Birthing Smart Blog

Using Nitrous Oxide in Labor for Pain Relief

There have been some (though not enough) studies performed by researchers of laboring women’s use of Nitrous Oxide (N2O) as an analgesic during childbirth.

Nitrous Oxide (also known as “laughing gas”) is an odorless, nonflammable, and tasteless gas that provides pain relief. By inhaling a 50% nitrous oxide and 50% oxygen mixture through a face mask, a laboring woman experiences some (not total) pain relief. The laboring woman holds the mask in her hand and inhales the gas either just before or during the contraction to take the edge off of the pain at the peak of the contraction.  (Best pain relief seems to come when a woman can time it so that she begins breathing in the gas 30 seconds before the start of her next uterine contraction.)

Please keep in mind that these advantages and disadvantages apply solely to intermittent, not continuous, use of Nitrous Oxide during childbirth. The presumption is that a woman would use the gas during a contraction and then remove the mask from her face in between contractions.

ADVANTAGES OF INTERMITTENT NITROUS OXIDE USE IN LABOR:

  • It decreases anxiety in some women.
  • It is noninvasive (unlike other available pain relief drugs offered to birthing women).
  • The laboring mom is in complete control of its use, and can choose to start its use or stop its use at any time.
  • It does not impair a laboring mom’s movements – she can use Nitrous Oxide in a variety of locations and positions.
  • The effects of the gas wear off in minutes.
  • There are currently no known side effects on the newborn from what has been observed after the baby’s birth (unlike other labor pain relief drugs).

DISADVANTAGES OF NITROUS OXIDE USE IN LABOR:

  • Some women have increased feelings of nausea (although there was not an increased incidence of vomiting associated with Nitrous Oxide use during childbirth)
  • Some women experience vertigo.
  • Some women feel claustrophobic (because of using a face mask to breathe in the Nitrous Oxide gas).
  • Some women find it distracting to establish her breathing rhythm while using the Nitrous Oxide.
  • Fatigue sets in when used for prolonged periods of time.
  • It does not provide total pain relief (more like, it takes the edge off).

SAFETY:

Nitrous Oxide has been available as an option for pain relief during childbirth in the United Kingdom since 1933, when it became widely distributed. In fact, “The use of [Nitrous Oxide] as a labor analgesic in the United Kingdom has produced a long track record of safe outcomes for both mother and child.” (p. e128)

However, recent studies of labor analgesics, including Nitrous Oxide, that have been performed on rodents and primates have suggested that these drugs may have a negative impact on the fetal brain, possibly inducing apoptotic changes if exposed to the drugs either in utero or shortly after birth. (Apoptosis is a process of cell self-termination within the body—and in this case, some component in the analgesics is causing these fetal brain cells to self-destruct.)

Though small concentrations of Nitrous Oxide exposure over a short period of time has imperceptible long-term effect on a newborn, it may be wise to keep in mind that “high concentrations for prolonged periods may be deleterious.” (p. e128)

As with any drug taken or intervention given during pregnancy, childbirth, or while breastfeeding, it is good to remember that there are always risks and benefits to be weighed. As of yet, the FDA has not recommended a shift in the use of anesthetics for either children or fetuses, but “the precise effects on brain development in human fetuses exposed to N2O or other anesthetic agents in utero remain largely unknown.” (p. e128)

Among all the options available to women hoping to avoid intervention but still seeking some pain relief, it seems that Nitrous Oxide may be a laboring woman’s best bet for some measure of pain relief in childbirth while experiencing the least negative impact for her and her newborn.


This article is a summary of an excellent review of Nitrous Oxide use in labor entitled “Nitrous Oxide for Labor Analgesia: Expanding Analgesic Options for Women in the United States”( by Michelle R. Collins, PhD CNM; Sarah A. Starr, MD; Judith T. Bishop, MSN, CNM; and Curtis L. Baysinger, MD) and originally published in Vol. 5 No. 3/4 of Reviews in Obstetrics & Gynecology in 2012. Read the full text online here (as of December 8, 2015): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594866/

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Breastfeeding Support Groups in Colorado

Let’s be honest about something: even though babies and mothers may have an instinctual knowledge that guides them toward breastfeeding correctly… sometimes it takes a lot of tenacity and support to sustain a breastfeeding relationship with your newborn!

