Nitrous Oxide now available for labor pain managment in Missoula

Pain relief during childbirth has come a long way, and women today have good ways to reduce pain while staying as alert as possible during labor — a balance that benefits both mom and baby. In the last few years another option has been added — nitrous oxide.

This inhaled gas helps lower pain and relieve anxiety during labor, with an important advantage. It is completely eliminated from the body in just a few minutes.

Not a newcomer

Nitrous oxide isn’t new to the delivery room. Women in Europe, Canada, Australia and other countries have used it for decades. It was used in the U.S. between the 1930s and 1970s, when other methods of pain relief, such as epidurals, became more popular. Nitrous oxide started making a comeback in this country in 2011.

Today’s nitrous oxide systems have been updated for safety and efficiency. The gas itself is the same, but it’s delivered at a lower concentration than 50 years ago. Back then, mothers got between 70 and 80 percent nitrous oxide and the rest oxygen. This was often given in combination with other medications, most commonly morphine and scopolamine, a combination known as “twilight sleep.”

Today nitrous oxide is given as a stand-alone treatment, not in conjunction with anything else. The ratio is 50 – 50, which allows women to stay awake and in control. Nitrous is now the most commonly used analgesic for labor pain world-wide.

 More than 150 hospitals and over 50 birth centers in the U.S. offer nitrous oxide to women during labor. Four of these are in Montana — Community Medical Center in Missoula, Providence St. Patrick Hospital, North Valley Hospital in Whitefish and Kalispell Regional Medical Center.

Safety first

Nitrous oxide delivery systems are equipped with safety features that minimize risks to both the patient and the staff. For example, a negative pressure valve allows the gas to flow only when the mask is securely sealed around the woman’s mouth and she is actively inhaling. Since she is the only person who can hold the mask, the possibility of overdosing is eliminated.  A support person, such as a nurse or family member, must be in the room any time the system is in use.

 The way nitrous oxide is metabolized does not leave by-products in the body, and it is eliminated quickly from both the mother and unborn baby via the lungs. Over many years of widespread use in a number of countries, no adverse effects on labor progress, fetal heart rate, Apgar scores, neonatal transition, or breastfeeding have been noted.

 Some women who use nitrous oxide during labor feel dizzy and/or drowsy. Nausea is also a possible side effect, although this symptom can be caused by labor alone. If any of these occur, the woman can simply stop using the gas. Since nitrous oxide is quickly cleared from the body, she can switch to a different method of pain control within 5 minutes.

 To keep others in the room from being affected by the gas, the woman also exhales back into the mask. A built-in scavenger device removes nitrous oxide from the room.

 Nitrous oxide for labor pain isn’t right for every woman. If you are interested in using it, talk to your doctor or other provider.

 A simple process

The effects of nitrous oxide peak in 30-60 seconds and dissipate quickly. With coaching from a trained staff member, the laboring mom learns to put the mask to her face and start inhaling 30 seconds before the contraction begins. She then breathes the gas until the contraction wears off. With a few minutes of breathing room air, the effects of nitrous oxide cease.

Nitrous oxide can be used during any stage of labor. In addition to taking the edge off the pain and reducing anxiety, it also causes mild euphoria. This combination helps moderate the perception of pain. The euphoric effect, which is more pronounced at higher concentrations, is what earned nitrous oxide the term “laughing gas.”

Nitrous oxide doesn’t make women laugh during labor. But it can help give them significant power over their pain, since they control when to use the gas and when to stop. Missoula is at the forefront in providing this important option to women.