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August 24. 2014 1:48AM

Labor pains... are no laughing matter


Mothers in labor at Monadnock Community Hospital have the option to inhale nitrous oxide to help them relax during labor. (COURTESY)


Mothers in labor at Monadnock Community Hospital have the option to inhale nitrous oxide to help them relax during labor. Courtesy 

Women looking to fight pain during labor have one more weapon in their arsenal if they deliver at some area hospitals.

Nitrous oxide, also known as laughing gas, is now being used as an analgesic in several New Hampshire hospitals, including Monadnock Community Hospital in Peterborough and Dartmouth Hitchcock Medical Center in Lebanon. This colorless, odorless gas when inhaled causes the woman's body to relax and for her to feel calm.

"If a woman uses nitrous she'll say 'I feel pain,' but, she'll say, 'I just don't really care," said Elizabeth Kester, a registered nurse who manages the Women and Children's Health Services at Monadnock Community Hospital, which was the first hospital in New England to offer nitrous.

The reason for that, Kester explains, is because of the dissociative effect of the gas on the user. When a woman is in labor, as she starts to feel a contraction, she places a facemask over her mouth and nose.

She takes a deep breath in, which releases the gas. As she breathes out, she does so into the mask, allowing the machine to recapture any remaining nitrous in her exhalation. This keeps anyone else in the room from taking in even a small amount of the residual gas.

After roughly 30 seconds, she feels the effect of the gas.

"If a woman doesn't like the way she's feeling with the gas, she can just take off the mask and it's gone," Kester said. "Where with narcotics or an epidural, if a woman doesn't like the way it feels, she's kind of out of luck."

Kester said that the pain relief of nitrous is a good alternative for women who want something in between feeling nothing - as with an epidural - and feeling everything. The gas also leaves the woman the option of being able to get up out of bed and walk around. This is not usually possible with an epidural, which largely numbs a woman from the waist down, and narcotics, which can leave a woman feeling drugged and sleepy.

Kester also said it gives a woman the feeling that she has some control over what's happening to her since she is the one who determines when she needs the gas and when she doesn't.

It's also relatively safe. Both narcotics and epidurals come with safety concerns and epidurals come with an increased risk of the mother needing medical interventions later in her labor. Nitrous does have side effects that include nausea, dizziness and drowsiness. These effects are relatively rare and usually go away when the gas is removed and the woman breathes in fresh air.

It's also, so far, considered safe for the baby. The gas is filtered through the mother's lungs and not her liver like you would see with a narcotic. The gas does pass through the placenta, but it's gone as soon as the mom takes in a breath of fresh air.

Further, getting gas for labor is not like getting gas for your teeth. The machines used for labor are set to a 50/50 blend of oxygen and nitrous and can't be adjusted, whereas dental gas is delivered can be titrated up or down and can be delivered in much higher concentrations, up to 70 percent.

At the 50/50 level used for labor, nitrous in not an anesthetic; it's simply an analgesic.

Though new in this area, nitrous is not a new method of pain relief. According to the study "Nitrous Oxide for Labor Analgesia," compiled by Dr. Curtis Baysinger of Vanderbilt University Medical Center, nearly 50 percent of laboring women in Finland and Canada, a full 50 percent of women in Australia, and 60 percent of laboring women in the United Kingdom, avail themselves of this colorless, odorless gas for pain relief, and have for generations. However, as of 2011, only 1 percent of U.S. hospitals were offering it.

As of this summer, there were 19 hospitals and 14 birthing centers in the country offering, or in the process of offering, nitrous oxide during labor.


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