Because of that, I believe it is SO important that new mommas know what support is available to them to help them work through any questions or concerns that may come up regarding breastfeeding. The list below includes a number of important support avenues for moms, with both free and fee-based meetings, run by both volunteers and trained lactation specialists.

Don’t be shy to attend! Moms often bring their infants with them to nurse at these meetings so that others can give them specific advice based on their situation. And if you feel nervous about attending, you should know that the folks who lead these meetings aim to create safe environments for moms to cry it out, in addition to receiving encouragement and feedback on the issue at hand. 😉

And remember: before you show up to one of these meetings, please, please double-check my research by visiting the website associated with each group in order to verify the time and place of the meetings!


Baby + Company – FREE

Visit http://www.babyandcompany.com/wheat-ridge/ for the most up to date schedule!

9AM every Tuesday at Baby + Company Birthing Center – 7777 West 38th Avenue, Wheat Ridge, CO 80033


La Leche League Meetings – FREE

Visit http://www.lllusa.org/locator/colorado/ for the most up-to-date schedules! You can also find a calendar of Metro Denver meetings here: http://bit.ly/1wvZEhc.

For urgent help, you can call the Denver Metro La Leche League phone line at 303-779-6722 or the Colorado Springs Metro La Leche League phone line at 719-481-2909.


The Mama’hood Breastfeeding Groups – $16 per class

Visit http://www.themamahood.com/breastfeeding-groups/ for up-to-date schedules!

DENVER:

1PM on every Monday, Tuesday, Thursday, and Saturday at the Mama’hood Denver – 2902 Zuni St., Denver, CO 80211

BOULDER:

1PM on every Tuesday and Friday at the Mama’hood Boulder – 2525 Arapahoe Ave., Boulder, CO 80302. (In the village shopping center on kids’ row, corner of Arapahoe & 28th St.)


 Belly Bliss “Blissful Breastfeeding Support Group” – $20 per class

Visit http://www.bellybliss.org/Schedule.html or call 303-399-1191 for up-to-date schedules.

11:15AM-12:15PM on every Wednesday – 300 Josephine St., Suite 10, Denver, CO 80206.


The Family Room Breastfeeding Support Group – FREE

Visit http://www.thefamilyroomdenver.com/breastfeedingsupport/ or call 303-356-6244 for an up-to-date schedule.

1-2PM on every Wednesday at The Family Roo – 6279 W. 38th Ave., Suite 1, Wheat Ridge, CO 80033.


Connecting Mamas Breastfeeding Support Group – $10

Visit https://www.lutheranmedicalcenter.org/calendar/women-and-family-classes/connecting-mamas-new-moms-group/ for an up-to-date schedule.

9-10:30AM on every Wednesday morning at Lutheran Medical Center – 8300 West 38th Avenue, Wheat Ridge, CO 80033.

The group takes place in the women’s education center classrooms (Main hospital – entrance #2, 2nd Floor, North).


Enso Mama Prenatal Mamas Group and Lactation Sessions – $17

Visit http://www.ensomama.com/mamas-group-and-lactation-sessions.html or call 719-660-5687 for up to date schedule.

10:30AM on every Friday at Enso Mama Prenatal – 10 S. 25th St., Colorado Springs, CO 80904.


Note: If you have any other groups you think I should add, or you notice that a location/date/time of a meeting listed is not right, please comment to let me know! I’d love to keep updating this  list.

Not for the Squeamish: Why I Became a Birth Doula

Infertility runs in my family. My maternal grandmother’s pregnancy was an act of God—it took her and my grandfather ten years using every fertility treatment available in the 1950s and a whole convent of praying nuns on their team before my grandma missed a period and kept the pregnancy long enough to discover that she was pregnant with not one girl, but two.

