In preparing this paper I have followed many authorities and will present briefly without prejudice the advantages and disadvantages of each drug and procedure.
The sedentary life of the average woman of today has contributed much to the suffering of the parturient woman.
The early years of my practice were spent in a small mining town in western Pennsylvania. Practically all of the women in this small town were emigrants from Czecho-Slovakia, Poland, Lithuania, Dalmatia and Russia. These women were strong, robust women who had worked in the fields and had excellent muscular development. This class of women never thought of calling a doctor for childbirth unless some complication arose. Some of their children were born almost pain free.
One instance that I recall particularly was a woman who had borne twelve children. At the request of her husband I arrived at the bedside at three oclock in the morning. The patient was seated placidly before her large open fire and on my inquiry as to how often she was having pains she advised that she had had no pain. Then when I requested why she thought I was needed, she replied that she had had twelve children and could tell by certain fullness in the lower abdomen that the child was soon to be born.
In a few minutes she asked me to prepare myself for the birth of the child. With that remark she walked to the bed, laid down quietly and the child was born, with only one pain that was not severe enough to cause her to make any outcry. It may be difficult for you to believe that I have a report of one Czecho-Slovakian patient whose baby was delivered during the night and both she and her husband, reliable individuals, reported that they did not know of the birth of the child until they awoke and found the bed soiled. The afterbirth had also passed during the night.
Another striking instance that I wish to report is that of the wife of one of the physical directors of the Y.M.C.A. Her husband requested that I allow him to develop her musculature during the months of pregnancy.
I suggested to him that this be done gradually and that I felt in his judgment he would not subject her to any violent exercise. Two weeks before the birth of this baby he asked me to visit his home. There he and his wife went through their regular form of gymnastics. I must admit that I was somewhat baffled to note the tremendous muscular exertion this pregnant patient went through. When the time came for the delivery of the child, it required but fifteen minutes. There were no complications whatever. The patient said she experienced not sufficient pain to require any form of anaesthetic.
DEMAND FOR PAIN-RELIEF IN LABOR TODAY IS DUE TO SEDENTARY LIFE OF WOMEN OF TODAY.
From the report on these few instances it is apparent that the demand of the public for pain-relief in labor today is due to the sedentary life of our women of today.
There are no drugs employed in labor but have some ill effect. Such drugs, unless recognized thoroughly and controlled, may result in disaster to both mother and child.
AUTONOMIC NERVOUS SYSTEM THROWN OUT OF BALANCE.
BY DRUGS THAT RELIEVE PAIN.
In the United States today the mortality of both mother and child is on the increase.
The autonomic nervous system is thrown out of balance easily by drugs that relieve pain. The reflexes may become either hypo- active or hyperactive and it is wholly impossible to predict with accuracy what will be the disturbance of reflex activity or its degree in a given case from a particular drug. If the pharyngeal or laryngeal reflexes are affected, serious disturbances in respiration may result with disastrous sequelae to both mother and child.
Scopalamine, opiates, barbiturates and other non-volatile as well as inhalation agents in sufficient doses to relieve pain all cause depression of the respiratory centers of the mother and child. These drugs decrease in minute volume pulmonary ventilation. At the time of delivery the childs respiratory center is usually subject to at least some depression from drug action and from trauma. It at the same time the blood is low in oxygen at base of respiratory center, depression is further enhanced. The effects of the various pain-relieving drugs commonly administered in labor have not received the consideration they deserve and lead to many clinical difficulties with both mother and child.
Forceps deliveries often become a necessity simply because the patient has been drugged to such depths that contractility of uterine and abdominal musculature has been interfered with. All analgesic and anaesthetic drugs produce a respiratory depression in both mother and child.
SPINAL ANAESTHESIA.
Some twenty year ago Dr. Harry T. Cook of Los Angeles, a homoeopathic physician, administered the first spinal anaesthesia for the relief of the pain of childbirth. This procedure was done with novocain, giving from 150 to 255 milligrams between the fourth and fifth lumbar vertebrae. After thoroughly testing out his new procedure he presented a paper to the American Medical Association, but this Association only condemned his procedure as unsafe. Since that time much work has been done in perfecting this method. Demand for relief of pain during childbirth has become so great today that a physician is compelled to accede to the demands of the patient, or lose his patient to another doctor.
It is my sincere opinion that the patient is better if she has some form of very conservative anaesthesia by the homoeopathic physician than that she fall into the hands of an allopathic physician and lose the advantage of homoeopathic care and treatment.
Inhalation anaesthesia is usually safe because it is completely under control, ether and nitrous oxide being preferable to chloroform.
In my experience there are only two anaesthesias which are safe for both mother and child, and these are used in very small doses. The two I refer to are caudal and spinal anaesthesia.
It is never wise to use any anaesthetic for childbirth until there is full dilatation. In caudal or spinal anaesthesia the dose must be small enough so that it affects the sensory side of the cord only. This leaves the patient well able to assist in the birth of her child while bearing down with each pain. As she has no sense of feeling, the obstetrician suggests to the patient the time when it is necessary for her to bear down.
Caudal anaesthesia has some disadvantages. In the first place the anaesthetic does not last more than an hour or so. Then there is the danger of breaking the needle in those patients where continuous anaesthesia is in use.
I have for years gradually reduced the dose of novocain in spinal anaesthesia from 150 milligrams to 30 to 50 milligrams, depending upon the weight of the patient. No needle is left in the spine and the patient is amply able to assist the obstetrician in the birth of the child. I use novocain crystals, allowing 1 c.c. of spinal fluid to flow into 30 to 50 milligrams of crystals, which is amply sufficient to dissolve the novocain.
If it is possible at all for any normal patient to have a spontaneous delivery, it can be done by this method with safety to both mother and child, as the dose is so small that it has no ill effect upon the autonomic nervous system or the respiratory center. The anaesthetic usually lasts two hours and then can be repeated if necessary.
In my obstetric practice I have tried practically all of the methods of analgesia used and find that the use of these various small doses of novocain are not only entirely satisfactory but free from all danger. The only objection I have to the caudal anaesthesia is the fact that it is often difficult to administer, and the short duration of the anaesthesia.
SEATTLE, WASH.
Seattle.
Chairman, Bureau of Surgery