Nitrous oxide now available for laboring moms
STEAMBOAT SPRINGS — For the first time, nitrous oxide is available for mothers during labor at UCHealth Yampa Valley Medical Center.
Nitrous oxide provides a relatively cheap and easy alternative to narcotics for pain relief during labor, said Dr. Jeff Chamberlain, an obstetrician/gynecologist with UCHealth Women’s Care Clinics in Steamboat Springs and Craig.
While new here, it isn’t new, Chamberlain said. It is widely used across Europe and Canada and has been for close to a century, he explained. It has been available in Steamboat since early September.
Since then, Chamberlain said he has seen it used during about 25% of deliveries.
With a number of women resistant to getting an epidural, Chamberlain said, nitrous oxide — the exact same stuff you’d get at the dentist’s office — can help ease pain for women who elect not to get an epidural.
There are also those who do not have time to get an epidural or cannot get one for medical reasons.
The choice on whether or not to get an epidural can be a daunting one, especially for first time moms. There are strong opinions on both sides, and a reality that is likely somewhere in between.
There are studies that show both negative impacts and benefits of epidurals — and the positive effects of going without. Epidurals have also evolved over the years, and doses have decreased, which in turn has decreased some of the potential negative side effects seen in prior decades.
Nitrous oxide is not necessarily a comparable replacement for an epidural, but is an additional option now available locally.
And at the end of the day, it is up to the mother.
For the average woman going into labor, it doesn’t have to be an either/or decision — nitrous oxide could be used well in advance of the decision to get an epidural or other intravenous narcotics.
Nitrous oxide would not be used simultaneously with an epidural, as the combination can slow breathing.
According to UCHealth’s patient education flyer, women would not be given nitrous oxide under the following conditions:
- If you cannot hold your own face mask.
- If you have received a dose of IV narcotic in the past 2 hours.
- If you have pernicious anemia or a B12 deficiency for which you take B12 supplements.
- If you have a magnesium sulfate drip.
Being able to hold the mask — and maintain that control — is a key stipulation for women who choose to utilize nitrous oxide.
Every pregnancy and birth is different, noted Chamberlain, and the process is inherently unpredictable. Every mother feels differently about what they do or do not want to take during labor, and every mother experiences pain differently.
Nitrous oxide simply gives women another option, he said, and one a bit more familiar and less intimidating than an injection into the spine.
And there are those cases when the baby is coming fast, and there simply is not enough time to administer an epidural. “If you get to be 9 or 10 centimeters,” Chamberlain said of the dilation measurement, “you’ve kind of missed the boat,” when it comes to getting an epidural.
Largely because nitrous oxide exits the body quickly, it has been deemed not harmful to the baby.
According to UCHealth, “There are no known effects on the baby. Nitrous is the only pain relief method used for labor that is cleared from the body through the lungs. As soon as you stop breathing the gas, the nitrous effect is gone within a breath or two.”
According to the American Pregnancy Association, nitrous oxide when used during labor does not disrupt the release of oxytocin, does not affect breastfeeding and does not affect “infant alertness during the early bonding period between a mother and her newborn.”
There is research showing that epidurals can interfere with or lower the release of hormones during the birthing process, like oxytocin, and epidurals can cause drowsiness in babies.
Nitrous oxide can also be used in the bathtub. With an epidural, mothers often cannot, or are not permitted to, stand up after the drug takes effect.
Chamberlain emphasizes that nitrous oxide is not going to provide the same type of pain management or relief as an epidural, and epidurals, when administered using best practices, certainly have their place.
But, he also noted that epidurals can mean longer labor, and if there is “too much pain relief,” it can “take away a mother’s ability to feel what they are doing — and make sure they are pushing correctly.”
Chamberlain supports a mother’s choice to use or to forgo an epidural — but he’s also happy about the availability of nitrous oxide as one more option — one more tool — to safely ease the pain of childbirth.
There are potential side effects of nitrous oxide on the mother, including sedation, nausea, vomiting and dizziness.
More severe side effects have been seen when mothers used concentrations of nitrous oxide higher than the 50% nitrous gas and 50% oxygen as is used at the medical center and as set by safety standards.
“A lot of people are afraid to get an epidural,” Chamberlain said, and it “helps to know there are some nonnarcotic pain relief options out there.”
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