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

Sarah Seltzer

Mad Men fans were shocked recently as Betty gave birth in a "twilight sleep" while hallucinating and tied to the bed. This once common practice was ended through the kind of advocacy we need to expand birthing choices today.

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.

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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.

Commentary Politics

A “Kerfluffle” Over Forced Ultrasound? An Open Letter to Governor McDonnell

Tara Casey

Governor Bob McDonnell is trying to play down the outrage over an intrusive law mandating unnecessary medical procedures by calling it a "kerfluffle," suggesting he is trying to "empower women," and spreading other misinformation about the bill.  A resident of Virginia responds.

As a Virginia citizen, and especially as a woman and a mother of a daughter, I have voiced my opposition to the mandatory ultrasound bill.  Although I participated in the public protests to this legislation, I also sought to engage legislators and other constituents in discussions tempered with mutual respect and moderate voice.  When the Virginia Senate passed this bill, I expressed my profound disappointment in what I viewed as the misguided failure of our legislative process.  Nevertheless, I strove to maintain an open dialogue, free of platitudes and presumptions.

This evening, I learned that my Governor does not hold to the same rules in this debate.

Last Friday, Governor McDonnell sat down with National Review Online’s Jim Geraghty to discuss “the kerfuffle over the ultrasound bill.”  I recommend this piece to every Virginian to read as the Governor has used this platform to express his perspective.

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Below are his words.  I would like to use this platform to share my responses:

“If you just read the papers, you have no idea what’s going on in the legislature because the reporting has been so poor this session.”

Governor, I have been there as a steadfast advocate and witness.  The reason people are outraged and protesting is that they have been paying attention, very close attention.  Sustained engagement in and educational outreach on the legislative process leading up this bill’s passage has been a civics lesson for many.  Please, do not blame the media for the response to this bill.

“I don’t think the objective of an abortion clinic is to try to talk women out of having the procedure. That obviously would not be positive for their bottom line.”

Governor, I encourage you to talk to a physician who has performed an abortion, because, based upon your comment, it would seem that you have not.  If you had, you would soon realize that “the bottom line” is not what motivates these physicians in practice.  To suggest otherwise would be an insult to their ethics and a gross mischaracterization.  Please, do not blame the physicians for what the legislature has done and your support for this bill.

“Despite the rhetoric of opponents, this was about empowering women with more medical and legal information that previously they were not required to get in order to give informed consent.”

Governor, Merriam-Webster has three definitions for “empower” – “to give official authority or legal power to; [to] enable; to promote the self-actualization or influence of.”  It defies basic comprehension of this word to deduce that a mandate represents empowerment.  In fact, this legislation thwarts any attempt at empowerment as it will interfere with a woman’s autonomous choice and assumes that her doctor would provide her insufficient information to make that choice.  The last time Virginia ever passed a mandated medical procedure was the forced sterilization of the mentally ill, a scenario in which there is no presence of empowerment.  Please, do not blame a misunderstanding of the word “empower” for your “kerfluffle.”

“Informed consent is required for every invasive medical procedure, from getting your ears pierced to having an abortion.”

Governor, even in an illustrative context, an abortion should not be placed on the same plane of medical procedures as an ear piercing.  Ears are pierced at kiosks in the mall.  Invasive medical procedures are performed by specially trained medical personnel in medical settings.  Your relation of an ear piercing to an abortion reveals either your complete insensitivity to this issue, or your complete ignorance.  Please do not blame a citizenry’s misunderstanding of this issue for this kerfuffle.

This is our Governor.  This is his perspective. 

Dear Reader, that is exactly what the “kerfuffle” is all about.

Morning Roundup: “Don’t Say Gay” in Tennessee

Beth Saunders

Tennessee wants to ban any mention of homosexuality in grade school, Iowa may be legalizing the murder of abortion providers, and Planned Parenthood clinics - and their advocates - across the country warn about the devastating impact of the Pence amendment.

Tennessee wants to ban any mention of homosexuality in grade school, Iowa may be legalizing the murder of abortion providers, and Planned Parenthood clinics – and their advocates – across the country warn about the devastating impact of the Pence amendment.

  • Tennessee legislators have introduced a bill opponents are calling, “Don’t Say Gay,” which would ban the mention of homosexuality in any sexuality curriculum in grades K-8. They say it is to ensure age-appropriate education, but it’s really about fear and bigotry. Bill sponsor Stacy Campfield says, “If we’re talking about homosexuality, we are talking about specific acts that are going to be unhealthy for anybody to engage in outside of marriage.” First, unhealthy? What makes a specific sexual act unhealthy? And secondly, gay folks can’t get married in your state, so that sentence pretty much makes no sense.
  • South Dakota backed down from its bill that would legalize the murder of abortion providers, but a combination of laws in Iowa could lead to the same result. The legislature has introduced two separate bills – one to declare personhood from the moment of conception, and another to allow the use of deadly force “’any place at which the person has a right to be present,’ and that in such instances, the citizen has the right to use reasonable force, including deadly force, to protect himself or a third party from serious injury or death or to prevent the commission of a forcible felony.”
  • Planned Parenthood clinics across the country are bracing for impact based on the House vote last Friday to defund the organization. In Arizona, 40,000 people would lose access to care, a California representative says the results of the cuts would be devastating, a Minneapolis woman says her sisters life was saved by a routine exam at Planned Parenthood, the Pennsylvania chapters of the organization say they would have to shut their doors if the amendment became law, hundreds of thousands of families in Texas would be without basic reproductive health care, in Utah, over 40,000 people would be affected,  and the Southern Oregon affiliate says their 25,000 patients are at risk.

Feb 23

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