Nitrous Oxide for Labor – No Laughing Matter

A simple technique to help manage labor pain is used commonly in the United Kingdom, Scandinavia, and Canada, but is offered to few U.S. women—nitrous oxide, or often known as “laughing gas.”

What is Nitrous Oxide?  New-Nitronox-System-Retouch

Nitrous oxide, commonly called “laughing gas”, reduces pain and anxiety. It is an odorless, tasteless gas that you breathe in through a mask. Nitrous Oxide is commonly used in labor by women in many other countries. For example, nitrous oxide is the most commonly used form of analgesia in the United Kingdom, where midwives use it in hospitals and carry it with them to home births, and three of every five women use it at some time during labor.

Labor pain is different for all mothers. Some women manage labor well with birth techniques such as position changes, water, hypnobirthing or techniques they have learned from their childbirth classes and others would like the option of “a little something to take the edge off.” Nitrous oxide is able to offer “that little something”.  There are women who want to have a birth that is as natural as possible, but also would like “just a little” pain relief to help them achieve their goal. This is the strength of nitrous oxide.

Most U.S. hospitals offer only the extremes of epidurals and narcotics for pain management. Many women would prefer options that are “good enough” pain relief measures without being completely numb and avoid the risks associated with more intensive anesthesia.

Is Nitrous Oxide safe?

Administration of nitrous oxide is not associated with increased risk of complications to either moms or babies and does not require more intensive or invasive monitoring. There has been widespread and extensive use of nitrous oxide for labor in many countries since the early 1900s with no studies or published observations identifying any significant adverse effects on the baby. There is no increased requirement for resuscitation, and newborn alertness and responsiveness during the important early period of maternal‐infant bonding and early effective breastfeeding are unaffected.

Why are mothers choosing Nitrous Oxide?

Doesn’t lead to further intervention. Mothers like nitrous oxide because, in contrast to the epidural, it does not lead to a possible “chain of interventions” that can end in a cesarean section, which has become the birth method for almost one in every three American mothers delivering in hospitals.

Doesn’t affect the natural progress of labor. When used under standard conditions, side effects are minimal (such as dizziness or euphoria).  Using nitrous oxide in labor does not interrupt or stall labor progression.

 A woman administers it herself.  Self- administration allows the woman to control management of her pain. The laboring woman must hold the mask or tube herself and not let another person hold it for them. If you breathe too much of the gas, you become drowsy, your hand will relax, and the mask or tube will fall away from your face, so that you breathe normal room air.

What are the advantages to using Nitrous Oxide?

Nitrous oxide can be administered quickly, easily and safely and has a very rapid onset of action and it can be discontinued as quickly and easily as it is started. The effects begin to dissipate immediately after the woman stops breathing nitrous oxide and are completely gone within minutes. Nitrous oxide has no adverse effects on the progress of labor.   After a brief period of explanation and supervision, nitrous oxide is self-administered through a mask that the woman holds to her own face. Self-administration allows the woman to determine when and how much nitrous oxide she uses. If a woman doesn’t like or tires of using nitrous oxide, she can stop using it without residual effects from the nitrous oxide.

What are the disadvantages to using Nitrous Oxide?

The mouthpiece is connected to a gas tank and can limit the area the mother can move around. However, the equipment used at the birth center allows a women to have a wide range or mobility so she can be on the bed, in the birth tub or in the bathroom.  To avoid over sedation it cannot be used within 6 hours of narcotic pain medication (which does not apply if you are at the birth center…we do not use narcotics). Some women report dizziness and mild nausea. Women with a history of Vit B12 deficiency, Crohn’s disease, chronic malnutrition, pernicious anemia, strict vegans, or who have middle ear disease or recent ear infection are not candidate for using Nitrous Oxide.

How is Nitrous Oxide administered?

Nitrous oxide is administered in combination with oxygen through a face mask that you hold. The gas only flows when you inhale into the mask or mouthpiece. Because it is self-administered the mother controls how much or how little she receives. The Nitrous Oxide machine blends the concentration to 50% Nitrous Oxide and 50% Oxygen and is set at a specific level so the mother cannot over medicate herself.

Can I use Nitrous Oxide while in the birth tub? pain_relief_during_labour_18ev8vr-18ev91l

Yes, Nitrous Oxide and warm water immersion work well together to provide relaxation and pain management for labor.

Does insurance cover the use of Nitrous Oxide?

Insurance companies do not cover the use of Nitrous Oxide in labor.  It is an out-of-pocket expense.

As with everything, nitrous oxide is not right for every woman during labor, but it is wonderful for some.

Here is a video that talks about the use of Nitrous Oxide for labor pain management and it’s reemergence into the United States as an option for women.

All about Birth Doulas

doula artMany of our clients wonder what is the benefit of hiring a doula for a birth center or home birth.  After all, isn’t your midwife a lot like a doula?  Not necessarily.

