“Laughing gas” added as childbirth pain control option
Vanderbilt University Medical Center started offering nitrous oxide this summer as a pain management tool for women during childbirth — joining only two other hospitals in the country offering this option.
Nitrous oxide, also called “laughing gas,” can be administered quickly by the patient, is widely known to rapidly ease pain and has been proven safe for both mothers and their babies.
“Childbirth is not a one-size-fits-all process,” said Frank Boehm, MD, professor of Obstetrics and Gynecology and vice-chair of the department. “Women deserve to have a wide variety of options available to them. Nitrous oxide is an option that takes the edge off of pain, and I think it may become a popular option for some women who give birth at Vanderbilt.”
The odorless, tasteless gas is inhaled through a mask. For labor, 50 percent nitrous oxide and 50 percent oxygen are blended together by a specialized device.
The mixture is then self-administered by the mother through a mask or mouthpiece she controls. This nitrous oxide mixture is safe for both the mother and baby because it is eliminated from the body through the lungs, rather than through the liver. The 50-50 mix does not cause newborns to be groggy.
“Labor pain is subjective and highly individualized depending on the laboring woman,” said Michelle Collins, MSN, a certified nurse-midwife and assistant professor at Vanderbilt University School of Nursing. “So this is a wonderful way to provide a non-invasive option that provides pain relief for many women, particularly those who do not want an epidural or intravenous narcotics for pain.”
Nitrous oxide has many advantages including a quick response time. Most women experience its effects in less than one minute, and then it dissipates fully within five minutes after stopping use. It can be started and stopped at any point during labor, depending on the mother’s preference.
“A hallmark of using nitrous oxide in a labor environment is that the mother is able to self-administer via the mask,” said Sarah Starr, MD, an assistant professor of Clinical Anesthesiology who works with obstetrics patients. “This increases her sense of control over the dosage, over her pain and over herself during labor.”
At Vanderbilt, the provider and the patient decide together if nitrous oxide is an appropriate option. If so, it will be initiated by an anesthesia provider who will teach the patient how to self-administer.
During the first full month of the program, 35 women used nitrous oxide during labor at VUMC. Twenty-two gave birth using the gas as their sole method of labor analgesia and the remaining 13 used it during labor and then converted to an epidural further along in their labor. By way of comparison, at University of California San Francisco, which has used nitrous oxide as an option for 30-plus years, about half of their patients start with the gas and convert to epidurals.
Starr and Collins have presented about nitrous oxide at several national and regional conferences, and since offering the option at VUMC, many other hospitals throughout the country have expressed interest in pursuing the option for their own labor and delivery services.