Diazepam, Alcohol (Ethanol), and the Drugs We Used to Stop Seizures and Labor
The Collaborative Eclampsia Trial changed everything. So did the realization that IV alcohol doesn’t stop contractions.
In the 1960s and early 1970s, if a woman arrived at the hospital in preterm labor, we started an intravenous line and infused ethanol. Alcohol. Directly into the vein of a pregnant woman. The mechanism was straightforward: ethanol inhibits oxytocin release. Inhibiting oxytocin should stop contractions.
It sounds like something from a different century. It was standard care.
If a woman with eclampsia seized, we treated her with diazepam. The benzodiazepine stopped the seizure, and that was the goal. It was the default anticonvulsant in obstetrics for decades.
If a woman needed a cesarean delivery, we put her under general anesthesia. Epidurals and spinals were available but not standard. General anesthesia was faster, more familiar, and the default choice.
Each of these practices was replaced within a single decade, from the late 1980s through the mid-1990s. The replacements were not incremental improvements. They were transformations. Magnesium sulfate for eclampsia. Nifedipine and atosiban for tocolysis. Neuraxial anesthesia for cesarean delivery. Each replacement was supported by definitive evidence. Each dramatically improved outcomes.
The speed of these reversals stands in sharp contrast to the decades-long persistence of practices like continuous EFM and routine episiotomy. Understanding why some changes happen quickly while others stall for generations is as important as understanding the evidence itself.
🎯 Free Subscriber Bottom Line: Three major drug-based obstetric practices were replaced within a single decade: diazepam by magnesium sulfate for eclampsia, IV ethanol and beta-agonists by safer tocolytics, and general anesthesia by neuraxial techniques for cesarean delivery. Each replacement was driven by definitive evidence. The contrast with practices that persisted for decades despite evidence reveals which forces accelerate or delay practice change.
Below, paid subscribers get: - The Collaborative Eclampsia Trial deep dive and why it was definitive - The ethanol tocolysis era: what it was like and why it ended - The anesthesia mortality data from Hawkins that drove the shift to neuraxial - The paracervical block complications that ended that practice - A complete table: drug, era, replacement, key trial, implementation lag - What these rapid reversals teach about the forces that drive or resist change.
