The Hippo


Jun 2, 2020








Laughing gas for labor
Nitrous oxide for childbirth pain is becoming more widely available in the state

By Ryan Lessard

A new pain-relief option for pregnant women in the U.S. is sweeping the nation, and New Hampshire is leading the way. Nitrous oxide has been the most popular childbirth pain reliever in the United Kingdom and Canada for years, while America has been slow to adopt it. But with recent FDA approval, at least half a dozen hospitals in the Granite State are already offering it and are calling it a safe, cheap alternative to traditional pain relief.

The genesis
Nitrous for childbirth is different from the mix used commonly at dentists’ offices. It’s a 50/50 blend with oxygen. It doesn’t knock the patient out. It just helps with the pain. And nitrous is self-administered, meaning the woman in labor holds the gas mask to her face and pulls away when she’s had enough. It’s not a narcotic or even an anesthetic, since women can still feel pain — they just become ambivalent to it.
Elizabeth Kester is the manager of the birthing suite at Monadnock Community Hospital in Peterborough.
“We were the first in New Hampshire to [start using nitrous oxide] and one of the first in the country,” Kester said.
She brought it up during her job interview, and her supervisors were enthusiastically receptive. After Kester started her new position, she wasted no time. FDA approval for this method came in July 2013, and Monadnock started offering it that October.
“The minute we could buy the equipment, we did,” Kester said. “I did not know until last week that we were the first to buy it, in the country, from Pro-Nox.”
Pro-Nox is a Canadian company that produces the nitrous cylinders for maternity wards in Canada and the U.K.
In short order, other hospitals followed her example. North Conway’s Memorial Hospital was the next to adopt nitrous, followed by St. Joseph in Nashua and Catholic Medical Center and Elliot Hospital in Manchester. The latest hospital to start offering it this month is Wentworth Douglas Hospital in Dover.
“Being a pioneer can be scary, especially in healthcare. It can be hard to be the first person doing it,” Kester said. “The normal response for a lot of administrators and risk managers is, ‘Let’s wait until somebody else will pave the way and we’ll learn from their mistakes,’ which I totally understand. But that’s not really how I roll.”
Since the program began about two years ago, Kester estimates about a third of childbirths at her maternity ward involved nitrous. It appeals largely to the expecting mothers who want very minimal medical intervention, though they can switch to an epidural easily after using nitrous since it leaves the mother’s system after a couple breaths. So far this year, 25 percent of women have used nitrous at Monadnock and about 8 percent of those women switched to an epidural.
The spread
CMC started using nitrous in its maternity ward last November and about 20 percent of women are already using it. While Kester hasn’t noticed a significant drop in epidural use in Monadnock, CMC is reporting a drop in epidural use by 5 percent since nitrous was introduced. And all but one birth involving nitrous were done without a C-section. Kester says epidural use contributes to a greater number of cesareans, so if nitrous catches on, she expects those numbers would also go down.
Nicole Pendenza is the director of women and children services at CMC and says New Hampshire is leading the charge for nitrous use during labor.
“We have a large number of hospitals within just New Hampshire that are using nitrous for labor analgesia,” Pendenza said. “Based on the sheer volume [of hospitals that offer it] in our state, we are definitely one of the leaders, for sure.”
Pendenza said the gas has proven popular among women and those who used it reported a positive experience.
“The word is spreading that it’s a great, viable option for women,” Pendenza said.
She said it eliminates the often numbing or sedating effects of narcotics, as well as the risks involved, such as transmission of the drugs to the baby.
In addition to its popularity, a number of other factors contributed to the rapid spread of nitrous in New Hampshire.
For one, virtually all of the maternity ward managers talk to one another, and Kester has been very active in sharing as much information as she can about the option.
“I think it’s something that should be available to as many women in this country as possible,” Kester said.
Still, she acknowledges that competition was as much a factor as cooperation.
“There are very few hospitals in the state that don’t have another hospital close enough to them that a women could [choose between them],” Kester said.
Plus, nitrous providers have been marketing their product aggressively.
“Pro-Nox was basically plunking units in every hospital that they could, as trials,” Kester said.
Add to that the fact that nitrous is very easy to use, doesn’t require an anesthesiologist to administer it and is easily affordable.
“It’s cheap. It’s dirt cheap, really,” Kester said.
Hospitals are still figuring out how to bill for it. Monadnock is billing only for the cost of supplies while other hospitals may charge a flat fee. 
For now, Kester is just glad more women are getting access to nitrous oxide.
As seen in the June 25, 2015 issue of the Hippo.

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