September 1997
Volume 61 |
Number 9
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| Management of
Childbirth Pain Before Anesthesia |
Donald Caton, M.D., Trustee
Wood Library-Museum of Anesthesiology
James Young Simpson's administration of ether to an obstetric
patient on January 19, 1847, began a new era in the management
of the pain of childbirth. Early attempts at pain management had
been crude and largely ineffective. In fact, childbirth did not
warrant the attention of a physician unless special problems existed.
One of the earliest references to the management of childbirth
pain appeared in a gynecologic text written in the first century
C.E. by the Greek physician Soranus of Ephesus. He suggested that
the physician "soothe the pains (by) touching with warm hands
and afterwards drench pieces of cloth with warm, sweet olive oil
and put them over the abdomen as well as the labia and keep them
saturated with the warm oil for some time, and one must also place
bladders filled with warm oil alongside." Fourteen hundred
years later, Cotton Mather, who was a Puritan minister but also
well-versed in medicine, advised women to use potions such as
the "livers and galls of Eeles, dried slowly in an Oven,"
or "Date, Stone, Amber and Cumin seeds."
Even in the first decades of the 19th century, American physician
and statesman Benjamin Rush still recommended bleeding. Rush reasoned
that the pain of childbirth stimulated a woman's central nervous
system to the point of causing serious side effects. In accordance
with accepted medical theory of his time, Rush recommended copious
bleeding, as many as three or more pints of blood. This was thought
to depress the nervous system and thereby counteract the danger
from the pain.
Better methods for pain relief existed even during these early
times. For centuries, physicians had administered opium. After
1809, when the German pharmacist Sertürner isolated some
of opium's active principles, they had "morphium." During
the 18th and early 19th centuries, however, physicians had been
reluctant to use either opium or morphine for labor. They believed
that either compound diminished uterine contractions and depressed
the child and, therefore, constituted an unacceptable risk for
normal labor. Later, in 1847, physicians used the same arguments
against the use of ether or chloroform to treat the pain of childbirth.
Physicians felt no compulsion to relieve the pain of childbirth
because they believed it to be a normal component of a physiological
process. Even a strong proponent of anesthesia such as Nicolai
Pirogoff once argued, "Haven't midwives and parturients and
indeed all others always viewed the agonies of delivery as an
indicator of safety and a well, nigh holy accompaniment of childbirth?"
A further complication was the fact that the midwives who attended
most deliveries were not authorized to administer opium or morphine
even had it been thought to be appropriate therapy.
The use of anesthesia for childbirth appeared at a time when
physicians were coping with several major changes in medical theory
and practice. They were emerging from an era of herbal medicine
to confront the problems of modern pharmacology. Physicians were
just beginning to displace midwives in the birthing chambers,
and they were beginning to suggest that the pain of childbirth
was neither necessary nor beneficial.
The transition was both rapid and challenging. Many of the papers
contained in this issue of the ASA NEWSLETTER describe
the contributions of anesthesiologists who, for the past century
and a half, have worked to resolve the technical, medical and
social issues that appeared during this period of transition.
Any member of the American Society of Anesthesiologists who wishes
to learn more about the medical and social development of obstetric
anesthesia may call or e-mail
the librarians of the Wood
Library-Museum of Anesthesiology. They maintain an extensive
file of pertinent books and papers that can be loaned or copied.
They also have a list of speakers who can address your local or
regional medical societies on subjects dealing with the history
of our specialty.
Donald Caton, M.D., is Professor of Anesthesiology
and Obstetrics and Gynecology at the University of Florida College
of Medicine, Gainesville, Florida.
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