The Mother and Her Child

by William S. Sadler; Lena K. Sadler

ANALGESIA VS. ANESTHESIA

The reader should understand the difference between analgesia and anesthesia. Anesthesia refers to the condition in which the patient is more or less unconscious—wholly or partially oblivious to what is going on, and, of course, entirely insensible to all pain. Analgesia is a term applied to the loss of pain sensation. The patient may not be wholly or even partially unconscious—merely under the influence of some agent which dulls, deadens, or otherwise destroys the realization of pain. This is the condition aimed at by the proper administration of any form of "twilight sleep," whether by the scopolamin-morphin method, or by the nitrous oxid ("sunrise slumber") method.

Any method of treatment which can more or less destroy the pain of labor without in any way interfering with its progress, and which in no way complicates its course or leaves behind any bad effects on either mother or child, must certainly be hailed with joy by both the patient and the physician. While chloroform has served these purposes fairly well, there have been numerous drawbacks and certain dangers; and it was the knowledge of these limitations in the use of both chloroform and ether, that has led to further experimentation and the development of these newer methods of producing satisfactory analgesia—freedom from pain—without bringing about such a state of profound anesthesia as accompanies the administration of the older methods.

It should be borne in mind that in using "sunrise slumber" (nitrous oxid) for labor pains, the gas is so administered that the patient is just kept on the "borderline"—in a typical "twilight" state—and not in the condition of deep anesthesia which is developed when nitrous oxid is employed by physicians and dentists as an anesthetic for major and minor surgical operations.

Analgesia is the first stage of anesthesia—the "twilight zone" of approaching unconsciousness—in which the sense of pain is greatly dulled or entirely lost, while even that which is experienced is not remembered. It seems to the authors that "gas" is the ideal drug for producing this condition whenever it is necessary, as nitrous oxid is the most volatile of anaesthetics, acts most quickly, and its effects pass away most rapidly, while its administration is under the most perfect control—it may be administered with any desired proportion of oxygen—and may be discontinued on a moment's notice. It is practically free from danger even when continued as an analgesic for several hours. Nitrous oxid never causes any serious disturbance in the unborn child, as chloroform sometimes does when used too liberally.

EFFECTS OF NITROUS OXID

It will not be necessary to compare the favorable and unfavorable claims for nitrous oxid as we did the contentions for and against "twilight sleep." Whatever service "laughing gas" or "sunrise slumber" can render the cause of obstetrics we can accept, knowing full well that, in competent hands, it can do little or no harm; and this we know from the facts herewith recited and from the further fact that we have gained a wide experience with this agent in the practice of both dentistry and surgery. In a general way, the influence of "sunrise slumber" on mother and child may be summarized as follows:

1. It can accomplish its purpose—can quite satisfactorily relieve the mother of severe pain—when employed as an analgesic. It is not necessary to administer the gas to the point of anesthesia except at the height of suffering at the end of the second stage of labor, when the head of the child is passing through the birth canal.

2. This method can be stopped at any moment—the patient ran be brought out from under its influence entirely and almost instantaneously. It is not like a hypodermic injection of a drug which may exert a varying and unknown influence upon the patient, and which, when once given, cannot be recalled.

3. It is a method which may be used in the patient's home just as safely as in a hospital; the only drawback being the inconvenience of transporting the gas-containing cylinders back and forth. This is even now partially overcome by the improved combination gas and oxygen form of apparatus which has been devised.