Ask the Expert: Nitrous Oxide with Michelle Collins

Cropped image of pregnant woman holding nitrous oxide mask

Is nitrous oxide an option for you to use in labor? We are happy to say that in Nashville, it is!

We were recently invited to an event with the Vanderbilt Midwives in which we were given a presentation on nitrous oxide from Michelle Collins PhD, CNM, FACNM, and Vanderbilt’s nitrous expert. She presents nationally on nitrous, has published widely on the topic, and is also the Director of Vanderbilt’s Nurse-Midwifery education program. We were so lucky to hear her speak, and are very pleased to be able to share some of what we learned with you.

Nitrous oxide is actually burned as fuel in rocket engines, used as an accelerant in whipped cream cans, employed as an aide for persons battling addictions, but it is most well known for its use in dental procedures. I’ve heard women say, “I don’t want to use that stuff during a birth.” An understandable sentiment! But nitrous oxide use during labor is completely different from the way that nitrous oxide is used at the dentist:

  • During a dental procedure there is a continuous streaming flow of nitrous oxide to the patient, whereas in labor the woman receives an intermittent flow of the gas that is initiated through inhalation.
  • Using it in labor, the woman controls when she inhales the nitrous. In a dental procedure the nitrous is not patient-controlled, but streams through the mask in a continuous stream into the patient’s nose.
  • In dentistry, the concentration of nitrous oxide may be increased up to a 70/30 mixture of nitrous oxide to oxygen. Conversely, in labor nitrous is only delivered at a fixed concentration of 50/50.
  • With dental use, there is far more exposure of the gas to the dental workers in the room as the patient exhales the inhaled gas directly into the faces of the dental workers as their teeth are being worked on. In the labor room, the patient exhales the gas back into the mask she has inhaled it from where the exhaled gas is carried away by a scavenging device, into a reservoir where the waste gas is disposed of. This protects everyone else present.

There is increasing consumer demand for access to nitrous oxide during birth. This is due to a large anecdotal history of safe use with positive results for birthing individuals and babies, as well as few comparatively safe analgesic alternatives. 60% of births occurring in the United Kingdom involve nitrous oxide use, and it is also widely used in Canada, Australia, Norway and Finland, as well as in many other countries.

So what are the benefits?

  • Nitrous oxide in labor is self administered with a rapid onset and offset of effects. It takes just a few breaths for it to leave the system.
  • It is fairly simple to use. At Vanderbilt, birthing women hold a facemask to inhale the nitrous into their nose and mouth and then exhale into the mask, where the scavenging system then removes the excess nitrous from the room, thus not affecting medical staff, partners, and doulas.
  • There is no evidence of adverse effects on labor progression or ability to push for the birthing parent.
  • There is no evidence of adverse fetal/newborn affects.
  • It can provide pain relief.
  • It can help curb anxiety.
  • You are not bound to the bed. You can actually be standing as well as sitting on a birth ball or chair while using nitrous oxide.
  • There is not a time limit for use, nor any indications that you must hold off as long as possible before you try it. Nitrous oxide works as well at hour 8 as it does at hour 1.
  • It can be a good alternative to narcotics, which do affect babies.
  • You can use it for more than getting through your contractions: Nitrous has been used during epidural placement, for bedside surgical procedures, during IV starts or blood draws, and for laceration repair after baby is born.

There are, of course, some instances when nitrous may not be the best option. For example, if you are unable to hold the mask yourself, or if you have a documented B12 vitamin deficiency, it would not be a good choice. As always, we recommend you consult your chosen OB or midwife.

What can you expect from your doulas?

You can expect your Music City Doulas to assist you in inhalation timing so that you are getting the full benefits of nitrous oxide. We will be available to help you get up and accomplish safe positions. We will clarify the purpose of nitrous oxide as a tool for labor and offer reasonable expectations. We will always work with your medical team to give you the most supported and positive experience possible.

 

Did you use nitrous oxide during the birth of your child? Tell us about your experience in the comments!