A Brief History of Obstetric anaesthesia before the epidural
On the 19th January 1847 James Simpson , a renowned obstetrician in Edinburgh, Scotland used ether for the first time to facilitate a manipulation during a delivery. A few months later, on the 20th October 1847 he carried out a delivery with the aid of chloroform. Similar reports were presented in February 1847 at the Academy of Medicine in Paris.
For a long time in the UK, USA and France the use of anaesthetics to relive pain during childbirth remained very controversial. The dictum in the book of Genesis ‘in pain shall you be born’ was always the response of those opposed to the use of ether, either through dogma or religious conviction.
Slowly, however most of them came around to understanding the value of small doses of chloroform to relieve pain during delivery. The decision by Queen Victoria to have small doses of chloroform during the birth of her eighth child on the 7th April 1853 led John Snow to call this technique ‘the anaesthesia of the Queen.’
Use of chloroform continued for a long time before being replaced by nitrous oxide in 1930 - an agent known for a long time as ‘laughing gas’ which carried a serious risk of hypoxia if used alone. It was not until 1940 that a reliable and safe mixture of the gas with oxygen became available. This is still used in maternity units up to the present day as Entonox® or MEOPA®.
Techniques of mixed anaesthesia has been known since the time of Claude Bernard which sought to produce ‘twilight sleep’ using subcutaneous injections of morphine and scopolamine and later barbiturates in small doses which were thought to be less dangerous for both mother and child. The 1930s saw the revival of so – called ‘natural’ methods of pain relief (or psychoprophylactic methods), based on controlled breathing, variation of positions and the use of antispasmodic drugs. But these techniques rapidly revealed their limitations.
At the same time, the concept of obstetric auto–anaesthesia was developed, where the mother inhaled of trilene or methoxyflurane via a Trilene or Cyprane inhaler, both lightweight hand – held devices.
Around 1970 similar devices (the Penthrane oxylator and the Penthrane analgiser) were available to deliver Penthrane on demand. Overall, the results were mixed, with a continuing risk of loss of consciousness.
From 1980, epidural anaesthesia would be progressively adopted for analgesia during labour in all the maternity units in France.