Medicine: Painless Childbirth

The new method of effecting painless childbirth by continued injections of metycaine in the caudal area just below the spinal column (TIME, Sept. 14) last week won approval in the Journal of the A.M.A. and hit the front pages of big U.S. dailies. Wrote Journal Editor Morris Fishbein for the Chicago Times: “The young physicians who developed this method [have] attained a goal long sought by mankind—and especially desired by womankind—since the beginnings of human life. . . .”

The New York Herald Tribune and the Chicago Tribune suspected that caudal anesthesia would prove to have drawbacks similar to those of the long series of “painless” methods introduced since the century’s turn—drawbacks to the mother such as delirium, narcosis, cyanosis, vomiting, short duration of anesthesia; drawbacks to the child such as narcosis and asphyxia—and asked obstetricians for opinions. The doctors’ answers were all conservative.

Most thought the method too new for general publicity, some refused to discuss the anesthetic, some feared the injection would be dangerous because of the needle’s nearness to the spinal column. Dr. George W. Kosmak of Manhattan, editor of the American Journal of Obstetrics and Gynecology, said he had no doubt of the method’s scientific value, “but it is one of those extremely dangerous things that need the utmost caution.”

So far, the method has proved safe—it has now been tried in nearly 600 cases with no maternal deaths and only three infant deaths “without reference to the method of analgesia . . . employed.” Cases include the wives of Drs. Waldo Edwards and Robert Hingson, who perfected the method. They deny that continuous caudal anesthesia is any more dangerous than spinal anesthesia—both injections must be done by experts. In the A.M.A. Journal two Chicago doctors reported that caudal anesthesia slowed up delivery in their 20 cases because the patient “has absolutely no urge to bear down.” But Drs. Edwards and Hingson believe it speeded labor in their series—all an obstetrician has to do is keep a hand on his patient’s abdomen, tell her when to help.

Drs. Edwards and Hingson have traveled to about 20 hospitals teaching the system, and some comments they won sound like patent medicine testimonials. Dr. Francis R. Irving of Syracuse University’s College of Medicine says “there is no question that it is perfect painless childbirth without deleterious effect on mother or child.” Dr. John S. Lundy of the Mayo Clinic says “I think it is fine.”

Even if caudal anesthesia is actually the answer to an obstetrician’s prayer, the recent rash of publicity may prove harmful. Prospective mothers may demand it before doctors learn the technique.