Medicine: Without Pain

Is pain an inevitable part of childbirth? One grin-&-bear-it school of doctors says it is.* But the search for ways to relieve the mother’s pain is as old as civilization. The ancient Egyptians tried herbs, the Chinese opium. Neither worked very well. The coming of anesthesia more than a century ago did not help much. General anesthetics such as chloroform and ether made the patient unconscious, and thus unable to cooperate with the doctor and with nature’s attempts to push out the baby.

Risky Past. An ideal childbirth anesthetic would be safe for both mother & child, take away most of the pain, leave the mother able to cooperate with nature. Doctors have tried many anesthetics, always found something wrong. The big drawback to “twilight sleep,” popular in the early 1900s; the drugs used (scopolamine or hyoscine hydrobromide, with barbiturates) might, like too much ether and chloroform, poison the baby through the blood of the mother. Continuous caudal anesthesia, first used for childbirth in 1941, has pitfalls for inexperienced doctors (if the needle gets into the spinal canal, the mother may die of an overdose of anesthetic).

Last week, doctors searching for a safe and effective anesthetic seemed nearer their goal. The new technique, gradually improved over the last several years, is a variation of spinal anesthesia (first used for general surgery at the turn of the century). Doctors describe it, in a jawbreaking phrase, as “heavy nupercaine to produce saddle-block anesthesia.” Nupercaine is a cocaine substitute. “Heavy” means that it is loaded with a glucose (sugar) solution to make it heavier than the body’s spinal fluid. “Saddle block” aptly describes the area anesthetized (the inner thigh and perineum).

Hopeful Future. The new technique has obvious advantages. Because the “heavy” anesthetic is heavier than the spinal fluid, doctors can control its rise in the spine by gravity (by tilting the delivery table until the proper areas are anesthetized). In conventional spinal anesthesia, the anesthetic may rise too far and stop the patient’s breathing. Usually only one injection is necessary. It acts quickly (in one to ten minutes), and relief from pain lasts from two to four hours. The patient is so comfortable that, when labor is long, she can eat, drink or smoke.

More than 20,000 cases have been reported in medical journals. In the current Connecticut State Medical Journal, Drs. Max L. Berlowe and Francis L. Herrick describe the results of 200 cases in the Grace-New Haven (Conn.) Community Hospital. Of the first 100 patients, 76% got complete relief from pain; of the second 100 patients, 96%. Only complications: headache and short periods of nausea and vomiting (possibly not due to the anesthetic). There was no dangerous lowering of blood pressure, a frequent complication in childbirth.

With typical restraint, the doctors concluded: “These results . . . merit further investigation with this type of anesthesia.” Last week doctors in Texas, Louisiana, Illinois, Alabama, Missouri, California and elsewhere were working toward the goal of 100,000 successful deliveries: the number many physicians consider essential before they accept a method as “proved.”

* Last fortnight London University Psychologist JamesArthur Hadfield solemnly suggested in the British Medical Journalthat painless childbirth might kill a mother’s love for her child.

-Last fortnight London University Psychologist James Arthur Hadfield solemnly suggested in the British Medical Journal that painless childbirth might kill a mother’s love for her child.