Twilight Sleep ... Childbirth Without Pain?

Last Editorial Review: 1/9/2003

"Twilight sleep" refers to a combination of analgesia (pain relief) and amnesia (loss of memory) that can be produced by giving a mixture of morphine and scopolamine ("scope") by a hypodermic injection (an injection under the skin).

Twilight sleep was once very much in vogue in obstetrics. The mixture of the two drugs created a state in which the woman, while responding somewhat to pain, did not remember it after she had delivered her baby.

Morphine and scopolamine are both venerable drugs that have been around a long time. Both are also naturally occurring members of the very large chemical class of compounds called alkaloids:

  • Morphine: The name "morphine" was coined in 1805 by the German pharmacist Adolf Serturner -- "morphine" refers to Morpheus, the mythologic god of dreams -- to designate the main alkaloid contained in opium. Opium, of course, comes from a plant: the poppy. Morphine is a powerful narcotic agent with strong analgesic action and other significant effects on the central nervous system. It is dangerously addicting.
  • Scopolamine: Scopolamine was introduced in 1902 and used up until the 1960's. The name comes from that of the 18th-century Italian naturalist Giovanni Scopoli. Together with atropine, scopolamine is a component of belladonna which comes from a plant called "deadly nightshade," once used as a means of poisoning ones enemy. When scopolamine is given in lower (non-poisonous) doses, it causes drowsiness, amnesia, and euphoria (a "high") and was thus used as a preanesthetic agent.

The combination of scopolamine and morphine provided childbirth without pain (or without the memory of pain), once a much sought- after objective. However, there were serious problems with twilight sleep. It completely removed the mother from the birth experience and it gravely depressed the baby's central nervous system. This sometimes made for a drowsy depressed baby who was difficult to resuscitate, to get breathing normally.

Twilight sleep is therefore no longer in use. It has faded into the twilight itself as one chapter in the history of obstetrics.

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