South County Hospital may be the first in Rhode Island to bring back laughing gas for women in labor. It hasn’t been used in the U.S. for decades. We delve into what happened to nitrous oxide, and why it’s making a comeback.
South County Hospital patient Amy Marks has just given birth. Her son, Ethan Thomas, is barely 24 hours old. He’s asleep in the crook of her arm as she receives visitors in her hospital bed.
“When the contractions started getting pretty intense, I was like, wow, this is pretty bad. I think I might want an epidural,” says Marks.
An epidural is an injection in the lower spine that blocks feeling in the lower body. Then someone reminded her that nitrous oxide, or laughing gas, was an option. So Marks decided to give it a try. It didn’t obliterate the pain of contractions, she says.
“You clearly, if you’re having a strong one, at the peak of it you feel, but it makes it so much better. So much more bearable.”
Easing pain, and anxiety
In other words, it lessened the pain a bit, but even more it lessened Marks’ anxiety about the next contraction. How? Marks’ midwife Cynthia Voytas jumps in to say that breathing in the mixture of 50% nitrous oxide and 50% oxygen releases chemicals in the brain that distract a woman from the pain.
“The nitrous stimulates the endogenous endorphins in our body,” says Voytas.
“Runner’s high,” I offer.
“It sort of gives you this euphoria that helps you sort of forget about the pain for a little bit,” Voytas says.
“Absolutely. That’s exactly what happened,” confirms Marks.
Voytas shows me the little cart stocked with two gas tanks. It’s mobile, so nurses can just roll it up to the woman’s bed side. There’s a hose with a breathing mask. And when she wants a little gas, a woman can just pick up the mask and breathe. Voytas says it gives a mom more control over her pain relief. Plus she’s not confined to bed – like she would be with an epidural. And that’s helpful if she wants to move around during an intense contraction.
Midwives lead the charge
That’s why a handful of nurse midwives began campaigning to bring nitrous back to the U.S. Around the 1930’s, nitrous oxide became a popular option. It’s been used for decades in Europe. But nitrous oxide fell out of favor in the U.S. Doctor Michelle Collins, who heads the nurse midwifery program at Vanderbilt University School of nursing, explains what happened.
“It had been used in the United States sometime in the 50s, and as epidurals came more in vogue, or more popular,” says Collins, “then the use of inhalational gases like nitrous oxide went by the wayside.”
Then, Collins says, birth became much more medicated.
“It got to this ‘twilight sleep’ era in the 60s when you know women just came in, you knocked them out, you pulled their babies out” says Collins, “and they woke up with a baby in their arms.
But Collins says today, women want more options. They want to be more involved in the birth of their baby.
“Now, women are more informed, and they’re demanding that their voices be heard, which is a really great thing in my book.”
Safety first
So Collins was among that handful of midwives who campaigned to bring nitrous oxide back to the U.S. They had to convince a new generation of doctors and hospitals the gas is safe. Nurse midwife and former Centers for Disease Control and Prevention epidemiologist Judith Rooks is one of those vocal advocates. She says nitrous is safe for mother and baby because it leaves the body in seconds.
“It does pass the placenta and go into the fetal circulation,” says Rooks, “but as soon as the baby takes a breath or two, it’s gone.”
The American College of Obstetrics and Gynecology has issued a bulletin in support of nitrous oxide. What’s more, says Judith Rooks, nitrous is cheaper than an epidural by hundreds –sometimes thousands—of dollars.
More hospitals on board
Those are just some of the reasons nitrous’ popularity is growing. In 2011, just two hospitals in the States were using it. Today, there are hundreds, according to the two main manufacturers of nitrous oxide systems. Women and Infants Hospital in Providence is considering the option, says Doctor James O’Brien, medical director of inpatient obstetrics. But they’re doing a little homework, first.
“We’ve actually done a field trip to Brigham and Women’s Hospital which is similar to us in terms of being a relatively large academic institution,” says O’Brien, “so we’re seeing how they’ve integrated it into their care. I foresee it as something that’s in our pretty close to immediate future but we want to make sure it’s done in the safest way possible.”
O’Brien says his staff has to consider how they teach women to use the gas. You have to breathe it in about 30 seconds before a contraction for the full effect, and it wears off pretty quickly. Plus the system has to have a built-in mechanism for capturing any stray nitrous oxide – you wouldn’t want nurses and doctors breathing it in.
But he says a pain reliever with few side effects – including no effect on the progress of labor – is an option more hospitals should be considering.
