By Todd Ackerman
Houston Chronicle December 3, 2017
A nurse at the Memorial Hermann hospital in the Woodlands briefs Dana and Casey Baltzell on the use of nitrous oxide, commonly known as “laughing gas,” during child birth and how it can be administered to … more
First-time expectant mother Lauren Lococo came to Memorial Hermann’s hospital in The Woodlands open to any procedure that would ensure a healthy baby and pleasant birthing experience but hoping she wouldn’t need an epidural.
She was already in labor when nurses suggested an alternative for her pain management: laughing gas.
The idea wasn’t new to Lococo, who’d read about the practice in Europe during her pregnancy and childbirth research. She jumped at the idea.
“It turned out to be the perfect option,” said Lococo, 26, a Spring proprietor of an online health and fitness business. “I felt like I was rocking on a hammock on a sunny day – relaxed, aware of my surroundings, not loopy or out of it.”
Lococo, who delivered a healthy 7-pound boy that June day, became Memorial Herman’s first patient to get the gas as part of a pilot program now being offered at The Woodlands hospital. The program, thought to be the first in Texas, is one of many increasingly being offered in hospitals and birthing centers around the nation.
As a pain management tool for women in labor, the Memorial Hermann Health System has begun offering laughing gas at its hospital in The Woodlands and expects to extend it to all its hospitals in mid-2018. The first such availability in Texas, it’s part of a national trend.
– Despite the nickname, inhaling nitrous oxide doesn’t make women in labor laugh. Rather, it decreases anxiety and puts the patient at ease.
– Laughing gas used in labor is a 50/50 mix of nitrous oxide and oxygen; the concentration used in dentist offices is typically 70/30 or even 80/20.
– The patient isn’t able to raise the mask to her face once she’s had sufficient nitrous oxide, a safety feature. No one is allow to hold the mask for her.
Source: Association of Women’s Health, Obstetric and Neonatal Nurses
Memorial Hermann expects to extend the program throughout the system in mid-2018, officials said.
It’s all about giving women in labor another option, say program leaders at Memorial Hermann and other hospitals.
The gas, known as nitrous oxide, is the same that’s used in dental offices but of a milder concentration. The woman in labor herself administers it through a mask.
It can be used during labor, delivery and even immediate postpartum procedures and is safe for the mother and baby, according to the American College of Obstetricians and Gynecologists. That’s because the gas is dissipated through the lungs within a breath or two of the mask being removed. It doesn’t reach the placenta.
“This won’t replace existing methods of pain relief, but it’s good to be able to offer another choice,” said Dr. Gregory Eads, chairman of obstetrics and gynecology at Memorial Hermann The Woodlands. “For patients who want to be in control and make their own decisions, nitrous oxide has its advantages.”
In style, out of style
Nitrous oxide was first used for pain relief in childbirth in 1881 and became more common in the 1930s and 1940s, though it never really caught on in the United States. It has been widely used for decades in the United Kingdom, Canada and Australia, but any use in the U.S. was supplanted by the arrival of powerful anesthetics such as the epidural, an injection near the spinal cord that blocks feeling below the waist. By the 1980s, nitrous oxide for childbirth had completely disappeared from American hospitals.
Today’s growing popularity is being driven by midwives, who stress a natural, unmedicated approach to labor. In a 2010 statement, the American College of Nurse-Midwives called nitrous oxide an inexpensive, simple, reasonably safe and effective analgesic and urged it be offered to more mothers.
In the years since, laughing gas has gone from being offered in a handful of maternity wards to more than 400 hospitals and 100 birthing centers, according to Michelle Collins, a Vanderbilt professor of nursing and expert on the subject. The movement, started at Vanderbilt and the University of California San Francisco, spread gradually around the country.
Still, Eads notes that Memorial Hermann is having to educate patients that nitrous oxide is an option for childbirth.
“The reality is that unless Hollywood stars promote a new medical procedure on Facebook, most people aren’t aware of it,” Eads said. “It’s not easy getting the word out.”
A lack of demand was one reason cited by Texas Children’s Hospital and The Woman’s Hospital of Texas for why they don’t offer the option. The other primary reason: questions about its effectiveness as a pain management tool.
“The reason there was an evolution away from nitrous oxide is because epidurals are superior for pain relief,” said Dr. Wycke Baker, chief of anesthesiology at Texas Children’s. “Even in places that have rolled nitrous oxide out as option, the epidural is still the gold standard.”
But epidurals aren’t without downsides. Lococo said she wasn’t crazy about the immobility they cause and wanted the freedom to move around in her room. She also feared one would prolong the pushing stage of labor, long thought to be a side effect, now a matter of debate among researchers.
Epidurals do require an IV, frequent blood pressure monitoring and continuous fetal monitoring.
A calming effect
Dr. McCallum Hoyt, chair of the American Society of Anesthesiologists’s Committee on Obstetric Anesthesia, said that early research confirms Baker’s contention, that the rate of epidural use appears unchanged even at hospitals that offer laughing gas. She said so far laughing gas tends to be used most as a precursor to an epidural, early in labor; and by women already committed to not having an epidural.
Hoyt, an anesthesiologist at Brigham and Women’s Hospital in Boston, said the consensus among patients there who use nitrous oxide is that it doesn’t provide great pain relief but helps tremendously with anxiety, that it exerts a great calming effect.
That likely explains its popularity in other countries, Hoyt said. It is used by 60 percent of women in the United Kingdom and 50 percent in both Canada and Australia, she said.
So far, about 50 Memorial Hermann The Woodlands patients have used the nitrous oxide during labor, none with any regrets, said program leaders. The vast majority switched to an epidural at some point during the procedure.
Lococo was among such patients, mostly because of first-time labor fears that the pain would escalate during the pushing stage. She used the nitrous oxide for the first hour of labor, putting the mask on as each contraction came and taking it off as each contraction weakened.
“I wasn’t pain free, but the pain wasn’t the first thing on my mind,” said Lococo. “I felt instant relaxation and loved being in control. Next time around I’ll expect I’ll just use the nitrous oxide.”