Janet Oliver (Guest): Well, we have IV pain medications which are like Nubain, we have Sensonal. I guess that the Cadillac would be the epidural, which is the most intensive pain medication that you could use; and then, we've started using nitrous oxide.
Melanie: So, people think of nitrous oxide as something you get at the dentist. Tell us about it for use in labor and delivery.
Janet: Well, it's actually been used for a number of years in Europe, since like the 1800s. It was used in the United States a long time ago, and it's making a resurgency. The difference is that the percentage of nitrous oxide combined with oxygen has been readjusted and it's a different percentage that they use nowadays.
Melanie: So, how is it used?
Janet: Well, the best example would be that as you're going into labor, you're not necessarily very uncomfortable, but as you become more uncomfortable, it is a system that you use with a mask that you apply to your face and secure it. It's a very simple process and it is extremely safe.
Melanie: Is it something that people might associate with a midwife-type birth or is it used in hospitals in general, as well?
Janet: Wow, that's a great question and it's being used in huge facilities out on the East Coast--West Coast. The East Coast has started to use it. Small hospitals, large hospitals. It's not associated necessarily with the midwife service, a lot of places are getting on board with this; it's a great option.
Melanie: So, how does it work for the patient and relieving their pain? Does it disrupt the release of oxytocin? Does it interfere with the birth or the feelings that you have during birth?
Janet: This is probably the best part about nitrous oxide. When you get into the other medications, which are intravenously given, or the epidural, there are a lot of medical interventions that we have to do like starting an intravenous, using a medication to keep you labor going. Nitrous oxide is pretty benign. It is not metabolized or stored in your body, so when you start breathing it in and you decide you're reaching the comfort level you want, then you stop using it. It's blown off probably within one or two breaths. The feeling is maybe a little drowsy, some people might get a little lightheaded. I think a lot of people associate nitrous oxide with laugh, with like laughing gas, so you might feel a little silly, but the primary function is to reduce anxiety and that sensation of discomfort.
Melanie: Are there any risks to using it?
Janet: Well, it doesn't affect labor. It doesn't affect your ability to move around, and for a lot of people, that's really important. With all the other options that are available, like IV or epidural, there are a lot of limitations that are put on your ability to move around. It doesn't affect the baby, again, because it's not stored in your system and it's not stored in the baby's system, so once you start breathing, it is basically blown off. It's very short-acting.
Melanie: Are there some women, Janet, that maybe should not use nitrous oxide?
Janet: Good question. It depends on the hospital and the anesthesia department, the integration with the obstetrician; each hospital sets their own guidelines for who and who should not be using it. There are certain people that for whom it is not available, but in the pregnant population, those exclusions are very, very rare. We're talking about people that have major abdominal surgeries recently, people that have had recent eye surgery, where you don't want to shift the balance in the body, but it's pretty easily administered, pretty easily relieves pain, basically active labor, and as a woman needs it.
Melanie: Now, this is not considered anesthesia, right? It's an analgesia-- it's something to make you feel better, but not yet totally take the pain away, right?
Janet: Exactly. And that, according to the American Society of Anesthesiologists, is rated as an analgesic which is at a lower alert level, I could say.
Melanie: So, it doesn't necessarily make it so that you're not aware of what's going on or fall asleep, and does it have any effect on the baby?
Janet: No, it does not. There have been research done, and you have to remember that a lot of the European countries have been using this for over, I'd have to say like 70 years or more and out on the West Coast for about 20 years, so it's no effect on--I'm trying to think--the respiratory system of the baby, no effect on the fetal monitoring, so heart rate. No. It's basically fairly safe. It hasn't changed Apgar scores, which is one of the things that everybody uses to rate a baby's transition from inside mom to making that adaption to being out on their own.
Melanie: If somebody is asking you, Janet, why would they choose nitrous oxide over, say, an epidural or the other types? What would you tell them if they asked you that question?
Janet: You know, I don't think this should be viewed as one or the other. I like to consider labor as going uphill. You kind of start out slow and at the top is the worst. Or, let's say preparing for a marathon. So, I really would think of this as a step ladder. You're going to start with non-medical comfort measures. Changing your position, getting into a tub, and these things you might do at home; listening to music--redirecting yourself. The nitrous oxide, I think, would be the next step because it is not anesthetic and then moving from that, maybe you might decide that it's not working as well as you want, moving on to an IV pain medication, and then moving up to an epidural. I don't think that people need to choose this as a one or the other, and the pain of labor is not something you can rate in the same manner because your satisfaction with your labor process and the delivery is what makes it for the mom. And last, I just want women to know that the best part of the nitrous oxide is that it is controlled totally by you. You control how much you breathe in, when you're breathing it in, when you've had enough, you can stop and start using it; it's just a wonderful option during labor.
Melanie: Really great information and so well put. Thank you so much, Janet for being with us today. You're listening to MMC Radio and for more information, you can go to www.mmc.org. That's www.mmc.org. This is Melanie Cole. Thanks so much for listening.