We love it when our families choose to have a doula and believe it provides many benefits before, during and after birth.  In fact, we believe so wholeheartedly in the benefits of a doula that we have a doula internship program, which links newer doulas with families in our care.

In this post, we’ll explore what a doula is, how she* fits into your birth team, what support she offers, and what he training looks like. In our next post, we will talk about the many benefits of a doula

*While there are some male doulas, most doulas are female and thus the use of “she” here.      

What is a birth doula? 

A birth doula is a trained professional with knowledge of the physiology of birth and the emotional needs of laboring women.  She offers continuous emotional and physical (but not medical) support to mom and her partner throughout labor.

Doula as a unique part of the care team

While a midwife knows and supports a mom and her partner, she is chiefly responsible for the medical and clinical care of mom and baby during labor.  She may offer intermittent support and comfort as well.  A doula will offer continuous emotional support and comfort as soon as early labor, as a woman and her family desires.  Nurses are present to help with the medical and clinical aspects of birth and may not be familiar to the family prior to birth.  A family often knows their doula before labor.  A partner offers emotional support and loves the mom and baby like no one else on the birth team, but does not typically have the knowledge and experience that a doula can offer.

What does a doula do?

doulalaborpushSome of the specific support services a doula provides include:

  • Before birth, she often meets with an expectant family one or more times to get to know them, their wishes, hopes, and fears, and so come to understand how best to serve them in labor.  This also gives the family and doula an opportunity to develop a rapport and build trust.
  • A birth doula works to empower families through education and access to resources before, during and after labor.  She does not speak for a woman or her partner, but helps them make informed decisions and advocate for themselves and their desired birth vision.
  • In labor, a birth doula provides continuous support, meaning they will come to your side during labor when you wish (at home or in the birth center) and stay with you all the way through your labor and delivery and the first few hours postpartum.
  • A doula supports the role of the partner, and does not usurp his role in a woman’s labor; conversely she supports and enriches this bond and this support.
  • A birth doula can help suggest and facilitate physical comfort measures to help a woman cope through labor.
  • She offers emotional support to both the laboring woman and her partner.  She remains calm and objective throughout the birth process.
  • She facilitates communication between members of the birth team (professionals and kin).
  • After the birth, doulas often meet with families, offering breastfeeding and early postpartum support.

What does a doula NOT do?

A doula does not:

  • Provide medical information or clinical advice.  She will not perform clinical or medical tasks such as taking mom’s blood pressure or temperature, monitoring fetal heart rate, performing vaginal exams, etc.
  • Make decisions for a woman or her partner, or interfere with their care
  • Judge a woman or her partner for their wishes and choices in birth
  • Take away from the role of the partner or any other birth team member

What training does a doula have?

doulatrainingBirth doulas have a choice to become certified with a certifying body or not. The most common, though not the only, certifying body is DONA, or Doulas International (formerly Doulas of North America, hence the acronym).  Bear in mind that uncertified doulas may have the same level of experience and qualifications but have chosen, for one reason or another, not to become certified.  For this reason, it is important to ask prospective doulas about their experience.

To become a DONA-certified doula, a person must:

  • Read five selected books on childbirth and breastfeeding and additional materials.
  • Complete childbirth preparation (often a childbirth education series of at least 12 hours)
  • Complete at least 3 hours of breastfeeding training
  • Complete a doula training program of at least 16 hours
  • Attend at least 3 births (evaluated by the laboring woman and her care team)
  • Develop a resource list for clients
  • And more.

How much does a doula cost?

Doula services, which vary based on a doula’s experience, her included services, and other factors, can range anywhere from free to over $1000.  Some doulas have a set fee while others use a sliding scale.

While most insurance coverage does not cover doula services, the benefits of having a doula are so well demonstrated that insurance companies and the state are beginning to consider and adopt coverage for doulas.  It’s always a good idea to ask your insurance carrier if they cover doula care (every request for a service, even if not approved, is documented and is taken into account by the insurance carrier when determining covered services in the future).

Bear in mind that a doula has often completed a rigorous training process, makes herself available on call for a 4 to 5 week period around a woman’s due date, spends anywhere from a few hours to a few days with a laboring family (sometimes paying for childcare and other expenses while away), devotes hours to supporting a family before and after labor, and has professional expenses like any other independent small business professional.

How do I find a doula? 

  • Talk to us!  We have a list of a few doulas we know and recommend. We can also talk to you about our doula interns.
  • Childbirth Collective Parent Topic Night: All About Doulas.  This is a great event held monthly in Saint Paul and Minneapolis where doulas and expectant families gather to meet and talk about doulas. The Collective also has a list of doulas on their website.
  • Blooma.  Many of the yoga teachers and educators at Blooma are also doulas.  This may be a great way to make a connection.
  • Childbirth education classes.  This can be another possible avenue to connect with a doula.
  • Word of Mouth.  Talk to other mamas who have had doulas and find out who they recommend.

Check out our related post on the benefits of having a doula!