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    Twilight Sleep in Obstetrics

    The term "twilight sleep" applied to the combination of analgesia
    (pain  relief) and amnesia (loss of memory) that was produced
    by a mixture of morphine  and scopolamine ("scope") given by
    a hypodermic injection (an injection under  the skin). The mixture
    of the two drugs created a state in which the woman,  while
    responding somewhat to pain, did not remember it after delivering
    her  baby. Twilight sleep was once in vogue in obstetrics.

    Morphine and scopolamine are both venerable drugs that have
    been around a  long time. Both are also naturally occurring
    members of the very large chemical  class of compounds called
    alkaloids:

    Morphine: The name "morphine" was coined in 1805 by the
    German  pharmacist Adolf Serturner -- "morphine" refers to
    Morpheus, the mythological god  of dreams -- to designate the
    main alkaloid contained in opium.

    Opium, of  course, comes from a plant: the poppy. Morphine is a
    powerful narcotic agent  with strong analgesic action and other
    significant effects on the central  nervous system.
    It is dangerously addicting.  

    Scopolamine: Scopolamine was introduced in 1902 and used up until the  1960s.
    The name comes from that of the 18th-century Italian naturalist Giovanni  Scopoli.
    Together with atropine, scopolamine is a component of belladonna which  comes
    from a plant called "deadly nightshade," once used as a means of poisoning  ones
    enemy. When scopolamine is given in lower (non-poisonous) doses, it causes  
    drowsiness, amnesia, and euphoria (a "high") and was thus used as a  preanesthetic
    agent. Combined with morphine, scopolamine provided childbirth without pain
    (or  without the memory of pain), once a much sought-after objective. However,
    there  were serious problems with twilight sleep. It completely removed the mother
    from  the birth experience and it gravely depressed the baby's central nervous
    system.  This sometimes made for a drowsy depressed baby who was difficult
    to resuscitate,  to get breathing normally.

    Twilight sleep has, therefore, fallen entirely out of favor and is now merely  a
    chapter in the past history of obstetrics.



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