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Old idea comes back to the delivery room: laughing gas for labor pain

Looking for an additional way to help women ride out the pain of childbirth, hospitals are turning to an old idea making a comeback – laughing gas.

Mercy Hospital in South Buffalo is among the latest to offer nitrous oxide to women in labor. It joins hundreds of other facilities nationwide that have embraced the option in just the last few years.

Pain during labor is different for every woman, but it's usually memorably severe.

Nitrous oxide offers modest help. But here's the curious thing about the gas. Many women who use it in childbirth report being satisfied with their experience even if the pain relief isn't that good or, as is often the case, they eventually turn to the strong pain medicine of an epidural.

How can that be? Experts say pain relief, although important, is not the only factor in a woman's perception of childbirth. Having choices and a sense of control play a part, too.

"Patient satisfaction is a tough issue. You want to give women options to help them through one of the most important days of their life. Nitrous oxide gives them some control. They use it when they want to," said Dr. Lynn Aronica, an obstetrician-gynecologist at Catholic Health.

In the case of labor in childbirth, nitrous oxide is mixed with oxygen in a 50-50 blend and inhaled through a mask from a portable unit. A woman holds the mask herself and inhales when she wants, though it works best about 30 seconds before the start of a contraction.

Taking the edge off

The gas helps cope with pain more than it diminishes pain, primarily by reducing anxiety, leaving a person aware of the discomfort but less distressed by it. Nitrous oxide earned a reputation as "laughing gas," but in this concentration and under these circumstances, no one is going to chuckle. Users are just looking to take the edge off a world of hurt.

"It numbs your thinking. I would forget about things for a moment, but I still felt everything. It was still rough," said Jordann Luce, who used the gas as her sole pain relief in 12 hours of labor before giving birth to a boy earlier this year.

Luce, a senior at Fredonia State College studying music business and audio-radio production, is terrified of needles and wanted a natural birth without an epidural, an injection of an anesthetic and pain medication into the spine that blocks pain in the lower part of the body.

This was her first delivery, and the pain and nervousness was extreme, especially during the birth. She remembers feeling such agony at times that she couldn't speak.

"I had to point to a glass of water or a wash cloth if I wanted something," she said.

"I think the nitrous oxide relaxed me. I wasn't tensing up as much. Maybe the gas dulled the pain a bit. I don't know how bad it would have been without it," Luce said.

Would she do it the same way again?

"If the pain is as bad as this time, I might try something else," she said.

Her advice: If your tolerance for pain is high, give nitrous oxide serious consideration. Use it with realistic expectations, Luce said, and see how long you can stick it out.

Remained common overseas 

Nitrous oxide is a nonflammable, tasteless and odorless gas first synthesized by the English scientist and theologian Joseph Priestly in 1772. It was known initially for its euphoric effect, but others eventually saw a benefit for pain relief in dentistry and medicine.

Perhaps its most unheralded application is one American consumers know well – as the propellant in canned whip cream.

The gas was administered to laboring women in the United States in the 1950s and 1960s, until it faded away with the advent of the epidural. However, nitrous oxide remained a common pain management technique during labor in other countries, including in the United Kingdom, Canada, Finland, Norway, New Zealand, and Australia.

In 2011, the Food and Drug Administration approved a portable machine that delivered nitrous oxide in a concentration that could be self-administered by a woman and not be altered, helping set in motion renewed interest in the option. At that time, there were only two hospitals in the U.S. using nitrous oxide for labor pain, according to a report by Vanderbilt University Medical Center, one of the early adopters.

Reports in medical literature indicate that at least several hundred U.S. hospitals and birthing centers now use it. The resurgence of nitrous oxide has been accompanied by discussion in the medical community about its effectiveness and potential adverse effects.

Given its long anecdotal track record outside the United States, the gas is considered safe for labor pain, although some women report feeling dizzy or nauseated for a few minutes, experts say. There are also patients for whom nitrous oxide would be withheld for medical reasons, including a recent history of substance abuse.

Few good studies 

Despite decades of use, there are few good studies to provide a clear picture of how well and why nitrous oxide works, as well as which patients may respond the best and if there are possible long-term downsides.

Its effectiveness appears to be variable, with some women finding the gas inadequate and others finding it helpful, research shows. Many patients who choose nitrous oxide ultimately decide to have an epidural.

But a large 2017 study of more than 6,500 women published in Anesthesia & Analgesia suggests there is a connection between nitrous oxide and patient satisfaction. Although nearly half of the women who delivered with nitrous oxide alone reported low or modest effectiveness, they were highly satisfied with their pain relief.

These women were as likely to express high satisfaction with anesthesia as those who received epidurals, the researchers said. Their conclusion: Like the birthing balls, Jacuzzis and other self-administered methods to relieve pain and anxiety in labor, nitrous oxide helps give patients a sense of self-control over their situation.

"You are letting patients have a say in the management of their care," said Aronica.

Mary Ann Murphy, director of maternity services, said Mercy Hospital began to look into nitrous oxide several years ago to increase its comfort options for women. So far, about two dozen patients have tried it.

"For some, it was their sole pain relief. Others also used an epidural. Some found it helpful. Others did not find satisfaction with it," she said.

Nitrous oxide is included as part of the standard maternity charge. The hospital uses a $4,000 Nitronox portable nitrous oxide unit made by Porter Instruments that includes a scavenging system to prevent excess gas from being vented back into the room.

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