Despite widespread use throughout Europe, Twilight Sleep initially experienced less popularity and more resistance in the United States where doctors were wary of the potential health risks that Twilight Sleep brought upon women and infants. Some adverse effects caused by incorrect doses of scopolamine and morphine included hallucinations and uncontrolled thrashing in women and depressed respiration in infants. Thus, Twilight Sleep’s status as a vogue topic in obstetrics during the first half of the 20th century came about due to the work of affluent and educated American women. While lacking formal medical training, a subset of women became experts in the matter of Twilight Sleep by traveling to Germany to experience and investigate Twilight Sleep firsthand then disseminating their findings through published books and articles.
This thesis explores the impact of Twilight Sleep on women and physicians and their perceptions of childbirth. Twilight Sleep empowered women to take on a more active role in shaping the medical care they received rather than accepting that childbirth as a natural event associated with physical and mental trauma and high risk of mortality. For doctors, the debate regarding Twilight Sleep’s safety and efficacy affirmed a ubiquitous notion that childbirth ought to be seen as a pathological rather than natural event. By considering childbirth a medical condition that necessitated treatment, physicians had to evaluate their duties to their patients. In empowering women to be involved in making medical decisions and forcing physicians to balance their medical training with their patients’ needs, Twilight Sleep helped to establishing more reciprocal doctor-patient relationships.
During the mid-twentieth century, Virginia Apgar worked as an obstetrical anesthesiologist and gave drugs to women that reduced their pain during childbirth in the US. In 1953, Apgar created a scoring system, called the Apgar score, that uses five measurements, including heart rate and breathing rate. The Apgar score evaluates newborn infants and determines who needs immediate medical attention. Apgar's work helped decrease infant mortality rates. As of 2020, hospitals around the world use the Apgar score.
An intrauterine pressure catheter (IUPC) is a device placed inside a pregnant woman’s uterus to monitor uterine contractions during labor. During labor, a woman’s uterus contracts to dilate, or open, the cervix and push the fetus into the birth canal. The catheter measures the pressure within the amniotic space during contractions and allows physicians to evaluate the strength, frequency, and duration of contractions. Those measurements enable physicians to evaluate the progression of labor and intervene when contractions are too weak to properly dilate a laboring woman’s cervix to successfully deliver a fetus. Though IUPCs are not used routinely, they are important in cases where external fetal monitoring is not sufficient to monitor a difficult labor. Intrauterine pressure catheters give physicians an extremely accurate measurement of intrauterine pressure, making it possible to determine whether intervention is needed to progress the labor.
Eclipse of Reason is a 1987 anti-abortion documentary film directed, filmed, and narrated by Bernard Nathanson, an obstetrician in the US. American Portrait Films released the film in 1987 featuring Nathanson’s commentary and footage of an abortion of a four-month-old fetus. The film also featured the testimony of women who had suffered following similar procedures. In Eclipse of Reason, Nathanson equates the fetus to a person, likening abortion procedures to murder and arguing for the illegalization of abortion. This documentary was a sequel to Nathanson’s first documentary film, The Silent Scream released in 1984. Both documentaries argued for illegalizing abortion, which had been decriminalized in 1973 in the United States. Eclipse of Reason was one of the most influential films that garnered public attention to the abortion debate in the US during the 1980s.
In the 2007 paper “Traditional postpartum practices and rituals: a qualitative systematic review,” Toronto-based researchers showed that women from different cultures around the world follow similar postpartum practices after giving birth. At the University of Toronto in Toronto, Canada, Cindy-Lee Dennis, Kenneth Fung, Sophie Grigoriadis, Gail Erlick Robinson, Sarah Romans, and Lori Ross examined fifty-one studies from over twenty countries that focused on traditional postpartum practices. The authors found that across the twenty countries, each culture’s postpartum practice included a specified rest period, a prescribed diet, and organized support from family members. In the literature review, Dennis and her team concluded that healthcare providers should consider the major similarities between cultural postpartum practices to deliver culturally competent perinatal care.
In 1955, obstetrician Edward Bishop, a physician specializing in childbirth, published the article “Elective Induction of Labor,” in which he proposed the best conditions for pregnant women to elect to induce, or begin, labor. Elective induction of labor requires an obstetrician to administer a drug to help a pregnant woman to start her contractions, and to rupture the fluid-filled sac surrounding the fetus called the amniotic sac. In the early 1950s, Bishop analyzed the results of one thousand elective inductions and discovered that some pregnant women had faster and easier deliveries with induced labor than other pregnant women. In “Elective Induction of Labor,” Bishop describes the characteristics an obstetrician can look for in a pregnant woman to determine if she can safely undergo an elective induction, metrics still used into the twenty-first century to determine whether or not to pursue elective inductions.
In the late 1990s researchers Yuk Ming Dennis Lo and his colleagues isolated fetal DNA extracted from pregnant woman’s blood. The technique enabled for more efficient and less invasive diagnoses of genetic abnormalities in fetuses, such as having too many copies of chromosomes. Lo’s team published their results in 1997’s “Presence of Fetal DNA in Maternal Plasma and Serum.” The results led to developments of clinical tests that can access fetal genetic information and detect genetic abnormalities before birth without the significant risks that can potentially harm the fetus associated with invasive genetic testing techniques.
Emmett McLoughlin wrote People's Padre: An Autobiography, based on his experiences as a Roman Catholic priest advocating for the health of people in Arizona. The Beacon Press in Boston, Massachusetts, published the autobiography in 1954. McLoughlin was a Franciscan Order Roman Catholic priest who advocated for public housing and healthcare for the poor and for minority groups in Phoenix, Arizona, during the mid twentieth century. The autobiography recounts McLoughlin's efforts in founding several community initiatives throughout Phoenix, including the St. Monica's Community Center, later renamed St. Pius X Catholic Church, the Phoenix housing projects, and St. Monica's Hospital, later renamed Phoenix Memorial Hospital. McLoughlin's autobiography discusses his advocacy for people to have greater access to maternity and prenatal healthcare, to testing and treatment for sexually transmitted infections, and to birth control in the Phoenix area.
John Chassar Moir lived in Scotland during the twentieth century and helped develop techniques to improve the health of pregnant women. Moir helped to discover compounds that doctors could administer to women after childbirth to prevent life-threatening blood loss. Those compounds included the ergot alkaloid called ergometrine, also called ergonovine, and d-lysergic acid beta-propanolamide. Moir tested ergometrine in postpartum patients and documented that it helped prevent or manage postpartum hemorrhage in women. Moir also developed methods to treat tears between the bladder and the vagina, called vesico-vaginal fistulas, that occur due to complications of childbirth, and that cause urinary incontinence in women who have them.