New at Einstein Medical Center Montgomery: Nitrous Oxide for Labor
Women giving birth at Einstein Medical Center Montgomery soon will be able to laugh their way through labor contractions. A program to be inaugurated in the fall will offer nitrous oxide—commonly known as laughing gas—to maternity patients to alleviate the pain of contractions.
Nitrous oxide, a quick-acting inhalant that induces euphoria and insensitivity to pain, is usually associated with dental work in the United States. However, it’s commonly been used as a labor analgesic elsewhere in the world—in Great Britain, Sweden, Finland, Canada, and Australia—and has become more popular in the U.S. as multiple studies have confirmed its safety and effectiveness. Einstein would be the largest teaching hospital in the region to employ it during labor.
“Being able to use nitrous up to and during delivery is an awesome option for pain management,” said Michelle Barcus, a Certified Nurse Midwife who received a grant from the Albert Einstein Society to launch the program. The Einstein Society is Einstein Healthcare Network’s internal foundation that funds new initiatives through a competitive process.
The use of nitrous oxide is part of a larger effort to reduce Cesarean sections by effective pain management, Barcus said. Although Einstein Montgomery’s rate of C-sections is low—19 percent, compared to the national average of more than 30 percent—“We’re still trying to reduce that even more.” Einstein is part of a collaborative effort of the American College of Nurse-Midwives to reduce so-called “primary C-sections,” performed during a woman’s first childbirth. “The first leads to a second or third and it’s a major drain on the patient as well as the health care system,” Barcus said. C-sections expose patients to risks of surgical complications and cost almost 30 percent more than vaginal births.
Nitrous oxide would supplement the use of epidurals and intravenous opioids during labor, the two options for pain relief now available. An epidural, an injection of numbing medication in the back, is effective, but, is “not without risks and requires increased needs for monitoring and limits the patient’s mobility. This limitation in mobility can lead to poor fetal positioning that can delay and sometimes prohibit labor from progressing,“ Barcus said.
Opioids can only be used in early labor because, she said, “administration of opioids in later stages of labor near the time of delivery can increase the risk of respiratory depression in infants.” Staying active during labor helps the process proceed, and both epidural and opioids require that a patient be confined to bed.
Nitrous oxide is a tasteless and odorless gas, mixed with 50 percent oxygen, which patients self-administer through a mask immediately prior to the onset of a uterine contraction. Laboring moms would continue to inhale during the contraction and stop when it’s over; the drug is out of a patient’s system within seconds.
“Adequate pain relief in labor is a top priority for women who deserve a variety of safe effective options,” Barcus said. “When provided with adequate pain relief, coping and birth experience are enhanced.”