IN THE PRESENT STATE OF OUR KNOWLEDGE - EARLY USE OF OPIOIDS IN OBSTETRICS

In retrospect, physicians responded to the use of twilight sleep in a predictable and appropriate way. Clinical experience and theory led th em to expect deleterious effects on labor and the neonate. Moreover, t hey could see readily that opioids could not provide patients the anal gesia that they had come to expect from ether of chloroform. In the co ntext, it seems predictable that physicians would reject the method. I t is more intriguing to ask why, even as physicians continued to rejec t the use of opioids, they persisted in using inhalation anesthesia. T he two most favored inhalation agents, ether and chloroform, caused th e problems that physicians feared from opioids. Was it inexperience, n aivete, or the novelty of having inhalation anesthesia? Regardless, it is quite clear that, in 1847, as in 1910, patients eventually forced physicians to adopt each new method into practice. Herein may lie an i mportant lesson. Throughout the las half of the 19th century, women sa id they did not want to experience pain associated with labor. Certain ly this reflects a general attitude toward pain and suffering prevalen t throughout Western Europe and the United States during this time. Ph ysicians knew that they could abolish the pain but said this involved medical risks, which they did not feel were warranted. The based this opinion both on theory and experience. In effect, the issue became a c onfrontation between patients' expectations of physicians and the phys icians' attempt to adhere to principles of clinical science. The confr ontation occurred as physicians struggled to establish a scientific ba sis for their practice. Patients prevailed, and physicians found ways to accommodate them. The compromise, however, had long-reaching effect s. Physicians modified the conservative limits on opioid medication fo r laboring women. More than a generation passed before patients an phy sicians recognized this change and the problems that it caused.