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Nitrous Oxide


The plan was for a natural childbirth.

But seven hours into labor, at seven centimeters dilated, Vanessa Vest needed a little help getting through the contractions. Rather than resort to an epidural, Vest chose her Plan B: nitrous oxide gas.

“It just made me relax,” she says. “I remember everything, it just let me take a break.”

Two hours later, her daughter Makaia Vest-Carr was born March 2. And the new mom takes comfort in knowing that her newborn didn’t have heavy-duty, intravenous pain medications flowing through her bloodstream.vaness_vest_1.jpg

In the fall of 2017, University of Utah Labor and Delivery doctors and nurse midwives started offering the analgesic to mothers.

“It’s a great option for women who want to have something that helps them take the edge off, but they don’t want an epidural,” says Sara Hake, DNP, CNM.

So far, a limited number of women have opted for nitrous oxide gas, says Dr. Hake, an adjunct assistant professor at the University of Utah College of Nursing.

Labor and delivery nitrous oxide is different from the “laughing gas” dentists use. For one thing, the gas is mixed at lower concentrations—50 percent rather than 80 percent. And laboring mothers administer the gas themselves, inhaling as needed from a mask.

Nurse midwives with the College of Nursing’s BirthCare HealthCare program pushed for the change after Danica Loveridge, DNP, CNM, focused on the issue in her doctoral project.

Polish physician Stanislav Klikovich first experimented with using nitrous oxide to help mothers in labor in 1881. Many U.S. hospitals offered the gas through the 1930s and 1940s. But that practice changed in the 1950s, when more powerful anesthetics that promised “pain-free” labor and knocked mothers out entirely pushed nitrous oxide out of favor.

Women started demanding more options starting in the 1970s, when epidural anesthesia provided pain-free labor while awake, but restricted movement and led to side effects. With nitrous oxide, laboring mothers can remain mobile, taking the tank and mask with them as they walk the halls, sit on birthing balls or “slow dance” with their partners.

The gas doesn’t eliminate pain entirely, but leads to a feeling of euphoria that helps the women move through discomfort. The gas takes 15 to 30 seconds to take effect and dissipates in the lungs almost as quickly.

“The best thing about nitrous oxide is that it allows a new mom to be present without feeling overtaken by pain,” Hake adds. “It gives her a feeling of control over what is happening and lets her concentrate on what’s most important—her new baby.”

vanessa_vest_2.jpgThe American College of Nurse Midwives released a position paper about the use of nitrous oxide in labor and delivery in 2011, urging midwives be trained to offer the gas to their patients. The American Society of Anesthesiologists reviewed research the same year and suggested more study, but noted “good safety outcomes” in Europe and Australia, where a majority of laboring women use nitrous oxide.

From that point, the number of U.S. hospitals offering the gas as an alternative to conventional pain medications started to grow. The University of California, San Francisco’s hospital has offered nitrous oxide continuously for 30 years. The maker of Nitronox—Porter Instrument Division, Parker Hannifin—reports that nearly 300 hospitals and birthing centers now make nitrous oxide available to laboring mothers. The University of Utah is one of the first hospitals in the state to offer the gas.

Vest discovered the option after listening to a podcast and asked her midwives to have it available—just in case.

“I would recommend it to anyone who’s planning on going natural, but has things change in the course of labor,” she says.

Leissa Roberts, DNP, CNM, the college’s associate dean of faculty practice, credits the synergy of an academic health system with putting U of U Health doctors and nurse midwives ahead of the curve in Utah. Besides Loveridge’s initial work, another student helped develop the policy, and nurse midwifery doctoral student Isabelle Armstrong, then an undergraduate RN to BS student, helped Labor and Delivery staff design and implement education and training programs.

“This shows how the College of Nursing is able to change care from an academic perspective,” Roberts says. “Our students were at the forefront of transforming and updating care every step along the way.”