Alternative Comfort Options For Labor and Delivery: Nitrous Oxide

Laura Ching
Featured Speaker:

Christiann Rosemurgy CNM
Christiann Rosemurgy is a Certified Nurse Midwife and a Board Certified Women’s Health Nurse Practitioner.

Christiann brings 19 years of experience in women’s health and midwifery to Aspirus Keweenaw. Christiann earned her CNM/WHNP at Georgetown University. She has a Master of Science in Nursing from University of Phoenix and a Bachelor of Science in Biology/Biological Sciences from Drake University. She completed training at Charleston Birth Place in South Carolina.

As your due date approaches, you might be wondering what the medical and natural options for pain relief are best for you and your baby. In recent years using nitrous oxide during pregnancy has grown in popularity.

According to the American College of Nurse-Midwives (ACNM), research has supported the reasonable efficacy, safety and unique beneficial qualities of nitrous oxide as an analgesic for labor.

Christiann Rosemurgy CNM, WHNP-BC discusses nitrous oxide as an alternative comfort option for labor, and the many benefits nitrous oxide has for women in labor.

Transcription

Melanie Cole (Host): As your due date approaches, you’ll want to become familiar with the natural and medical intervention options for pain relief. One option for pain relief during labor is Nitrous Oxide. My guest today is Christiann Rosemurgy. She’s a Certified Nurse Midwife at Aspirus Keweenaw. Welcome to the show, Christiann. What is Nitrous Oxide?

Christiann Rosemurgy (Guest): Hi Melanie, thanks for having me. Nitrous Oxide a lot of people would know more familiarly as laughing gas. We often times will have that in the dentist, which is the least favorite place for most of us to be. The difference between the Nitrous Oxide that we use for labor and birth is a 50/50 blend of Nitrous Oxide and Oxygen as opposed to in the dentist’s office you’ve got a blend of 70/30 instead. I know a lot of people feel like they would be sedated from it, but it’s a little bit different. What we know about these gasses is they are analgesia, and not anesthesia – a lot of times people will have gas to put them to sleep for surgery. This is something different. And while it doesn’t completely take a patient’s pain away, it will be metabolized in the lungs, so if you have any side effects you’re going to breathe in and out some room air, and the effects go away within 60 seconds. It’s currently being used about 1% in the US, but it has been widely used for many decades as a good option for pain relief during labor and birth and sometimes post-birth procedures if they’re necessary.

Melanie: How does it work during labor, and what happens?

Christiann: The nice thing about the Nitrous Oxide is it give the patient the ability to administer herself, so she is going to have a mask that she places over her nose and mouth and with some deep breaths, she will administer the medication to her with the gasses. What it does is it essentially tricks your brain into thinking that maybe this isn’t so bad and maybe I can get through this. It doesn’t necessarily like I said before, take your pain away to zero, so we caution patients this isn’t going to be something you feel no pain at all as opposed to say an epidural where you get fairly good pain relief in that regard. It is really good for anxiety, so sometimes it’s used just to calm a mom down so she can get back to her rhythm in terms of breathing through contractions. Some women are able to use it the entire time. Some use it up until they want to change up what they’re doing. Sometimes moms use it after birth. The nice thing is again like I said before, it’s metabolized in the lungs. What we know about Nitrous Oxide is that while it provides some good brain trickery in terms of pain and anxiety relief that it has very little effect on our babies. They do quite well – no signs of respiratory depression afterward and if we’re doing any amount of monitoring – which we should be – babies have good heart rates and no deleterious effects.

Melanie: What are some of the benefits of Nitrous Oxide and contrast and compare it with other pain relief options?

Christiann: That’s a great question. Like I talked about, it’s not widely used in the United States at this time. Nitrous Oxide is one of the many pain relief options we have at Aspirus Keweenaw for our maternity patients, which is very exciting for us. Nitrous Oxide, we’ve already talked about as opposed to other pain relief methods. We have water birth – we offer water for labor pain relief and a birth option. We also have options for spinal anesthesia traditionally known as epidural, or we do have a few other different options in terms of spinal anesthesia.

