth sometimes would not remember any pain, although these results were variable. Because of how variable the scopolamine dosages are between patients, and the need for accurate assessment of performance on the memory test, the twilight sleep method required skillful, well-trained practitioners for proper execution.
To effectively keep women in an amnesic state, sensory isolation was necessary. Women gave birth in a darkened room, and the birth attendants wore uniforms designed to minimize noise. Women were sometimes blind-folded, had their ears plugged with oil-soaked cotton, or were tied to padded beds with leather straps to "promote sleep." Sensory deprivation also prevented delirium, one of the adverse side effects of scopolamine.
Prior to the 20th century, childbirth predominantly happened in the home, without access to any medical interventions for pain management. Childbirth was a leading cause of death for women, largely due to the movement of childbirth from the home to hospitals in the early 20th century. Doctors (primarily, if not all men) were now managing the vast majority of childbirths as opposed to midwives or Doulas.
Source officielle
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