When Nicole Hostetter was pregnant last year with her second child, she knew she wanted her birth experience to be more positive than it had been with her first child.
“I really wanted to try to embrace the labor process as fully as I could this time around,” says Hostetter, 35, of Harrisonburg. “But I also knew that I wanted some kind of pain-relief option.”
At a pregnancy class, Hostetter learned about the benefits of receiving nitrous oxide gas during labor, which seemed to her like a good way to maintain control over her labor and still have access to some pain relief.
So when she arrived at the hospital while in labor on Oct. 31, 2018, she requested nitrous. Then, whenever she began to sense a contraction building, she would press the mask to her face and inhale as deeply as she could.
“I was still able to feel the pain of the contraction, but the nitrous oxide allowed my body to relax and do its work,” Hostetter says. “The nitrous also helped me mentally detach from the pain.”
A Long History of Use for Pain Relief
Sentara RMH began offering nitrous oxide to obstetric patients in June 2018. Sentara Martha Jefferson Hospital began to offer nitrous in March 2019.
“There has been more patient interest in nitrous than we’d ever dreamed,” says Jennifer Baugher, BSN, RN, RNC-MNN, C-EFM, team coordinator for the Family Birthplace at Sentara RMH.
Many people are familiar with nitrous oxide by its more common name, “laughing gas,” which has long been used to help with pain management during dental procedures.
The nitrous oxide used for labor pain, however, is less concentrated than the gas used by dentists, and is a mixture of 50 percent oxygen and 50 percent nitrous gas. At one time it was widely used at higher concentrations or in combination with other drugs for labor pain in the United States, and its use during childbirth is common in Europe. Over the past few years, nitrous has once again become a popular, low-intervention option in the U.S.
As a matter of fact, both Sentara RMH and Sentara Martha Jefferson began looking into offering nitrous after patients began inquiring about it.
“Our patients are pretty savvy,” says Sharon Fickley, MSN, RNC-OB, C-EFM, CNL, clinical educator at Sentara Martha Jefferson. “They’d read and heard about it, and wanted to have the option to use it during birth.”
“Patients who desire a low-intervention birth may want minimal medication—or none at all—but they still may prefer to use nitrous oxide to help reduce their anxiety,” Fickley says.
How it Works
Nitrous oxide helps alter a patient’s perception of pain and also takes the “edge” off by lowering anxiety, which helps women feel less tense during contractions. This helps their bodies work with the contractions rather than against them.
“With nitrous, they’re able to relax more during their contractions, and also to feel a bit disconnected from the pain,” Baugher says.
The patient holds the mask, ideally breathing in the gas about 30 seconds before a contraction begins. This allows the nitrous oxide to take effect, giving the most relief at the peak of a contraction. The woman can put the mask down between contractions and, in many cases, use it as needed throughout labor.
“Ultimately, much of what occurs in childbirth may be out of our control,” says Fickley. “Using nitrous oxide helps women feel more in control, helping them feel better about the experience overall.”
Another benefit of nitrous is that the effects of the gas wear off quickly, leaving the system in a minute or two and preventing patients from feeling doped or drowsy.
“As soon as I removed the mask following a contraction, I was back to feeling normal,” Hostetter recalls. “There were no residual effects, and I could carry on a conversation and move around the room to change positions and get ready for the next contraction.”
One of Several Pain-Management Options
Both Sentara RMH and Sentara Martha Jefferson continue to offer other pain-management options to their patients—such as epidural injections and intravenous (IV) medicine—along with nitrous oxide. Patients can learn about these options through patient education brochures, childbirth education classes, and at prenatal visits with physicians and midwives.
According to Fickley, medical literature shows that although nitrous oxide doesn’t necessarily decrease the use of epidurals, it does offer another option to use prior to an epidural, if desired by the patient. Nitrous cannot, however, be used in conjunction with an epidural or IV pain medication.
“If the patient decides she wants an epidural, we discontinue the nitrous oxide,” Baugher says. “To help ensure the patient’s safety and avoid extra sedation, we also don’t use nitrous together with IV narcotics.”
Only a few conditions may prevent a patient from being eligible for using nitrous oxide: if she is unable to hold her own face mask, if she has a known vitamin B12 deficiency, or if she has some other medical condition that could put her at risk.
“All of our physicians and midwives look over the patient’s medical history to make sure there’s no other reason nitrous shouldn’t be used,” Baugher adds.
Since nitrous oxide was first offered at Sentara RMH, patient feedback has been very positive. Mothers have reported being happy with their use of nitrous during the birth experience, indicating that it was effective in taking the edge off the pain—and that they would be willing to use it again.
“The benefits of nitrous oxide during labor really have been impressive,” Baugher says.
From the patient’s perspective, Hostetter truly appreciates having had access to nitrous during her birth experience.
“Using nitrous during my second labor really allowed me to ‘own’ my birth experience,” she says. “I felt like I was in control, and I loved being able to feel every contraction and the urge to push. It was an incredible feeling, and I’m so thankful I had such a great tool to use during one of the most powerful experiences of my life.”