Nitrous Oxide in Labor and Delivery in the Louisville area.
Yesterday, Woman Care Midwifery Services, based out of Southern Indiana, posted to their Facebook page that starting soon, their patients will be able to use Nitrous Oxide during labor!
So if you've chosen or are considering choosing a midwife on "the sunny side of the river", what should you consider when determining if Nitrous Oxide should be part of your birth plan?
Let's start by talking about what it is.
WHAT IS NITROUS OXIDE?
Nitrous Oxide (sometimes just called "nitrous" or N2O) is the same as the laughing gas you may have received at the dentist before, but in lower concentrations and with patient controlled administration. In other words, you'll feel less loopy than you might at the dentist office.
In high concentrations, it's a weak anesthetic. In the lower concentrations typically used during labor, it has anti-anxiety and pain relief qualities.
At one point, the use of nitrous oxide was fairly common in the United States, but it fell out of favor as epidurals became more popular. There's a recent resurgence in its use in this country, and now Kentuckiana is joining in!
In several other countries, including Canada and the UK, a mix of 50% nitrous oxide and 50% oxygen is available for pain relief during labor. It's administered using a handheld mask so that the birthing mother can control when she wants to inhale, and can put it down when she doesn't. The mask only delivers the medication when pressed against the mother's mouth and nose to create a seal, another difference from its use in a dentist's office.
So should you use Nitrous Oxide during your labor? Let's use the BRAIN decision making model (click link for a free printable) to walk through the benefits, risks, alternatives, and other factors in determining if this is an option that you would like to utilize.
what are the benefits of using nitrous oxide during labor?
Nitrous has the same basic benefit that all pain relief medications have: lessening the feeling and/or perception of pain during childbirth and immediately after.
But Nitrous Oxide also has some unique benefits.
- It has no effects on the normal physiological process of birth and labor, including pushing
- There no evidence that it has an adverse effect on the mother, or the baby (before or after birth)
- Since anxiety can cause labor to stall or slow down, the anxiety relieving properties can help the patient relax and allow labor to progress
- It does not interfere with newborn alertness, making early bonding and breastfeeding easier
- It is self administered, fast acting, and the effects are short lasting, giving the mother a lot of control over her perception of pain.
- It can be easily discontinued if the mother decides to stop using it. The effects cease after 5 minutes.
- With it being fast acting, it can be use immediately, where as other forms of medical pain relief usually require a wait (for the anesthesiologist to be available, for a bag of fluid to run, for an IV to be placed, etc)
- Compared to other pain management option, many women feel more in control of their medication when using Nitrous.
what are the risks of using nitrous oxide during labor?
As with any medication, as safe as Nitrous Oxide is, it does have some risks. When given in correct concentrations, the risks include:
- Sedation, dizziness, nausea and vomiting are all potential side effects
- Women with vitamin B12 deficiencies and MTHFR gene mutations are at greater risk of developing certain acute conditions and neurotoxic symptoms related to using Nitrous Oxide.
- N2O cause changes in pressure in the inner ear, so women who have had a recent ear surgery should not use it.
what are the alternatives to using nitrous oxide during labor?
There are many other alternatives to pain relief during labor and birth. Just a few include:
- An epidural
- Hydrotherapy in a tub or shower
- IV narcotics such as stadol
- Hypnotherapy techniques
Each of these options, and all of the others, have their own benefits and risks that should be considered.
wHAT ARE YOUR INSTINCTS AND INTUITION TELLING YOU?
Here's one thing this blog can't answer for you: how do you feel about using nitrous oxide? Maybe you have a friend that used it and had a great experience, so your gut feeling is that this is a great option. Maybe a friend has had a terrible experience, so despite the benefits, you're wary.
Maybe, since it's new to the area, you don't know anyone who has used this option and that makes you uncomfortable. Maybe you like the idea of having more control over your pain relief, so this seems like the best idea for you.
Some people place more emphasis on their gut than on the evidence based risks and benefits. If you're one of those people, that's perfectly okay. When it comes to your birth and baby, you should make the decisions that you are comfortable with.
what if you do nothing?
Doing nothing can mean two different things in this situation: choosing not to make a decision right now, or deciding not to use pain medication during labor at all.
Both of these options are perfectly reasonable. You can always make the decision to ask for or forgo Nitrous Oxide in the moment during labor, assuming you're delivering with a provider at Clark Memorial or Floyd Memorial that allows this option.
You can also decide to focus your birth plan on a completely natural birth. There are plenty of resources available to you, in the form of childbirth education classes, hiring a labor doula to provide support (who can also support you if you choose to use any kind of pain medication!) , and finding a provider and medical staff that is supportive of unmedicated birth.
As the midwives at Woman Care said in a comment on the announcement post "This is just another something in our toolbox if needed. We know our moms are strong and rock at natural birth!"
Making the right decision for you.
Ultimately, the decision is yours to make, as with any other choice surrounding your pregnancy, birth, and parenting journey. As always, consult with your medical care provider, as they know your medical history and condition whereas this blog post does not.
We're thrilled that Woman Care is joining the ranks of professionals offering Nitrous Oxide to laboring patients, and making this an option at one of the more popular hospitals to have a baby in Kentuckiana.