Saturday, January 17, 2015

Nitrous. Yes, No or Don't Know?

****I do not want this to become a discussion on the safety of nitrous. The evidence is strong and overwhelming on the safety; it has been used for decades with no documented concerns for women or babies. I am wanting to have a discussion about the philosophy of using something like nitrous.****

Several months ago my birth center started offering Nitrous Oxide (N2O) for the use of pain management in labor. This is something that I had been wanting to do for several years. I have been reading about it and researching it for quite some time. The first time I proposed this to the other midwives, it was not popular and was basically 'voted' down. A year or so passed, we had some changes in midwives and I presented the idea again. This time the response was very positive and we decided to go for it. I then did all the necessary things; staff training and education, ordering the equipment, letting our families know complete with educational handouts and consent forms, and all the other technical requirements. And in September of 2014 we rolled it out.

Prior to this, I had never seen N2O used. I was simply passionate about it as a safe option for women. As a midwife, I am committed to ensuring that women have options and are presented those options with true informed consent. I spoke with several people; other midwives, experts in the field and women and felt that it should be an option. At the time there was no other facility in our entire state offering N2O. Since then, one of our local hospitals has started offering it as well. I am very happy about that as it only increases access and choice to the women of my community.

Now that we have been using it, I have several observations from experience. There are things that I really like about it and others that I don't. Overall though I really like this option and am very glad that we have it available. I know for a fact that it has helped to prevent several transfers from our center to the hospital and that is a huge success to me. We have also used it to prevent a transfer postpartum for a laceration repair in a woman with severe anxiety about the process. Here is a little break down of my thoughts so far;

Things That I Like
  • The woman is in complete control.
  • It can be used in the birth pool, sitting on the birth ball, in the bathroom on the toilet, standing at the get the point.
  • It can become a sort of focal point that helps her to focus on her breathing.
  • It really seems to decrease anxiety
  • It can be used at anytime during labor
  • It can be used for other indications; laceration repair, third stage, IUD insertions
  • If she does not like it for any reason, she simply stops using it and the effects wear off within minutes
Things That I Don't Like
  • The machine is cumbersome and takes up a good amount of space
  • The scavenging vacuum is loud, it becomes a 'white' noise but is still there
  • The mask can seem claustrophobic
  • It can be distracting for some women to figure out the timing, making it harder to focus on her breathing
Clearly, N2O is not for everyone and sometimes it just does not offer any benefit for an individual woman. It does not take the pain away and so the expectations have to be appropriate. What I have noticed in the social media forums is that there is a definite bias in some of the "natural childbirth" communities against N2O. Bias that using N2O is not "natural birth". That it is a type of cop out or that only women who don't have good enough midwives, support persons or who are not properly prepared would need it. To me, this smacks of judgment, which is something I think that we all as humans need to be very careful of. Judgment runs rampant in our current birth culture and this is just another example of that. So, what do you think? Have you used N2O yourself or have you had clients use it? I would love a positive, open discussion about all thoughts.


  1. I work as a doula, and the local hospital has the nitrous oxide piped right into the rooms, which means no cumbersome tanks, but also means it can only be used in/around the bed. They also have the option of the mouth-piece attachment instead of a mask. Do you have this option? Most people find it less claustrophobic. I have had quite a few of my clients use it and enjoy it. I love that it puts a woman in control of her own pain relief, and allows her to decide how much she needs. The thing I think is a real benefit is that it focuses the breathing! I love that clients can use it while having laceration repairs, as something extra to take an edge off, and focus on during that time. I also love that clients can use it as a bridge (between medication options), such as while waiting for an epidural, or while waiting for an urge to push.

    1. Thanks for the thoughts. I have not tried the mouthpiece attachments, but can order them. How do you ensure that the exhaled nitrous does not "contaminate" the room when using them? And yes, having it "piped in" would have pros and cons just like the mobile unit I suppose.

    2. The nitrous doesn't come out on its own... Only when the person is "sucking" on it. I'm not exactly sure how that works. Is your type different?

    3. The concern is for occupational exposure for support staff from the exhaled gas of the woman using it. With the mask, she exhales into it so it is removed from the room. With the mouth-piece does the woman exhale into it?

    4. I work in Australia where nitrous is in common use in birthing rooms. The woman sucks then blows out through the mouthpiece so the nitrous travels back through the scavenging tube.


  2. A caution. I can send a woman with vitamin B 12 deficiency into a downward spiral even years later. Many times this is not properly diagnosed and even leads to death.

    1. Yes, Vitamin B12 deficiency is one of the few and rare contraindications to the use of nitrous. Women who receive good prenatal care and who have this rare type of anemia should be discovered and treated well before labor. And then may still not be eligible for nitrous.

  3. Any other thoughts? I am genuinely open to discussion of both the pros and cons if that discussion is respectful.

  4. While I had read of Nitrous use previously, it had never occurred to me that it could be a common option again. I'd love to learn more about it!

    1. It is becoming more common, having a 'come back' of sorts. I know of several birth centers that are using it as well as some hospitals around the country.