A method of effecting painless childbirth through the use of scopolamine and morphine was first used in 1902 by Steinbuechel, and in 1906 Gauss, of the University of Freiburg in Baden, reported a series of five hundred obstetrical cases in which scopolamine and morphine had been used. The woman's condition was called in Freiburg a Dämmerschlaf, a Twilight Sleep, because she is somnolent and forgetful of pain. In 1903 the chief obstetricians in several of the leading American and German universities tried the drugs, but they quickly abandoned the method because they found it dangerous and unscientific. The process was exploited here by McClure's Magazine,[203] The Ladies' Home Journal, and other lay periodicals. The articles in these magazines were written by persons who are not physicians, and their erroneous statements are misleading. The Ladies' Home Journal, however, while favoring the method, published letters from several leading obstetricians in the United States, all of whom are opposed to the use of these drugs during parturition because they had tried them and found them unscientific. The method is illicit morally, and it is unscientific.
Obstetricians divide a parturition into three stages. In most primiparae and many multiparae there is a prodromal stage, in which false labor pains (dolores praesagientes) are the most evident symptom. When the real labor sets in there are rhythmic uterine contractions about every fifteen minutes, which cause pain to the woman by the pressure of the fetus on the uterine nerves—dolores praeparantes. From the time the pains become rhythmic, and are effective in dilating the neck and mouth of the womb, until the mouth of the womb is completely stretched and flush with the vaginal wall, thus completing the continuous parturient canal, is the first stage of labor. The fetal enveloping membranes (the "bag of waters") usually rupture at the end of this stage, but sometimes the bag bursts before the end, or as late as the second stage of labor. The first period is the stage of dilatation.
The second stage extends from the end of the dilatation until the expulsion of the child is completed. This is the stage of expulsion.
The third stage lasts from the delivery of the child until after the expulsion of the placenta and membranes and the retraction of the uterus has ended—the period of the afterbirth.
Normal parturition is always painful to the woman. As the labor progresses the pains gradually grow more intense, and the interval between them shorter. After a few hours the pain is strong enough to cause the woman to cry out, but there is a great variety in the endurance of these pains, as the women's characters differ. Neurotic women begin to scream and act hysterically even in the early part of the first stage. When the pains are fully developed each lasts about half a minute.
In most cases the infant comes out head first, but almost any part of its body may present. Before the advancing child part of the liquor amnii within the fetal enveloping membranes is forced down into the neck of the womb, and causes dilatation. In primiparae especially the bag of waters may rupture prematurely and thus cause what is called a dry labor, which is commonly tedious and painful. Often operative interference is required in dry labors.
In the second stage the pains are stronger, recur every two or three minutes, and are expulsive. The woman then strives to expel the child. She strains violently with the abdominal muscles—literally labors; her pulse is high, the veins of her neck stand out, her face is turgid, and her body is covered with sweat. When at last the head of the child is driven out the woman feels as if she were being torn asunder in the dolores conquassantes. The pain is so great that the woman may faint from it, but that is not the rule. After a pause the shoulders are forced out, and then the trunk in one long convulsive effort. The umbilical cord is tied and cut, and the child is born.
After from five to twenty minutes the womb begins to contract again, but the pains (dolores ad secundum partum) are not nearly so intense as they were during labor. Then in from fifteen minutes to about three hours the placenta is expelled.
The pains of labor are so evident that the expulsive contractions of the uterus, of which the pains are symptoms, are themselves called "the pains." These pains in all scientific exactness of statement are, as has been said, agonizing. "In dolore paries filios" is a very literal text. The scopolamine-morphine method was devised with the intention of mitigating them, or mercifully rendering the woman unconscious of them during at least a part of the labor. If she is unconscious of pain she is thus saved also from shock and depression, which render her susceptible to infection. Such results certainly are immeasurably valuable if attainable without taint of moral evil, but as the method stands just now, they are not free from that taint.
Scopolamine hydrobromide, one of the drugs used in this method, is an alkaloid obtained from the roots of Scopolia (or Scopola) carniolica, and it cannot be differentiated chemically from hyoscine hydrobromide, which is made from henbane and other plants of the Solanaceae group. Rusby was of the opinion that scopolamine is really a mixture of hyoscine, hyoscyamine, and atropine: one-tenth hyoscine and nine-tenths hyoscyamine and atropine. Cushny and others find different proportions of these alkaloids. As the leaves of Scopolia are used to adulterate the belladonna leaves from which atropine is derived, hyoscine and scopolamine are substituted for each other—if, indeed, there is an any real difference between them. Some of the largest drug-houses in Germany before the war supplied hyoscine and scopolamine from the same stock bottle—the name depended on the asker. Even in a pure state hyoscine and scopolamine have the same chemical formula (C17H21NO4), and their physiological action is the same. Each can exist in three isomeric forms, and in one of these forms they turn polarized light to the left, in another to the right, while in a third form they do not affect the light at all. The higher the rotatory power of the drugs, the more active they are physiologically. The levorotatory scopolamine has, according to Cushny, Peebles, and Hug, double the action of the inactive scopolamine on the cardiac inhibitory fibres of the vagus, but the levoactive and the inactive scopolamine produce the same effect on the central nervous system. The drug on the market is usually composed of a mixture of the levoactive and the inactive forms, and as one or the other predominates the results differ: the rotatory power of a given specimen should be known. Old solutions of scopolamine decompose and give rise to toxic substances. Gauss attributed post-partum hemorrhages in the women and asphyxia in infants to these decomposition products, but he avoided these untoward effects somewhat by cutting down the morphine dose. He had five infant deaths before he cut down the morphine, and 25 per cent. of the children were intoxicated. The chief action of scopolamine or hyoscine is upon the cerebral cortex, producing sleep, which is accompanied often by a low delirium. They depress the centre of respiration, and have a depressant effect also on that part of the spinal cord which governs the motions of the body. They intensify the action of morphine and other narcotics.