My aunt, my mom’s twin, married at thirty, experienced an ectopic pregnancy and a trip to the emergency room, and then never was able to conceive again. My mother, on the other hand, easily grew and birthed three babies without any losses at all and with minimal waterworks. (Can any living, breathing woman go through a pregnancy without weeping daily?)

So when my husband and I decided to casually forgo our birth control, “just to see what would happen,” he and I were shocked, ecstatic, terrified, and jubilant when, after skipping my period that first month, a test confirmed that we were pregnant.

A dear friend happened to be pregnant as well. She was a few months ahead of me, and she began to tell me all about her midwife, Emily. While the midwifery style of prenatal care sounded interesting to me — if a bit hippie — I decided that for my first birth, I should be conservative.

I made an appointment with an OB-GYN just a block away from my house. The first couple of appointments were uneventful, and even helpful — my husband and I saw a little peanut in my belly and heard its heart beat like a tambourine. But after our third appointment, I found myself weeping on my husband’s shoulder in the parking lot.

Between sobs, I managed to complain, “This is the birth of our first child, and our OB can’t even find the time to write your name in my chart even though you’ve come to every appointment with me. Is this how we want to welcome our child into the world?”

The next day, I mentioned our troubles to my friend, and she handed me a copy of the movie, “The Business of Being Born,” which my husband and I watched, enthralled, a few evenings later. Another week later, my husband and I peppered my friend and her husband with questions about home birthing: was it really safe? What if something goes wrong? What if there’s a truly unpredictable emergency? And the next week, we met with Emily the midwife to again ask her all the questions we could think of and find out if home birthing was really for us.

Ultimately, we realized that any concern we had ultimately came down to fearing the wildness of childbirth. My husband found Emily’s answers and presence convincing (Is it safe? Yes, according to many research studies. What do you do in emergencies? We use all the tools nurses do in the same situation and you’re a 10 minute drive from the nearest hospital. What are your qualifications?, etc.).

However, I found I had to wrestle within myself. While I trusted and respected Emily and truly felt a kinship with the relational style of midwifery that she practiced, I doubted myself. Could I handle the intensity of labor if it really was as painful as I’d always believed it would be? Could I trust my body to do the work of childbirth all on its own, without any interventions? Could I forgive myself if an emergency took my child from me?

I finally decided that I did not want the first decision I made as a mother to be made for me by my fear of the unknown; I wanted to begin mothering my daughter with strength and courage, even in the way I birthed her. For me, that looked like being honest with myself and choosing the birth that I really wanted (a home birth with a Certified Professional Midwife), rather than choosing a birth based on what might go wrong (meaning, for me, a birth in a hospital. I should say that there were no birthing centers in my area, though of course, that’s a great middle ground between the poles of hospital birthing and home birthing).

I began to prepare for my birth as fearlessly as I could — I read every book my midwife recommended to me, including Ina May Gaskin’s classic Ina May’s Guide to Childbirth and Pam England’s Birthing from Within. I made birth art, depicting myself in my pregnancy and visualizing what my labor might be like. I wrote mantras and Bible verses on a chalkboard to encourage me during labor. I stockpiled all the supplies we’d need. I prayed fervently to God for the strength to fearlessly (and quickly) deliver my baby into the world.

The day of my daughter’s birth came, and my labor started slowly while a pink birthday cake baked in the oven. When active labor finally began, it hit like a train, and my baby was born into her father’s hands in a tub in the middle of our living room within just six hours of when those first active labor contractions began.

However, the hard part of labor was not over for me — while my baby said hello to her new world, my placenta was expelled, and I began to bleed. On the way from the tub to my bed, I began to hear a ringing in my ears, and my midwife realized that I was slowly hemorrhaging. I remember she and her assistants consulting in my living room, after the herbal remedies they had given me had not curbed my steady bleeding. My husband and I were left alone in my room with our child. I remember I felt afraid.

