The labor was lengthened by about seven hours over untreated cases. As to the amnesia, in twenty-six cases the memory was not dulled at all, although they received more scopolamine than thirty-nine cases in which the memory was cloudy.
Thirty-two women had unbearable thirst throughout the labor, and nothing would slake this thirst. Their incessant cries for water were very distressing to the attendants. Headache was present in twenty-seven cases and vertigo in thirty-one, and the headache, which was very intense in some women, lasted for several days after delivery.
Pain was diminished in thirty-nine cases, absent in one, as severe as in the average untreated woman in nineteen, and increased in one. That is, only one woman in sixty did not suffer the pain for which the treatment was devised. The reason evidently is that his dose of morphine was too small, yet if he went above this dose he ran the risk of post-partum hemorrhage and of narcotizing the baby. As it was, he had seven post-partum hemorrhages, but in a series of sixty unselected normal delivery cases he had only one hemorrhage.
Restlessness was present in eighteen cases, and delirium in nine; six of these women had to be wrapped in restraining sheets, and one had to be shackled for four days after she had overpowered a nurse in an effort to jump out of a window. It took three attendants to get her into the strait-jacket. Chandler of Philadelphia saw a woman in a like delirium who was shackled only after six attendants together had tackled her. Two physicians in the Chicago maternity were severely beaten by women in a twilight sleep delirium.
Baer says the serious risk of self-infection during labor through the uncontrollable motion of these women is a source of constant anxiety. They sit cross-legged, and the heel infects them with coli communis from the expressed feces. The dazed women constantly try to get at the vague pain with their hands, and on this account, according to Baer, some clinics that practise the twilight sleep method keep all the women in strait-jackets, but they omit to publish this fact.
One of Baer's patients died from a ruptured uterus, and her dead baby was taken from her belly-cavity. The drug will mask symptoms in a case like this. Sudden cessation of puerperal pain as a symptom of rupture, and the peculiar pain of a premature loosening of the placenta, are both covered from observation by the drugs, the darkening of the room, and the tossing of the patient, which prevent proper examinations.
One patient had a mitral insufficiency and myocarditis. This should be an ideal case for the treatment, according to the twilight sleep men. The woman, however, after three doses of the scopolamine developed pulmonary edema. Her child was delivered in asphyxia pallida and resuscitated with difficulty.
Thirteen of the children did not breathe at delivery, six were asphyctic, and two cases relapsed into asphyxia. One child was killed, as we said, when the mother's uterus ruptured. Avarffy[214] had one fatal case in fifty, and Chrobak one in one hundred and seven.
Eight of the women had blurred vision after delivery, which lasted for over twenty-four hours; two had marked delirium for from two to four days after childbirth. As to exhaustion after labor, Baer says he found no difference between the twilight sleep women and the normal cases.
Some advocates of the twilight sleep method say that there is less use of the forceps in this method than in normal delivery. At Freiburg, for example, operative delivery has been "reduced" to six or seven per cent. Six per cent., as a matter of truth, is two per cent. above the normal average for forceps delivery in eighteen German maternities. In 95,025 deliveries in these hospitals the average forceps delivery was 4.5 per cent., and some were small teaching hospitals where the forceps were used on any provocation for class demonstration. The twilight sleep method has a much higher operative delivery, and this varies, of course, according to the skill and judgment of the operators.