Right down to even having myself on staff, the midwifery model of care in terms of offering mom’s a wide variety of pain relief options is something that the US is trending towards in hospitals and birth centers across the country. Nitrous Oxide is – like we talked about, a very safe option for babies. We have lots of studies that are done overseas showing that babies born to moms that have no pain relief options versus Nitrous have good, what we call APGAR scores. Babies have a score that we give them one minute and five minutes after birth, which gives us an idea of how they’re doing right afterward as opposed to sometimes with spinal anesthesia we can see some respiratory depression – some issues. Although, spinal anesthesia is also considered to be a very safe and viable option.

I think the thing that attracts most women and myself as a provider about the Nitrous Oxide in comparison to other options that we have is that it can be used at any point during the labor and birth and post-delivery period of time, so she can use it early labor when she’s two or three centimeters. She can use it in active labor. She can use it up until the time she feels she needs spinal anesthesia and gets her epidural. She doesn’t need anything like that at all, but perhaps she needs a repair afterward, it’s good to use then as well. We’ve got lots of women who are very nervous about needles so we can even use it if she needs an IV for some reason, so it’s a very versatile method compared to some of the other methods that we use. It is something that we have in our repertoire to offer moms who need something.

Melanie: Are there some risks and side effects that you think that women should know about before they decide and what to choose?

Christiann: Absolutely, so anything we do during labor and birth is not without any risk at all. The current studies that we have available do show that it is – we have to believe that some of the medication must cross the placenta just because of the physiology of the body – that would be something safe to assume. Although, like I said before, our babies score out just as well and don’t have any notable adverse effects, but side effects are probably the bigger thing I talk to my patients about in the office.

It’s not for everybody. Not every woman is going to get the sensation that their pain is decreased or their anxiety is decreased. To be clear, some women will feel like they’re not doing anything more than breathing room air. We don’t know until you try it, certainly, but the biggest side effects for moms who are using it would be some may be lightheadedness, dizziness. Some moms even have some nausea, which often times we can’t always know if that’s because of her stage of labor or the Nitrous Oxide. The great thing about the Nitrous is we take it away, and we have you breathe a couple of breaths of room air, and if you’re not feeling better then it’s most likely the process of labor, but if you’re feeling better, then we have her back off of the nitrous.

It can be used, like I said, up until the time a woman would need another form of analgesia if that’s the case. It’s not for everybody, and we have to use caution when a woman has had perhaps IV medication early in labor. There’s a certain amount of time we have to wait before we can have her use the nitrous so that we don’t have any adverse effects on mom or baby.

Melanie: So give women your best advice on how to make this decision, Christiann, between an epidural, and using Nitrous Oxide, or any other methods of pain relief during labor and what you want them to know about making this decision.

Christiann: I think it’s important to have a close relationship with your maternity provider. Something that I don’t waver on with my patients would be a birth plan, and I know that scares a lot of people out there, but a birth plan, I find, is a communication tool. It’s a communication tool between me and my patients, and then we share that with the nursing staff. It’s a great time for me to go over all of the options available to a woman in terms of pain relief for labor and birth and possibly post-delivery pain relief – answer her questions, talk about the risks and the benefits and see if she’s got questions and help her decide what may or may not be right for her.

I think the biggest thing I impress upon all of my patients is, “You know what? Let’s talk about all of these options.” You know what’s available. While you’re in labor is not the time to say, “Hey, let’s talk about this.” Get that out ahead of time and then just see how you feel. Every labor and birth, whether it’s your first baby or your fifth or your tenth, is going to be different and I think we just have to trust the process of labor and birth and see how moms feel when they come into labor. When they think, on paper, one thing looks good, they may feel a different way when they come in, so I think flexibility is the key, but education before labor and delivery is, I think, an essential part of maternity care.

Melanie: What great information for women to hear. Thanks, so much, Christiann, for being with us today. You’re listening to Aspirus Health Talk, and for more information, you can go to Aspirus.org, that’s Aspirus.org. This is Melanie Cole. Thanks, so much, for listening.

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