In 1907, researchers Bernhardt Kronig and Carl Gauss combined the drugs morphine and scopolamine to induce twilight sleep in women during childbirth. Physicians in the early twentieth century in Germany used twilight sleep, Dammerschlaf, to cause women to enter a state of consciousness in which they felt no pain and did not remember giving birth. Twilight sleep was associated with increased use of forceps during delivery, prolonged labor, and increased risk of infant suffocation. Because of those disadvantages, physicians stopped using morphine and scopolamine to prevent pain during childbirth. Morphine and scopolamine were among the first anesthetics to be used during childbirth, and after physicians stopped using them, researchers searched for safer alternatives.

Marshall Henry Klaus was a scientist and pediatrician who studied maternal-infant bonding in the twentieth century in the United States. Maternal-infant bonding is the psychological and chemical attachment between mother and infant. Klaus cofounded DONA International, an organization that trains birthing aides, called doulas, to provide physical and emotional support to laboring mothers. He also studied the differences between the layouts and quality of care provided in nurseries and birthing centers in different countries and compared them to those found in the United States. Klaus’s study influenced national and international initiatives to create hospital policies focused on promoting early bonding between mother and infant. Klaus catalyzed the advent of doulas and international policies that emphasized interaction between new mothers and their infants.

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 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 establish more reciprocal doctor-patient relationships.

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 1964 article, “Pelvic Scoring for Elective Induction,” obstetrician Edward Bishop describes his method to determine whether a doctor should induce labor, or artificially start the birthing process, in a pregnant woman. Aside from medical emergencies, a woman can elect to induce labor to choose when she gives birth and have a shorter than normal labor. The 1964 publication followed an earlier article by Bishop, also about elective induction. In both articles, Bishop used data gathered from the obstetrics department of Pennsylvania Hospital in Philadelphia, Pennsylvania, where he worked. In “Pelvic Scoring for Elective Induction,” Bishop introduces a scoring system later known as the Bishop Score, used into the twenty-first century, to determine if a pregnant woman fits the criteria for a safe and successful induction.

Mary Ware Dennett, an activist in the US for birth control and sex education in the early twentieth century, wrote an educational pamphlet in 1915 called “The Sex Side of Life, and it was published in 1919. The pamphlet defined the functions of the sex organs, emphasized the role of love and pleasure in sex, and described other sexual processes of the body not usually discussed openly. In the early twentieth century in the US, individuals did not have wide access to sex education due to the limitations enforced by the Comstock Act, which prohibited the distribution and discussion of topics that were considered obscene. In 1929, the US tried Dennett for mailing her pamphlet as a violation of the Comstock Act, sending obscene material through the United States Postal Service. Dennett’s pamphlet, Tthe “Sex Side of Life,” and her subsequent trial, United States v. Dennett, contributed to a national discussion about sex education and human reproduction and led to the revision of reproduction- related obscenity laws.