New pain relief option for delivering moms

Staff Report

Forsyth Medical Center in Winston-Salem and Huntersville Medical Center in Charlotte expect to make nitrous oxide available to maternity patients by the end of August. Widely used in labor overseas and gaining popularity in the U.S., it’s safe, effective and empowering: Moms who need pain relief simply hold a mask over their nose and mouth and inhale.

“Nitrous oxide can be used early, it can be used late, it can be used at any stage of labor,” said Dr. Lewis D. Lipscomb, who supervises Novant ob-gyns in the Winston-Salem area. Its introduction at the two hospitals stems from patient demand and midwives’ push for more ways to manage labor.

Certified nurse-midwife Tammy Brothers is co-leader of Baby+Co birth center in Winston-Salem, which has offered nitrous oxide since it opened last year. The center partners with Novant Health. About 30 percent of the birth center’s patients use nitrous oxide.

“It’s a big patient-satisfier,” Brothers said. “You’ll still feel the pain — you just won’t care about it as much.”

While making mom more comfortable, nitrous oxide (sometimes referred to as laughing gas) won’t slow her labor or stop her from walking around, squatting, or using a birthing pool or ball, though she’ll need an assist.

It can take the edge off during transition, pushing and postpartum repairs. Best of all, because nitrous oxide is broken down in the mother’s lungs, very little reaches the baby. Continuous fetal monitoring is not required.

But women shouldn’t expect the same experience they might have had at the dentist. Using a nosepiece, dentists can give patients a blend of up to 70 percent nitrous oxide, 30 percent oxygen. Laboring moms, meanwhile, get a 50-50 mix, and they must self-administer it. That’s a safety step.

“Only when she’s able to hold the mask to her face and inhale is the nitrous administered,” Lipscomb said. “If she becomes too sedated, she will not be able to do that. It’s quite similar to patient-controlled analgesics, where the patient has a button that administers a narcotic pain medicine: It’s virtually impossible for them to get too much of it.”

While no one else can hold mom’s mask, birthing partners still have an important job: timing contractions and letting her know when one is on the way. Nitrous oxide offers the most benefit if mom gets a dose one to two minutes before a contraction is about to begin.

Side effects are rare. When they do occur, they’re usually limited to nausea and dizziness.

And if the gas doesn’t provide enough relief, laboring women can always move to something stronger, like an epidural, a pain-blocking anesthetic.

But nitrous oxide is not for everyone. Women who have a vitamin B-12 deficiency or who have had bariatric surgery shouldn’t use it, Lipscomb said. It’s also not appropriate for women who go into labor before their 35th week of pregnancy, those who use narcotic medicines, or for those who have sleep apnea, low blood pressure or low oxygen levels. Still, that means it’s an option for more than 9 out of 10 mothers, said Lipscomb.

“It is just good to have a lot of options, and nitrous oxide is a great tool in the tool bag,” said nurse-midwife Brothers.

Because midwives pushed for nitrous oxide and they do deliveries at both hospitals, Forsyth and Huntersville were logical places to introduce it, Lipscomb said. He predicts other Novant Health hospitals will eventually follow suit.

Meanwhile, he urges mothers-to-be to discuss pain relief with their doctor or midwife before they get to the hospital so they understand their options and “can have realistic expectations.”

“At this early stage, I would advocate that women ask about it,” Lipscomb said. “It’s so early in the game that I suspect a lot of providers will be relatively unfamiliar with it. I feel comfortable … that we’ve put together a protocol that makes it easy for providers to use and to feel comfortable and safe using it.”

Staff Report