Twilight Sleep: Edith Wharton's Brave New Politics
ENERATiONS of critics have claimed that Edith Wharton liked both her gardens and her society well-pruned. In her late fictions, however, Wharton addresses the politics of intimate experience in the context of social debates. To that end, her characters often echo social policy, transformed as it is by Wharton's own bias against legislation of private morality. Although her late fictions have been read conservatively, they are not written in isolation from larger political issues. Instead, they insist on the relation between private and public rather than on a divorce between the two. In challenging her class's (as well as her culture's) gender ideology, Wharton manipulates the conventions of the realist novel to reconcile popular fiction with cultural criticism. My aim is not to reduce the ambivalence with which Wharton writes about anti-Semitism, nor her hatred of black culture, especially as Carl van Vechten describes it in his 1926 Nigger Heaven. I do, however, want to show how writing literature and writing culture, for Wharton, draws on a cultural unconscious, one associated for her with fascism. In Nancy Armstrong's terms, "individual works and kinds of writing gather force, not as they exemplify [an] individual imagination, genre, or tradition of ideas, but as they enter into an unwitting conspiracy that extends throughout the figurative operations of cultural production to shape the lives of real people" (357). I do not so much want to place Wharton's Twilight Sleep in the "context" of history, thereby writing a new historicism, as
Birthing and Anesthesia: The Debate over Twilight Sleep
"At midnight I was awakened by a very sharp pain," wrote Mrs. Cecil Stewart, describing the birth of her child in 1914. "The head nurse ... gave me an injection of scopolamin-morphin. ... I woke up the next morning about half-past seven ... the door opened, and the head nurse brought in my baby. ... I was so happy."1 Mrs. Stewart had delivered her baby under the influence of scopolamine, a narcotic and amnesiac that, together with morphine, produced a state popularly known as "twilight sleep." She did not remember anything of the experience when she woke up after giving birth. This 1914 ideal contrasts with today's feminist stress on being awake, aware, and in control during the birthing experience. In 1914 and 1915, thousands of American women testified to the marvels of having babies without the trauma of childbirth. As one of them gratefully put it, "The night of my confinement will always be a night dropped out of my life."2
Obstetric Analgesia and Anesthesia
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician’s care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of “other medical indications.” Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I–IV) (1). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient’s ability to pay. The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions. The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, although they may be useful as adjuncts or alternatives in many cases.