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Sunday, August 10, 2014

St. Joseph Hospital starting to offer nitrous oxide to take edge off labor pain

Nitrous oxide could be the next big thing for pain management in childbirth.

Its use is already commonplace in Europe and Canada, and offering gas for pain during labor has spread to dozens of hospitals across the U.S., including St. Joseph Hospital in Nashua. ...

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Nitrous oxide could be the next big thing for pain management in childbirth.

Its use is already commonplace in Europe and Canada, and offering gas for pain during labor has spread to dozens of hospitals across the U.S., including St. Joseph Hospital in Nashua.

Mother of three Amanda Eversen was one of the first to try nitrous when it became available there early this year.

She was so relaxed during the birth of her third child that she gave out answers to the “Jeopardy!” program playing on the TV of her delivery room.

Eversen’s gave birth to her first child at Southern New Hampshire Medical Center, where she managed labor pain with an epidural. But it was too effective; she couldn’t tell when to push.

For baby No. 2, she had a natural birth at St. Joseph’s.

“Not by choice – I got here too late, there was no time for anything,” Eversen said.

When she came in to deliver her son Brenton on May 23, she was ready for a new option.

“I was nervous with the nitrous, but I was like, ‘OK, let’s give it a go,’ ” she said. “At first, I couldn’t really feel it, but after a few tries, you felt just disconnected. I could still feel it, but it wasn’t as painful. I just felt a lot more relaxed. It wasn’t as scary as my first ones.

“When it came down to push time, once you stop inhaling, it’s gone,” Eversen said. “Through the labor, through contractions, it was so relaxing, so calming. It’s not like the gas at the dentist.”

The nitrous oxide – 50 percent nitrous, 50 percent oxygen – is only active immediately after being inhaled.

Sharon Redfearn, a certified nurse midwife at Full Circle Midwifery Care Center at St. Joseph’s, said the gas manages pain rather than eliminating it.

“The beauty of it is, you breathe it in, and when you stop, after three or four breaths, it’s out of your system,” Redfearn said. She said because the nitrous is filtered by the lungs rather than the liver, it doesn’t reach the baby.

“It is totally self-
administered. I think we’re now at a point in obstetrics where women think, ‘OK, I need to take some control back.’ (The nitrous option) is a great feeling of control for women,” she said.

St. Joe’s tried the gas in early 2014.

“Our patients tried it; 85 percent like it a lot. The women who didn’t like it said it made them feel really dizzy … with some nausea, and there was one person who felt panicky. Even then, they stop breathing it and it’s gone,” she said.

St. Joe’s in only the third hospital in New England to offer nitrous oxide during childbirth. Monadnock Community Hospital in Peterborough was the first to offer it, in November. In early 2014, Memorial Hospital in North Conway adopted the practice, followed by St. Joseph’s. At the moment, St. Joseph’s is the only hospital in Nashua for nitrous labor relief.

Redfearn said 35-40 of their patients have tried it so far.

“People are coming in asking for it,” she said. “We have patients transferring to us … for the nitrous and 24/7 midwifery.”

Advocates said nitrous is efficient during early labor and it doesn’t stop contractions. In addition, the gas can be partnered with other pain-management methods. For instance, a woman can use nitrous, then decide to move on to an epidural.

Although it has been widely used in Europe since the 1930s, it is still relatively unknown in the U.S.

“The medical center at the University of California, San Francisco, has been using the nitrous for over 25 years,” Redfearn said. However, only a handful of East Coast centers provide the service.

Redfearn said she attributes its slow adoption to a cultural preference for “designer births” which completely eliminate pain, but at a price.

“It’s contributed to where we are with the C-section rate,” she said.

In 2012, the Centers for Disease Control reported a 32.8 percent C-section rate, compared with about 20 percent in 1996.

Jennifer Pedley, the Director of Maternal Child Health at St. Joseph’s, said the mobility allowed by using nitrous could help avoid C-sections.

“Research shows that if a patient is up and moving, there’s a decrease in C-section rate,” she said.

While it might not be for everyone, it’s another option, at the very least.

“Hydrotherapy, nitrous, epidural … it’s just another tool in the toolbox for patients to be able to use,” Pedley said. “It is a growing trend … Many hospitals are in the process of trialing it.”

St. Joseph’s has a portable nitrous machine that administers the gas through a face mask or mouthpiece. “It looks like a little robot,” Redfearn said. She said there’s another suction tube that runs from the machine into the wall to pull excess nitrous out of the air, so no one else is affected.

“Part of our job as midwives is really talking to women about their options, what to expect in labor, and how things usually go. And to know their rights. If you’re looking for minimum intervention, this is a good option,” Redfearn said.

“We’re just thrilled with it. I’m glad other places are looking into it too.”

Tina Forbes can be reached at 594-6402 or tforbes@nashuatelegraph.com. Also, follow Forbes on Twitter (@Telegraph_TinaF).