I had not hired a doula for my birth, though I had heard of the concept from Ina May Gaskin’s book; however, I believed doulas were only necessary for hospital births. Why would I need one when I was in the care of a midwife? Looking back, I realize that I needed a doula in that moment right after the birth of my daughter, when my midwife and her assistants were huddled together in my living room, planning how they could help me. I needed someone to hold my hand while my midwife was attending to my health. I needed someone to tell me it was okay to be afraid. I needed someone to say that she’d be there with me, regardless of what happened.

Afterward, I dealt with some trauma related to my hemorrhage and also related to my experience of the pain of my labor. While my midwife did talk through my experience with me within a week of the birth, I realize now that I needed someone to sit with me and work through all the intricacies of my birth story — the parts that proved I was brave and strong, and the parts that scared me and made me feel weak and vulnerable. Perhaps a presence like that could have helped me avoid the crippling Postpartum Depression that followed my daughter’s birth.

My second birth, the birth of my son, shared similarities with my first except that I knew what to expect and I opened myself to the experience in a way that I was unable to do for my first birth. I still birthed at home — even with the same midwife — but this time, everyone played a slightly different role. My husband was still involved, but my midwife and her assistants became doulas to me. They held my hands as I tried to retain my rhythm during the intense transition contractions. They spoke words that focused my efforts as I pushed my baby down the birth canal. And they encouraged me to hold and guide my baby’s head as it exited my body — they gave me the power to deliver my baby all on my own, as they watched just inches away. And because they knew to expect it, they made sure to give me a shot of Pitocin in the thigh to help avoid any extra bleeding. My midwife and her assistants provided timely support to help me be the strong and powerful woman they believed me to be.

Even so, I never considered working as a doula until my children had grown a bit, and my husband and I decided that at least for the time being, we were done having children. I began to notice myself continuing to take an intense interest in my friends and acquaintances who were pregnant. I would volunteer to bring them meals just after they had delivered babies, even if we were only loosely connected, and I would find myself asking specific questions about how long the different stages of labor were, which drugs were used when, and how different procedures had been performed. I noticed that what I had believed to be just a seasonal interest (“I’m pregnant, so I’m interested in pregnancy”) had progressed to something else entirely: it had graduated to a personal passion.

It wasn’t long after that realization when I pursued becoming a certified birth doula. Today, I feel privileged that I get to walk along the path of pregnancy and childbirth with a women and her supporters. I feel equipped to give her timely, personal information about her choices during pregnancy, childbirth, and the postpartum period. I feel honored to be invited into a pregnant woman’s birth as a gracious and continuous presence in the midst of the unpredictability of the birth experience. I enjoy the challenge and spontaneity of adapting to a new stage of labor and adjusting my support to meet a laboring woman’s needs in each unique moment. I delight to see fathers and partners take ownership of the birth of their child, and I like to find ways that I can help fathers and partners be even more involved as labor supporters. I savor the conversations I have with families when a family is waiting for labor to begin and after the newborn has arrived — these conversations are ones of intense vulnerability and intimacy in which I get to bring words of understanding, encouragement, empowerment, and trust.

Whether a birth happens at home under the care of a Certified Professional Midwife, in a birthing center under the care of a Certified Nurse Midwife, or in a hospital under the care of a OB-Gyn, birth is beautiful, breathtaking, unpredictable, and normal! My story has led me down this path, and I couldn’t be more thrilled – because to me, being a doula is the best job in the world.

Pregnancy Struggles: Featuring “Story of This Life”

Let’s get real: while every pregnant woman I know is thrilled-beyond-thrilled to be having a baby, for most moms-to-be, pregnancy is a struggle. For example, how in the world do you put on your socks around that belly? Or trim your toenails? Or keep up with your cravings for hot wings? Or, for that matter, roll over in bed!?!? This video, produced by “Story of This Life,” perfectly captures that end of pregnancy struggle all women experience – because we’d all rather laugh about it than cry! (Honestly, we’re all crying enough as it is.)